The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer
Eisenhauer, Eric L; Abu-Rustum, Nadeem R; Sonoda, Yukio; Levine, Douglas A; Poynor, Elizabeth A; Aghajanian, Carol; Jarnagin, William R; DeMatteo, Ronald P; D'Angelica, Michael I; Barakat, Richard R; Chi, Dennis S
OBJECTIVES: To determine the survival impact of adding extensive upper abdominal surgical cytoreduction to standard surgical techniques for advanced ovarian cancer. METHODS: The records of all patients with stages IIIC-IV epithelial ovarian cancer who underwent primary surgery at our institution from 1998 to 2003 were reviewed. The cohort was divided into 3 groups. Group 1 patients required extensive upper abdominal surgery, such as diaphragm peritonectomy/resection, resection of parenchymal liver or porta hepatis disease and/or splenectomy with or without distal pancreatectomy, to achieve optimal cytoreduction (residual disease
Phase I study of abagovomab in patients with epithelial ovarian, fallopian tube, or primary peritoneal cancer
Sabbatini, Paul; Dupont, Jakob; Aghajanian, Carol; Derosa, Felicia; Poynor, Elizabeth; Anderson, Sybil; Hensley, Martee; Livingston, Phillip; Iasonos, Alexia; Spriggs, David; McGuire, William; Reinartz, Silke; Schneider, Sally; Grande, Cathy; Lele, Shashikant; Rodabaugh, Kerry; Kepner, James; Ferrone, Soldano; Odunsi, Kunle
PURPOSE: This open-label study assessed the safety and immunogenicity of two doses and two routes of the anti-idiotypic monoclonal antibody abagovomab (formerly ACA125) in patients with epithelial ovarian, fallopian tube, or primary peritoneal cancer. EXPERIMENTAL DESIGN: Eligible patients from the three participating institutions were any stage at diagnosis, had relapsed, and had complete or partial response to additional chemotherapy. Patients were randomized to receive abagovomab at 2.0 versus 0.2 mg and i.m. versus s.c. for four immunizations every 2 weeks and then monthly for two additional immunizations. Planned evaluation included interval physical examinations and laboratory assessments with immune assessment, including HLA typing, human anti-mouse antibody, ELISA, and enzyme-linked immunospot. Patients were required to remain on study until week 10 (the first post-baseline Ab3 determination) to be considered for immunologic assessment. The primary end points were safety and immunogenicity primarily determined by Ab3 response. RESULTS: Forty-two patients received at least one vaccination and were eligible for safety analysis. Thirty-three patients were available for Ab3 analysis (removed for progression of disease, 6; withdrawal of consent, 2; unrelated adverse event, 1). The most common adverse events were self-limited pain at injection site, myalgia, and fever. No hematologic or nonhematologic toxicity grade>2 related to immunization was seen. Ab3 was detectable in all patients (median, 236,794 ng/mL); none of route of administration (P=0.6268), dose (P=0.4602), or cohort (P=0.4944) was statistically significant in terms of effect on maximum post-baseline Ab3 titer. Human anti-mouse antibody was not detectable at baseline but was present in all patients at week 16 (range, 488-45,000 ng/mL). CONCLUSIONS: Immunization with abagovomab is well tolerated and induced robust Ab3 responses at the two doses and routes tested. A phase III randomized study with abagovomab (2.0 mg s.c.) is warranted.
Fifth International Conference on Ovarian Cancer: challenges and opportunities [Meeting Abstract]
Sood, Anil K; Abu-Rustum, Nadeem R; Barakat, Richard R; Bodurka, Diane C; Brown, Jubilee; Donato, Michele L; Poynor, Elizabeth A; Wolf, Judith K; Gershenson, David M
OBJECTIVE: This paper provides a summary of the presentations given at the Fifth International Conference on Ovarian Cancer in Houston, Texas on December 1-4, 2004. METHODS AND RESULTS: The focus of this meeting was to discuss the most current information regarding development, progression, diagnosis, and therapy of ovarian cancer. The presentations at this conference were grouped into 7 sessions, and are summarized in this paper as follows: ovarian cancer biology, novel therapeutic approaches, surgical and pathological controversies, quality of life/biobehavioral aspects of ovarian cancer, screening/prevention approaches, management of uncommon ovarian cancers, and treatment controversies. CONCLUSION: While many challenges remain in the overall management of ovarian carcinoma, the speakers at this conference reviewed the opportunities available to scientists and clinicians to work collaboratively to make advances.
