IGCS 2014

MELBOURNE – Staging endometrial cancer using sentinel lymph node mapping reduces side effects for patients, and enables selection of lymph nodes for pathology that are more likely to have disease in them, an investigator reported at the biennial meeting of the International Gynecologic Cancer Society.

The procedure results in fewer lymph nodes being removed – usually two to three on each side, and no more than ten – which meant less side effects such as lymphedema, and potentially avoided the need for pelvic lymphadenectomy said Dr. Nadeem Abu-Rustum, chief of the gynecology service at Memorial Sloan Kettering Cancer Center, New York.

“One, you are removing fewer lymph nodes so there’s less radicality in surgery and less side effects; two, it makes the operating time faster, and three, you give the pathologist fewer lymph nodes but they can work on them in more depth to try to find low-volume metastases,” Dr. Abu-Rustum said in an interview.

Bianca Nogrady/Frontline Medical News

“It’s a win-win situation for the patient.”

Dr. Abu-Rustum and colleagues at Memorial Sloan-Kettering have developed a sentinel lymph node mapping algorithm for stage I cervical or endometrial cancers.

“It is applicable for any women who has endometrial cancer where the surgeon feels that the cancer is contained, and you need staging information,” he said.

However he stressed it was not applicable in patients with obvious metastases or with abnormal lymph nodes.

“This is for normal-appearing lymph nodes, clinical stage I, and the algorithm checklist really protects you because it will exclude those patients [with abnormal lymph nodes].”

While there was ongoing debate about where to inject the dye to best identify the sentinel node, Dr. Abu-Rustum told the conference that he and his colleagues believed injecting into the cervix at the three o’clock and nine o’clock positions was the most reasonable option.

He also commented on the different dyes used, saying that while methylene blue or lymphazurin had been the traditional choice – with or without technetium-99 – the near-infrared fluorescing indocyanine green and use of a laser significantly improved accuracy of the procedure.

“Now you’re able to increase the chance of finding the lymph node from 80% to almost 100%, and finding it on the right and the left was 60%, now it’s 80%,” he said.

In another presentation, a speaker reported an overall sentinel lymph node detection rate of 92%, and a 74% rate of bilateral detection, using a combination of methylene blue, technetium-99, and indocyanine green, in 100 patients who underwent sentinel lymph node mapping for endometrial cancer.

Among the 10 patients in the prospective study who had metastatic disease, 9 had a positive sentinel lymph node. The sentinel node was found to be the only positive node in 66% of these patients, suggesting that this was the most clinically relevant node. There was one case of a false negative for a sentinel lymph node, reported Dr. Jeffrey How, obstetrics and gynecology resident at the McGill University Health Centre, Montreal.

The addition of indocyanine green increased the precision of in vivo detection of sentinel lymph nodes, aiding detection of the highest-yield lymph nodes for pathology, he said.

No conflicts of interest were declared.

MELBOURNE – Staging endometrial cancer using sentinel lymph node mapping reduces side effects for patients, and enables selection of lymph nodes for pathology that are more likely to have disease in them, an investigator reported at the biennial meeting of the International Gynecologic Cancer Society.

The procedure results in fewer lymph nodes being removed – usually two to three on each side, and no more than ten – which meant less side effects such as lymphedema, and potentially avoided the need for pelvic lymphadenectomy said Dr. Nadeem Abu-Rustum, chief of the gynecology service at Memorial Sloan Kettering Cancer Center, New York.

“One, you are removing fewer lymph nodes so there’s less radicality in surgery and less side effects; two, it makes the operating time faster, and three, you give the pathologist fewer lymph nodes but they can work on them in more depth to try to find low-volume metastases,” Dr. Abu-Rustum said in an interview.

Bianca Nogrady/Frontline Medical News

“It’s a win-win situation for the patient.”

Dr. Abu-Rustum and colleagues at Memorial Sloan-Kettering have developed a sentinel lymph node mapping algorithm for stage I cervical or endometrial cancers.

“It is applicable for any women who has endometrial cancer where the surgeon feels that the cancer is contained, and you need staging information,” he said.

However he stressed it was not applicable in patients with obvious metastases or with abnormal lymph nodes.

“This is for normal-appearing lymph nodes, clinical stage I, and the algorithm checklist really protects you because it will exclude those patients [with abnormal lymph nodes].”

While there was ongoing debate about where to inject the dye to best identify the sentinel node, Dr. Abu-Rustum told the conference that he and his colleagues believed injecting into the cervix at the three o’clock and nine o’clock positions was the most reasonable option.

He also commented on the different dyes used, saying that while methylene blue or lymphazurin had been the traditional choice – with or without technetium-99 – the near-infrared fluorescing indocyanine green and use of a laser significantly improved accuracy of the procedure.

“Now you’re able to increase the chance of finding the lymph node from 80% to almost 100%, and finding it on the right and the left was 60%, now it’s 80%,” he said.

In another presentation, a speaker reported an overall sentinel lymph node detection rate of 92%, and a 74% rate of bilateral detection, using a combination of methylene blue, technetium-99, and indocyanine green, in 100 patients who underwent sentinel lymph node mapping for endometrial cancer.

Among the 10 patients in the prospective study who had metastatic disease, 9 had a positive sentinel lymph node. The sentinel node was found to be the only positive node in 66% of these patients, suggesting that this was the most clinically relevant node. There was one case of a false negative for a sentinel lymph node, reported Dr. Jeffrey How, obstetrics and gynecology resident at the McGill University Health Centre, Montreal.

The addition of indocyanine green increased the precision of in vivo detection of sentinel lymph nodes, aiding detection of the highest-yield lymph nodes for pathology, he said.

No conflicts of interest were declared.

MELBOURNE – Staging endometrial cancer using sentinel lymph node mapping reduces side effects for patients, and enables selection of lymph nodes for pathology that are more likely to have disease in them, an investigator reported at the biennial meeting of the International Gynecologic Cancer Society.

The procedure results in fewer lymph nodes being removed – usually two to three on each side, and no more than ten – which meant less side effects such as lymphedema, and potentially avoided the need for pelvic lymphadenectomy said Dr. Nadeem Abu-Rustum, chief of the gynecology service at Memorial Sloan Kettering Cancer Center, New York.

“One, you are removing fewer lymph nodes so there’s less radicality in surgery and less side effects; two, it makes the operating time faster, and three, you give the pathologist fewer lymph nodes but they can work on them in more depth to try to find low-volume metastases,” Dr. Abu-Rustum said in an interview.

Bianca Nogrady/Frontline Medical News

“It’s a win-win situation for the patient.”

Dr. Abu-Rustum and colleagues at Memorial Sloan-Kettering have developed a sentinel lymph node mapping algorithm for stage I cervical or endometrial cancers.

“It is applicable for any women who has endometrial cancer where the surgeon feels that the cancer is contained, and you need staging information,” he said.

However he stressed it was not applicable in patients with obvious metastases or with abnormal lymph nodes.

“This is for normal-appearing lymph nodes, clinical stage I, and the algorithm checklist really protects you because it will exclude those patients [with abnormal lymph nodes].”

While there was ongoing debate about where to inject the dye to best identify the sentinel node, Dr. Abu-Rustum told the conference that he and his colleagues believed injecting into the cervix at the three o’clock and nine o’clock positions was the most reasonable option.

He also commented on the different dyes used, saying that while methylene blue or lymphazurin had been the traditional choice – with or without technetium-99 – the near-infrared fluorescing indocyanine green and use of a laser significantly improved accuracy of the procedure.

“Now you’re able to increase the chance of finding the lymph node from 80% to almost 100%, and finding it on the right and the left was 60%, now it’s 80%,” he said.

In another presentation, a speaker reported an overall sentinel lymph node detection rate of 92%, and a 74% rate of bilateral detection, using a combination of methylene blue, technetium-99, and indocyanine green, in 100 patients who underwent sentinel lymph node mapping for endometrial cancer.

Among the 10 patients in the prospective study who had metastatic disease, 9 had a positive sentinel lymph node. The sentinel node was found to be the only positive node in 66% of these patients, suggesting that this was the most clinically relevant node. There was one case of a false negative for a sentinel lymph node, reported Dr. Jeffrey How, obstetrics and gynecology resident at the McGill University Health Centre, Montreal.

The addition of indocyanine green increased the precision of in vivo detection of sentinel lymph nodes, aiding detection of the highest-yield lymph nodes for pathology, he said.

No conflicts of interest were declared.

MELBOURNE – Measurement of the human epididymis protein 4 (HE4) tumor marker in women presenting with elevated cancer antigen 125 may improve the specificity of testing and help guide referral and management decisions, an investigator reported at the biennial meeting of the International Gynecologic Cancer Society.

Dr. Nithya Ratnavelu, subspeciality fellow at the Northern Gynaecological Oncology Centre in Gateshead, England, presented data from a prospective pilot study which showed the inclusion of HE4 measurement at the time of cancer antigen 125 (CA 125) measurement improved the specificity and positive predictive value of testing.

Bianca Nogrady/Frontline Medical News

The study involved 601 women presenting to primary care with vague abdominal symptoms, such as pelvic mass, abdominal pain, bloating, nausea, vomiting, or weight loss, who then had both their CA 125 and HE4 levels tested.

Women with abnormal CA 125 or HE4 were then referred for pelvic ultrasound, which identified two cases of ovarian cancer, both in postmenopausal women with elevated CA 125 and HE4.

The inclusion of HE4 at the time of CA 125 testing improved the specificity of testing from 95% with CA 125 alone to 98.6%, and the positive predictive value from 6.25% with CA 125 alone to 20% with the combined tests.

A total of fifty women presented with elevated HE4 levels, and ten of these also had abnormal CA 125. No cancers were found among the 40 women with elevated HE4 but normal CA 125, and doctors diagnosed one cecal tumor and one endometrial cancer in the 22 women with elevated CA 125 but normal HE4.

HE4 is a protease inhibitor that is overexpressed in certain histologies including ovarian, endometrial, respiratory, and renal cancers, Dr. Ratnavelu said, and was one of the more frequently investigated tumor markers in ovarian cancer.

While there were only two ovarian cancers found in the study, Dr. Ratnavelu said she had found the HE4 marker useful in her clinical practice.

“We have actually started using it clinically, and in a woman with maybe a slightly raised CA 125, with quite a small pelvic mass, to say instead of a big midline laparotomy, should we maybe just do laparoscopic surgery if your HE4 and ROMA score suggest it’s probably benign,” Dr. Ratnavelu said in an interview.

Another example she gave was of a premenopausal woman with bilateral ovarian cysts and a very high CA 125 but normal HE4, who turned out to have endometriosis rather than ovarian cancer.

“There is the potential here to aid management for community referrals,” Dr. Ratnavelu told the conference.

“Obviously, this is a pilot study, and to draw firm conclusions, further prospective multicenter studies are warranted.

In addition, a poster presented at the conference showed that an algorithm incorporating both HE4 and CA 125 measurements could be used to identify higher-risk patients with newly diagnosed endometrial cancer who were more likely to benefit from referral to specialist gynecologic oncologist services.

When they used cutoff points of a CA 125 greater than 35U/mL and/or an HE4 measurement greater than 111 pm, researchers found the odds of patients having deep myometrial invasion were 11.7 times higher among those with a positive test, compared with a negative test (95% confidence interval, 3.4-39.5; P < .001).

Similarly, patients who met those same cut-offs and had a high body mass index were 8.7 times more likely to require specialized treatment, compared with the negative population (95% CI, 3.7-20.5; P < .001), according to the retrospective cohort study in 200 patients surgically treated for endometrial cancer.