A fertility-sparing alternative to radical hysterectomy: how many patients may be eligible?
Sonoda, Yukio; Abu-Rustum, Nadeem R; Gemignani, Mary L; Chi, Dennis S; Brown, Carol L; Poynor, Elizabeth A; Barakat, Richard R
OBJECTIVE: To determine the percentage of patients with early-stage cervical cancer who may be eligible for fertility preservation with laparoscopic radical vaginal trachelectomy (LRVT). METHODS: We retrospectively reviewed the records of patients who underwent a radical hysterectomy for invasive cervical cancer at our institution from 12/85 to 8/01, before our use of LRVT at Memorial Sloan-Kettering Cancer Center. Institutional eligibility criteria for LRVT were applied. Patients > or =40 years of age were considered ineligible. RESULTS: We identified 435 patients who had undergone radical hysterectomy for cervical cancer; 186 were age < 40 at surgery and constituted our study population. Eighty-nine (48%) patients may have been eligible by our pathologic criteria. In 12 patients, LRVT may have been aborted or altered because of unexpected disease spread. CONCLUSION: A significant number of patients < 40 with early-stage cervical cancer may be pathologically eligible for LRVT and should be counseled on this preoperatively.
Improved optimal cytoreduction rates for stages IIIC and IV epithelial ovarian, fallopian tube, and primary peritoneal cancer: a change in surgical approach
Chi, Dennis S; Franklin, Corinna C; Levine, Douglas A; Akselrod, Faina; Sabbatini, Paul; Jarnagin, William R; DeMatteo, Ronald; Poynor, Elizabeth A; Abu-Rustum, Nadeem R; Barakat, Richard R
OBJECTIVE: To determine the impact of the incorporation of extensive upper abdominal debulking procedures on the rates of optimal primary cytoreduction and complications in stages IIIC and IV epithelial ovarian, fallopian tube, and primary peritoneal carcinomas. METHODS: Two groups of patients were identified for comparison. Group 1, the control group, consisted of 70 consecutive patients who underwent "standard" primary cytoreductive surgery before May 2000. Group 2, the study group, was composed of 70 consecutive patients who underwent surgery after January 2001, during which time, a more comprehensive debulking of upper abdominal disease was used, including diaphragm stripping/resection, splenectomy, distal pancreatectomy, liver resection, resection of porta hepatis tumor, and cholecystectomy. RESULTS: The median age of the entire cohort was 60 years (range, 36-88 years). The majority had stage IIIC disease (86%) and serous histology (76%). Optimal cytoreduction (residual disease =1 cm) rates were 50% for group 1 and 76% for group 2 (P < 0.01). Patients in group 2 were more likely to have undergone extensive procedure(s) (27% versus 3%; P < 0.001). Operative time and estimated blood loss were greater in group 2 than group 1 (264 versus 174 min, 880 versus 460 cc, respectively; P < 0.001 for both). Complication rates and length of hospitalization were not significantly different between the two groups. CONCLUSION: The use of extensive upper abdominal surgical procedures significantly increased the rate of optimal primary cytoreduction. Although operative time and estimated blood loss were increased, the rate of major complications and length of hospitalization remained the same.
Gastrointestinal adenocarcinoma arising in a mature cystic teratoma of the ovary [Case Report]
Levine, Douglas A; Villella, Jeannine A; Poynor, Elizabeth A; Soslow, Robert A
BACKGROUND: Mature cystic teratoma of the ovary (MCTO) is the most common ovarian germ cell neoplasm and is usually diagnosed in early adulthood. Malignant transformation is rare, occurring in approximately 2% of all cases. Though malignant transformation can occur from any of the embryonic germ layers, the most common malignancy arising in these otherwise benign tumors is squamous cell carcinoma. CASE: We present a patient with a MCTO where malignant transformation of gastrointestinal epithelium resulted in moderately differentiated adenocarcinoma. After 3 years of follow-up, she remains free of disease. CONCLUSION: Although gastrointestinal epithelium is often found in MCTOs, adenocarcinoma arising from this cell type is uncommon. This is the third reported case of adenocarcinoma arising in gastrointestinal epithelium of a MCTO.