“Using an algorithm to triage higher-risk endometrial cancer patients to specialized centers could contribute to standardizing referral practices, optimizing the use of healthcare resources while improving oncologic outcomes, and overall quality of patient care,” wrote Dr. Eleftheria Kalogera and colleagues from the Mayo Clinic.

Dr. Ratnavelu declared travel expenses from Roche UK. There were no other conflicts of interest declared.

MELBOURNE – Measurement of the human epididymis protein 4 (HE4) tumor marker in women presenting with elevated cancer antigen 125 may improve the specificity of testing and help guide referral and management decisions, an investigator reported at the biennial meeting of the International Gynecologic Cancer Society.

Dr. Nithya Ratnavelu, subspeciality fellow at the Northern Gynaecological Oncology Centre in Gateshead, England, presented data from a prospective pilot study which showed the inclusion of HE4 measurement at the time of cancer antigen 125 (CA 125) measurement improved the specificity and positive predictive value of testing.

Bianca Nogrady/Frontline Medical News

The study involved 601 women presenting to primary care with vague abdominal symptoms, such as pelvic mass, abdominal pain, bloating, nausea, vomiting, or weight loss, who then had both their CA 125 and HE4 levels tested.

Women with abnormal CA 125 or HE4 were then referred for pelvic ultrasound, which identified two cases of ovarian cancer, both in postmenopausal women with elevated CA 125 and HE4.

The inclusion of HE4 at the time of CA 125 testing improved the specificity of testing from 95% with CA 125 alone to 98.6%, and the positive predictive value from 6.25% with CA 125 alone to 20% with the combined tests.

A total of fifty women presented with elevated HE4 levels, and ten of these also had abnormal CA 125. No cancers were found among the 40 women with elevated HE4 but normal CA 125, and doctors diagnosed one cecal tumor and one endometrial cancer in the 22 women with elevated CA 125 but normal HE4.

HE4 is a protease inhibitor that is overexpressed in certain histologies including ovarian, endometrial, respiratory, and renal cancers, Dr. Ratnavelu said, and was one of the more frequently investigated tumor markers in ovarian cancer.

While there were only two ovarian cancers found in the study, Dr. Ratnavelu said she had found the HE4 marker useful in her clinical practice.

“We have actually started using it clinically, and in a woman with maybe a slightly raised CA 125, with quite a small pelvic mass, to say instead of a big midline laparotomy, should we maybe just do laparoscopic surgery if your HE4 and ROMA score suggest it’s probably benign,” Dr. Ratnavelu said in an interview.

Another example she gave was of a premenopausal woman with bilateral ovarian cysts and a very high CA 125 but normal HE4, who turned out to have endometriosis rather than ovarian cancer.

“There is the potential here to aid management for community referrals,” Dr. Ratnavelu told the conference.

“Obviously, this is a pilot study, and to draw firm conclusions, further prospective multicenter studies are warranted.

In addition, a poster presented at the conference showed that an algorithm incorporating both HE4 and CA 125 measurements could be used to identify higher-risk patients with newly diagnosed endometrial cancer who were more likely to benefit from referral to specialist gynecologic oncologist services.

When they used cutoff points of a CA 125 greater than 35U/mL and/or an HE4 measurement greater than 111 pm, researchers found the odds of patients having deep myometrial invasion were 11.7 times higher among those with a positive test, compared with a negative test (95% confidence interval, 3.4-39.5; P < .001).

Similarly, patients who met those same cut-offs and had a high body mass index were 8.7 times more likely to require specialized treatment, compared with the negative population (95% CI, 3.7-20.5; P < .001), according to the retrospective cohort study in 200 patients surgically treated for endometrial cancer.

“Using an algorithm to triage higher-risk endometrial cancer patients to specialized centers could contribute to standardizing referral practices, optimizing the use of healthcare resources while improving oncologic outcomes, and overall quality of patient care,” wrote Dr. Eleftheria Kalogera and colleagues from the Mayo Clinic.

Dr. Ratnavelu declared travel expenses from Roche UK. There were no other conflicts of interest declared.

MELBOURNE – Measurement of the human epididymis protein 4 (HE4) tumor marker in women presenting with elevated cancer antigen 125 may improve the specificity of testing and help guide referral and management decisions, an investigator reported at the biennial meeting of the International Gynecologic Cancer Society.

Dr. Nithya Ratnavelu, subspeciality fellow at the Northern Gynaecological Oncology Centre in Gateshead, England, presented data from a prospective pilot study which showed the inclusion of HE4 measurement at the time of cancer antigen 125 (CA 125) measurement improved the specificity and positive predictive value of testing.

Bianca Nogrady/Frontline Medical News

The study involved 601 women presenting to primary care with vague abdominal symptoms, such as pelvic mass, abdominal pain, bloating, nausea, vomiting, or weight loss, who then had both their CA 125 and HE4 levels tested.

Women with abnormal CA 125 or HE4 were then referred for pelvic ultrasound, which identified two cases of ovarian cancer, both in postmenopausal women with elevated CA 125 and HE4.

The inclusion of HE4 at the time of CA 125 testing improved the specificity of testing from 95% with CA 125 alone to 98.6%, and the positive predictive value from 6.25% with CA 125 alone to 20% with the combined tests.

A total of fifty women presented with elevated HE4 levels, and ten of these also had abnormal CA 125. No cancers were found among the 40 women with elevated HE4 but normal CA 125, and doctors diagnosed one cecal tumor and one endometrial cancer in the 22 women with elevated CA 125 but normal HE4.

HE4 is a protease inhibitor that is overexpressed in certain histologies including ovarian, endometrial, respiratory, and renal cancers, Dr. Ratnavelu said, and was one of the more frequently investigated tumor markers in ovarian cancer.

While there were only two ovarian cancers found in the study, Dr. Ratnavelu said she had found the HE4 marker useful in her clinical practice.

“We have actually started using it clinically, and in a woman with maybe a slightly raised CA 125, with quite a small pelvic mass, to say instead of a big midline laparotomy, should we maybe just do laparoscopic surgery if your HE4 and ROMA score suggest it’s probably benign,” Dr. Ratnavelu said in an interview.

Another example she gave was of a premenopausal woman with bilateral ovarian cysts and a very high CA 125 but normal HE4, who turned out to have endometriosis rather than ovarian cancer.

“There is the potential here to aid management for community referrals,” Dr. Ratnavelu told the conference.

“Obviously, this is a pilot study, and to draw firm conclusions, further prospective multicenter studies are warranted.

In addition, a poster presented at the conference showed that an algorithm incorporating both HE4 and CA 125 measurements could be used to identify higher-risk patients with newly diagnosed endometrial cancer who were more likely to benefit from referral to specialist gynecologic oncologist services.

When they used cutoff points of a CA 125 greater than 35U/mL and/or an HE4 measurement greater than 111 pm, researchers found the odds of patients having deep myometrial invasion were 11.7 times higher among those with a positive test, compared with a negative test (95% confidence interval, 3.4-39.5; P < .001).

Similarly, patients who met those same cut-offs and had a high body mass index were 8.7 times more likely to require specialized treatment, compared with the negative population (95% CI, 3.7-20.5; P < .001), according to the retrospective cohort study in 200 patients surgically treated for endometrial cancer.

“Using an algorithm to triage higher-risk endometrial cancer patients to specialized centers could contribute to standardizing referral practices, optimizing the use of healthcare resources while improving oncologic outcomes, and overall quality of patient care,” wrote Dr. Eleftheria Kalogera and colleagues from the Mayo Clinic.

Dr. Ratnavelu declared travel expenses from Roche UK. There were no other conflicts of interest declared.

MELBOURNE – Bariatric surgery may provide a useful opportunity to screen morbidly obese women for endometrial cancer, according to the presenter of a study showing a 15% prevalence of occult endometrial cancer or atypical hyperplasia in this population.

Speaking at the biennial meeting of the International Gynecologic Cancer Society, Dr. Michelle MacKintosh, clinical research fellow at the Institute of Cancer Sciences at the University of Manchester (England), presented data from a prospective cohort study examining the endometrial effects of weight loss in morbidly obese women.

Among the 67 women so far enrolled and assessed via a regional weight management service, Dr. MacKintosh and her colleagues detected endometrial cancer or atypical endometrial hyperplasia in 10 women; 1 woman presented symptoms suggestive of an underlying endometrial abnormality.

Endometrial biopsies were conducted while the women were under general anesthesia for bariatric surgery, and the researchers also took blood and cervical cytology samples.

Three-quarters of the women were premenopausal, and among those undergoing bariatric surgery, as opposed to a medically-supervised weight management program, the median body mass index was 52.5 kg/m².

Twelve-month follow-up data showed bariatric surgery–induced weight loss led to a significant reduction in insulin resistance and significant improvements in reproductive function, as measured by sex hormone binding globulin, follicle-stimulating hormone and luteinizing hormone.

The researchers examined the impact of weight loss on levels of Ki67 – a marker of endometrial proliferation that can be used to generate a proliferation index.

“We know that proliferation is a feature of cancer development and we know it increases along that spectrum, so what we wanted to see was if that process appeared to be reversed by weight loss and we thought that looking at the proliferation index would be a way of quantifying that,” Dr. MacKintosh said in an interview.

These analyses are ongoing but Dr. MacKintosh said initial data look promising, with suggestions that endometrial Ki67 expression drops with weight loss.

“The 15% baseline prevalence of endometrial cancer and atypical hyperplasia, which we found in these women, is clinically significant and is far in excess of anything previously been reported,” Dr. MacKintosh said at the conference.

“Ours is the first prospective cohort study to assess blood and endometrial change with weight loss and in answer to the question we posed, we do believe that we can support endometrial screening of such high risk women.”

There were no conflicts of interest declared.

MELBOURNE – Bariatric surgery may provide a useful opportunity to screen morbidly obese women for endometrial cancer, according to the presenter of a study showing a 15% prevalence of occult endometrial cancer or atypical hyperplasia in this population.

Speaking at the biennial meeting of the International Gynecologic Cancer Society, Dr. Michelle MacKintosh, clinical research fellow at the Institute of Cancer Sciences at the University of Manchester (England), presented data from a prospective cohort study examining the endometrial effects of weight loss in morbidly obese women.

Among the 67 women so far enrolled and assessed via a regional weight management service, Dr. MacKintosh and her colleagues detected endometrial cancer or atypical endometrial hyperplasia in 10 women; 1 woman presented symptoms suggestive of an underlying endometrial abnormality.

Endometrial biopsies were conducted while the women were under general anesthesia for bariatric surgery, and the researchers also took blood and cervical cytology samples.

Three-quarters of the women were premenopausal, and among those undergoing bariatric surgery, as opposed to a medically-supervised weight management program, the median body mass index was 52.5 kg/m².

Twelve-month follow-up data showed bariatric surgery–induced weight loss led to a significant reduction in insulin resistance and significant improvements in reproductive function, as measured by sex hormone binding globulin, follicle-stimulating hormone and luteinizing hormone.

The researchers examined the impact of weight loss on levels of Ki67 – a marker of endometrial proliferation that can be used to generate a proliferation index.

“We know that proliferation is a feature of cancer development and we know it increases along that spectrum, so what we wanted to see was if that process appeared to be reversed by weight loss and we thought that looking at the proliferation index would be a way of quantifying that,” Dr. MacKintosh said in an interview.

These analyses are ongoing but Dr. MacKintosh said initial data look promising, with suggestions that endometrial Ki67 expression drops with weight loss.

“The 15% baseline prevalence of endometrial cancer and atypical hyperplasia, which we found in these women, is clinically significant and is far in excess of anything previously been reported,” Dr. MacKintosh said at the conference.

“Ours is the first prospective cohort study to assess blood and endometrial change with weight loss and in answer to the question we posed, we do believe that we can support endometrial screening of such high risk women.”

There were no conflicts of interest declared.

MELBOURNE – Bariatric surgery may provide a useful opportunity to screen morbidly obese women for endometrial cancer, according to the presenter of a study showing a 15% prevalence of occult endometrial cancer or atypical hyperplasia in this population.

Speaking at the biennial meeting of the International Gynecologic Cancer Society, Dr. Michelle MacKintosh, clinical research fellow at the Institute of Cancer Sciences at the University of Manchester (England), presented data from a prospective cohort study examining the endometrial effects of weight loss in morbidly obese women.

Among the 67 women so far enrolled and assessed via a regional weight management service, Dr. MacKintosh and her colleagues detected endometrial cancer or atypical endometrial hyperplasia in 10 women; 1 woman presented symptoms suggestive of an underlying endometrial abnormality.

Endometrial biopsies were conducted while the women were under general anesthesia for bariatric surgery, and the researchers also took blood and cervical cytology samples.

Three-quarters of the women were premenopausal, and among those undergoing bariatric surgery, as opposed to a medically-supervised weight management program, the median body mass index was 52.5 kg/m².

Twelve-month follow-up data showed bariatric surgery–induced weight loss led to a significant reduction in insulin resistance and significant improvements in reproductive function, as measured by sex hormone binding globulin, follicle-stimulating hormone and luteinizing hormone.

The researchers examined the impact of weight loss on levels of Ki67 – a marker of endometrial proliferation that can be used to generate a proliferation index.

“We know that proliferation is a feature of cancer development and we know it increases along that spectrum, so what we wanted to see was if that process appeared to be reversed by weight loss and we thought that looking at the proliferation index would be a way of quantifying that,” Dr. MacKintosh said in an interview.

These analyses are ongoing but Dr. MacKintosh said initial data look promising, with suggestions that endometrial Ki67 expression drops with weight loss.

“The 15% baseline prevalence of endometrial cancer and atypical hyperplasia, which we found in these women, is clinically significant and is far in excess of anything previously been reported,” Dr. MacKintosh said at the conference.

“Ours is the first prospective cohort study to assess blood and endometrial change with weight loss and in answer to the question we posed, we do believe that we can support endometrial screening of such high risk women.”

There were no conflicts of interest declared.

MELBOURNE – Patient-initiated follow-up is a safe, cost-effective alternative to conventional follow-ups every 3 months in patients with gynecological cancer, according to data from a prospective trial presented at the biennial meeting of the International Gynecologic Cancer Society.

Researchers found a much longer time to follow-up among patients who chose patient-initiated follow-up compared with those who elected to remain with conventional follow-up (718 days vs. 386 days), but the median time to death also was longer: 1,035 days in the patient-initiated follow-up group compared with 795 days in the conventional follow-up group.

Bianca Nogrady/Frontline Medical News

“What is very clear is that many of our patients want an alternative to conventional follow up,” said Dr. Peter Larsen-Disney of the department of gynecology at Brighton and Sussex University Hospital NHS Trust, Brighton, England.

Dr Larsen-Disney told the conference that he realized patients with a good prognosis after treatment for their gynecological cancers were being given mixed messages by being asked to return for regular follow-up.

“We were saying, ‘there’s every reason to believe you’re cured, you have an excellent prognosis, and we’ll see you every 3 months,’ ” he said.

“The other realization I had was, with the exception of ovarian cancer patients, who we were following up for tumor markers, I believe that I make very few diagnoses of recurrence that the patient didn’t tell me was there.”

After realizing there was little evidence to support follow-up every 3 months in these patients, Dr. Larsen-Disney and his colleagues conducted a prospective study of 997 patients who were offered the choice of conventional follow-up or patient-initiated follow-up.

Patients who chose patient-initiated follow-up were registered in a database, and were provided with disease-specific booklets that outlined the follow-up system, listed details on what symptoms to look out for, and gave information on how to access review if needed.

Patients were able to access a nurse specialist by phone for advice and referrals for other services such as counseling.

Of the 568 patients who registered for patient-initiated follow-up, 71 later switched back to conventional follow-up, mostly at the time of recurrence.

More than half of the patients who registered for patient-initiated follow-up had endometrial cancer, while there were significantly more patients with cervical and vulvar cancer in the conventional follow-up arm than in the patient-initiated follow-up arm, which Dr. Larsen-Disney said partly reflected physician bias.

“We were a little bit reluctant to release the [patients with] very early cervix cancers back into the community because we wanted to follow them up with smears, and ... we weren’t confident that they would get the appropriate smears in the community,” he said.

He said there was no doubt in his mind of the importance of patient-led follow-up to the patients themselves, as well as the fact that it appeared to be a safe, acceptable, and cost-effective alternative to conventional follow-up.

“I think the concerns are that people are nervous that they’re going to miss recurrences and, to be honest, there will be a tiny minority of patients where you will, who won’t present with classical signs of recurrence but I’m not convinced you’d pick them up anyway,” Dr. Larsen-Disney said in an interview.

There were no conflicts of interest declared.

MELBOURNE – Patient-initiated follow-up is a safe, cost-effective alternative to conventional follow-ups every 3 months in patients with gynecological cancer, according to data from a prospective trial presented at the biennial meeting of the International Gynecologic Cancer Society.

Researchers found a much longer time to follow-up among patients who chose patient-initiated follow-up compared with those who elected to remain with conventional follow-up (718 days vs. 386 days), but the median time to death also was longer: 1,035 days in the patient-initiated follow-up group compared with 795 days in the conventional follow-up group.

Bianca Nogrady/Frontline Medical News

“What is very clear is that many of our patients want an alternative to conventional follow up,” said Dr. Peter Larsen-Disney of the department of gynecology at Brighton and Sussex University Hospital NHS Trust, Brighton, England.

Dr Larsen-Disney told the conference that he realized patients with a good prognosis after treatment for their gynecological cancers were being given mixed messages by being asked to return for regular follow-up.

“We were saying, ‘there’s every reason to believe you’re cured, you have an excellent prognosis, and we’ll see you every 3 months,’ ” he said.

“The other realization I had was, with the exception of ovarian cancer patients, who we were following up for tumor markers, I believe that I make very few diagnoses of recurrence that the patient didn’t tell me was there.”

After realizing there was little evidence to support follow-up every 3 months in these patients, Dr. Larsen-Disney and his colleagues conducted a prospective study of 997 patients who were offered the choice of conventional follow-up or patient-initiated follow-up.

Patients who chose patient-initiated follow-up were registered in a database, and were provided with disease-specific booklets that outlined the follow-up system, listed details on what symptoms to look out for, and gave information on how to access review if needed.

Patients were able to access a nurse specialist by phone for advice and referrals for other services such as counseling.

Of the 568 patients who registered for patient-initiated follow-up, 71 later switched back to conventional follow-up, mostly at the time of recurrence.

More than half of the patients who registered for patient-initiated follow-up had endometrial cancer, while there were significantly more patients with cervical and vulvar cancer in the conventional follow-up arm than in the patient-initiated follow-up arm, which Dr. Larsen-Disney said partly reflected physician bias.

“We were a little bit reluctant to release the [patients with] very early cervix cancers back into the community because we wanted to follow them up with smears, and ... we weren’t confident that they would get the appropriate smears in the community,” he said.

He said there was no doubt in his mind of the importance of patient-led follow-up to the patients themselves, as well as the fact that it appeared to be a safe, acceptable, and cost-effective alternative to conventional follow-up.

“I think the concerns are that people are nervous that they’re going to miss recurrences and, to be honest, there will be a tiny minority of patients where you will, who won’t present with classical signs of recurrence but I’m not convinced you’d pick them up anyway,” Dr. Larsen-Disney said in an interview.

There were no conflicts of interest declared.

MELBOURNE – Patient-initiated follow-up is a safe, cost-effective alternative to conventional follow-ups every 3 months in patients with gynecological cancer, according to data from a prospective trial presented at the biennial meeting of the International Gynecologic Cancer Society.

Researchers found a much longer time to follow-up among patients who chose patient-initiated follow-up compared with those who elected to remain with conventional follow-up (718 days vs. 386 days), but the median time to death also was longer: 1,035 days in the patient-initiated follow-up group compared with 795 days in the conventional follow-up group.

Bianca Nogrady/Frontline Medical News

“What is very clear is that many of our patients want an alternative to conventional follow up,” said Dr. Peter Larsen-Disney of the department of gynecology at Brighton and Sussex University Hospital NHS Trust, Brighton, England.

Dr Larsen-Disney told the conference that he realized patients with a good prognosis after treatment for their gynecological cancers were being given mixed messages by being asked to return for regular follow-up.

“We were saying, ‘there’s every reason to believe you’re cured, you have an excellent prognosis, and we’ll see you every 3 months,’ ” he said.

“The other realization I had was, with the exception of ovarian cancer patients, who we were following up for tumor markers, I believe that I make very few diagnoses of recurrence that the patient didn’t tell me was there.”

After realizing there was little evidence to support follow-up every 3 months in these patients, Dr. Larsen-Disney and his colleagues conducted a prospective study of 997 patients who were offered the choice of conventional follow-up or patient-initiated follow-up.

Patients who chose patient-initiated follow-up were registered in a database, and were provided with disease-specific booklets that outlined the follow-up system, listed details on what symptoms to look out for, and gave information on how to access review if needed.

Patients were able to access a nurse specialist by phone for advice and referrals for other services such as counseling.

Of the 568 patients who registered for patient-initiated follow-up, 71 later switched back to conventional follow-up, mostly at the time of recurrence.

More than half of the patients who registered for patient-initiated follow-up had endometrial cancer, while there were significantly more patients with cervical and vulvar cancer in the conventional follow-up arm than in the patient-initiated follow-up arm, which Dr. Larsen-Disney said partly reflected physician bias.

“We were a little bit reluctant to release the [patients with] very early cervix cancers back into the community because we wanted to follow them up with smears, and ... we weren’t confident that they would get the appropriate smears in the community,” he said.

He said there was no doubt in his mind of the importance of patient-led follow-up to the patients themselves, as well as the fact that it appeared to be a safe, acceptable, and cost-effective alternative to conventional follow-up.

“I think the concerns are that people are nervous that they’re going to miss recurrences and, to be honest, there will be a tiny minority of patients where you will, who won’t present with classical signs of recurrence but I’m not convinced you’d pick them up anyway,” Dr. Larsen-Disney said in an interview.

There were no conflicts of interest declared.

MELBOURNE – Surgical removal of the fallopian tubes could be a viable option for reducing the risk of ovarian cancer in high-risk women, a speaker said at the biennial meeting of the International Gynecologic Cancer Society.

Dr. Henrik Falconer, head of gynecologic oncology at the Karolinska Institute, Stockholm, said there is an emerging hypothesis that ovarian cancer arises primarily in the fallopian tubes, not in the ovaries, although this is difficult to prove.

Researchers therefore conducted a retrospective, population-based cohort study of women who had previously undergone sterilization; salpingectomy; hysterectomy and bilateral salpingo-oophorectomy; or hysterectomy for a benign indication between 1972 and 2010 in Sweden.

They found that women who had undergone unilateral salpingectomy had a 28% lower risk of ovarian cancer, while those who had undergone bilateral salpingectomy had a 65% lower risk, compared with the general population.

Women who underwent hysterectomy with removal of fallopian tubes and ovaries had the lowest overall risk of ovarian cancer (hazard ratio, 0.06; 95% confidence interval, 0.03-0.12), while those who had hysterectomy alone had a 22% reduction in risk.

Dr. Falconer said a case could be made for proactive removal of the fallopian tubes in women carrying the BRCA mutation, which might then enable a delay in removal of their ovaries.

“Today, we counsel the patients and advise them to take away the tubes and the ovaries, sometimes at 40-45, after they have completed their family planning,” Dr. Falconer said in an interview.

“I think now we could take away the tubes instead earlier, to have risk reduction while they wait to have their ovaries removed, perhaps in their 50s or 60s then, or maybe never.”

This would avoid the morbidity associated with oophorectomy, such as cardiovascular disease and Alzheimer’s disease, Dr. Falconer said, and could not only reduce the risk of cancer but also improve the quality of life in this population of relatively young women.

He also suggested that prophylactic salpingectomy might even be considered in women undergoing sterilization, even if they weren’t necessarily at high risk of ovarian cancer.

The study included data from more than 5 million women, with over 250,000 women exposed to some form of surgery and more than 30,000 cases of ovarian cancer.

One audience member raised concerns about the use of prophylactic salpingectomy in an otherwise healthy population, suggesting that the procedure was not without its risks and could have unintended consequences because of the loss of blood supply to the ovaries.

The study did not control for oral contraceptive use or histological subtypes.

Dr. Falconer declared support from Intuitive Surgical. There were no other conflicts of interest declared.

MELBOURNE – Surgical removal of the fallopian tubes could be a viable option for reducing the risk of ovarian cancer in high-risk women, a speaker said at the biennial meeting of the International Gynecologic Cancer Society.

Dr. Henrik Falconer, head of gynecologic oncology at the Karolinska Institute, Stockholm, said there is an emerging hypothesis that ovarian cancer arises primarily in the fallopian tubes, not in the ovaries, although this is difficult to prove.

Researchers therefore conducted a retrospective, population-based cohort study of women who had previously undergone sterilization; salpingectomy; hysterectomy and bilateral salpingo-oophorectomy; or hysterectomy for a benign indication between 1972 and 2010 in Sweden.

They found that women who had undergone unilateral salpingectomy had a 28% lower risk of ovarian cancer, while those who had undergone bilateral salpingectomy had a 65% lower risk, compared with the general population.

Women who underwent hysterectomy with removal of fallopian tubes and ovaries had the lowest overall risk of ovarian cancer (hazard ratio, 0.06; 95% confidence interval, 0.03-0.12), while those who had hysterectomy alone had a 22% reduction in risk.

Dr. Falconer said a case could be made for proactive removal of the fallopian tubes in women carrying the BRCA mutation, which might then enable a delay in removal of their ovaries.

“Today, we counsel the patients and advise them to take away the tubes and the ovaries, sometimes at 40-45, after they have completed their family planning,” Dr. Falconer said in an interview.

“I think now we could take away the tubes instead earlier, to have risk reduction while they wait to have their ovaries removed, perhaps in their 50s or 60s then, or maybe never.”

This would avoid the morbidity associated with oophorectomy, such as cardiovascular disease and Alzheimer’s disease, Dr. Falconer said, and could not only reduce the risk of cancer but also improve the quality of life in this population of relatively young women.

He also suggested that prophylactic salpingectomy might even be considered in women undergoing sterilization, even if they weren’t necessarily at high risk of ovarian cancer.

The study included data from more than 5 million women, with over 250,000 women exposed to some form of surgery and more than 30,000 cases of ovarian cancer.

One audience member raised concerns about the use of prophylactic salpingectomy in an otherwise healthy population, suggesting that the procedure was not without its risks and could have unintended consequences because of the loss of blood supply to the ovaries.

The study did not control for oral contraceptive use or histological subtypes.

Dr. Falconer declared support from Intuitive Surgical. There were no other conflicts of interest declared.

MELBOURNE – Surgical removal of the fallopian tubes could be a viable option for reducing the risk of ovarian cancer in high-risk women, a speaker said at the biennial meeting of the International Gynecologic Cancer Society.

Dr. Henrik Falconer, head of gynecologic oncology at the Karolinska Institute, Stockholm, said there is an emerging hypothesis that ovarian cancer arises primarily in the fallopian tubes, not in the ovaries, although this is difficult to prove.

Researchers therefore conducted a retrospective, population-based cohort study of women who had previously undergone sterilization; salpingectomy; hysterectomy and bilateral salpingo-oophorectomy; or hysterectomy for a benign indication between 1972 and 2010 in Sweden.

They found that women who had undergone unilateral salpingectomy had a 28% lower risk of ovarian cancer, while those who had undergone bilateral salpingectomy had a 65% lower risk, compared with the general population.

Women who underwent hysterectomy with removal of fallopian tubes and ovaries had the lowest overall risk of ovarian cancer (hazard ratio, 0.06; 95% confidence interval, 0.03-0.12), while those who had hysterectomy alone had a 22% reduction in risk.

Dr. Falconer said a case could be made for proactive removal of the fallopian tubes in women carrying the BRCA mutation, which might then enable a delay in removal of their ovaries.

“Today, we counsel the patients and advise them to take away the tubes and the ovaries, sometimes at 40-45, after they have completed their family planning,” Dr. Falconer said in an interview.

“I think now we could take away the tubes instead earlier, to have risk reduction while they wait to have their ovaries removed, perhaps in their 50s or 60s then, or maybe never.”

This would avoid the morbidity associated with oophorectomy, such as cardiovascular disease and Alzheimer’s disease, Dr. Falconer said, and could not only reduce the risk of cancer but also improve the quality of life in this population of relatively young women.

He also suggested that prophylactic salpingectomy might even be considered in women undergoing sterilization, even if they weren’t necessarily at high risk of ovarian cancer.

The study included data from more than 5 million women, with over 250,000 women exposed to some form of surgery and more than 30,000 cases of ovarian cancer.

One audience member raised concerns about the use of prophylactic salpingectomy in an otherwise healthy population, suggesting that the procedure was not without its risks and could have unintended consequences because of the loss of blood supply to the ovaries.

The study did not control for oral contraceptive use or histological subtypes.

Dr. Falconer declared support from Intuitive Surgical. There were no other conflicts of interest declared.

MELBOURNE – Simple trachelectomy can achieve fertility-sparing outcomes similar to those obtained from radical trachelectomy in women with early-stage cervical cancer without any increased risk of recurrence, according to a poster presented at the biennial meeting of the International Gynecologic Cancer Society.

A retrospective cohort study of 25 patients who underwent a simple vaginal trachelectomy to remove the cervix after a diagnosis of cervical cancer found that 6 of the 10 patients who declared an intention to conceive were successful in doing so.

“The radical trachelectomy procedures [resulted in] a pregnancy rate between 70% and 80%, so we think the simple trachelectomy will do quite well,” said lead author Dr. Shamitha Kathurusinghe, an obstetrics/gynecology trainee at Royal Women’s Hospital, Melbourne.“We had 10 people with the intention to conceive, and we had 10 pregnancies in 6 patients, and our intention to conceive was about 50%,” she said in an interview.

While the majority of patients in the study sought assisted reproductive technologies, some also conceived naturally.

All pregnancies were treated as high risk, and all patients delivered via cesarean section. Two pregnancies were achieved via a surrogate; there was one first-trimester miscarriage; one ectopic pregnancy; and one second-trimester miscarriage, but the cause was unknown.”

Researchers found no incidence of cancer recurrence during the median 54-month follow-up period, among a group of patients which included 7 with stage IA1 disease, 5 with stage IA2, 11 with stage IB1 disease, and 2 with stage IB2 disease.

The study group included 7 cases of squamous cell carcinoma, 10 adenocarcinomas, 4 adenosquamous tumors, 2 adenosarcomas, and 2 neuroendocrine tumors. In all, 48% of patients were nulliparous prior to the procedure.

Dr. Kathurusinghe said surgical treatments for cervical cancer seemed to be shifting away from more radical toward more conservative approaches.

“What we’ve noticed over time is that the gold standard management is a radical hysterectomy, but we’ve gone back from that and said, maybe we can get away without that, let’s do a radical trachelectomy,” Dr. Kathurusinghe said.

“Now we’re slowly going back and saying we can be a little bit less radical and leave a bit more behind.”

While the study included women with stage IB2 tumors, Dr. Kathurusinghe said the general advice would be to use the more conservative procedure up to stage IB1 tumors only.

“Every patient should be considered on an individual basis by a specialist that’s in that area. Sit down with the patient and decide, does this patient need radical therapy? Is this woman still of a childbearing age, [who] would want to preserve their fertility; and can this be an option for that patient?”

Researchers also found that 15 patients actually had no residual disease on the final histopathology, echoing similar findings from an earlier study.

There were no conflicts of interest declared.

[email protected]

MELBOURNE – Simple trachelectomy can achieve fertility-sparing outcomes similar to those obtained from radical trachelectomy in women with early-stage cervical cancer without any increased risk of recurrence, according to a poster presented at the biennial meeting of the International Gynecologic Cancer Society.

A retrospective cohort study of 25 patients who underwent a simple vaginal trachelectomy to remove the cervix after a diagnosis of cervical cancer found that 6 of the 10 patients who declared an intention to conceive were successful in doing so.

“The radical trachelectomy procedures [resulted in] a pregnancy rate between 70% and 80%, so we think the simple trachelectomy will do quite well,” said lead author Dr. Shamitha Kathurusinghe, an obstetrics/gynecology trainee at Royal Women’s Hospital, Melbourne.“We had 10 people with the intention to conceive, and we had 10 pregnancies in 6 patients, and our intention to conceive was about 50%,” she said in an interview.

While the majority of patients in the study sought assisted reproductive technologies, some also conceived naturally.

All pregnancies were treated as high risk, and all patients delivered via cesarean section. Two pregnancies were achieved via a surrogate; there was one first-trimester miscarriage; one ectopic pregnancy; and one second-trimester miscarriage, but the cause was unknown.”

Researchers found no incidence of cancer recurrence during the median 54-month follow-up period, among a group of patients which included 7 with stage IA1 disease, 5 with stage IA2, 11 with stage IB1 disease, and 2 with stage IB2 disease.

The study group included 7 cases of squamous cell carcinoma, 10 adenocarcinomas, 4 adenosquamous tumors, 2 adenosarcomas, and 2 neuroendocrine tumors. In all, 48% of patients were nulliparous prior to the procedure.

Dr. Kathurusinghe said surgical treatments for cervical cancer seemed to be shifting away from more radical toward more conservative approaches.

“What we’ve noticed over time is that the gold standard management is a radical hysterectomy, but we’ve gone back from that and said, maybe we can get away without that, let’s do a radical trachelectomy,” Dr. Kathurusinghe said.

“Now we’re slowly going back and saying we can be a little bit less radical and leave a bit more behind.”

While the study included women with stage IB2 tumors, Dr. Kathurusinghe said the general advice would be to use the more conservative procedure up to stage IB1 tumors only.

“Every patient should be considered on an individual basis by a specialist that’s in that area. Sit down with the patient and decide, does this patient need radical therapy? Is this woman still of a childbearing age, [who] would want to preserve their fertility; and can this be an option for that patient?”

Researchers also found that 15 patients actually had no residual disease on the final histopathology, echoing similar findings from an earlier study.

There were no conflicts of interest declared.

[email protected]

MELBOURNE – Simple trachelectomy can achieve fertility-sparing outcomes similar to those obtained from radical trachelectomy in women with early-stage cervical cancer without any increased risk of recurrence, according to a poster presented at the biennial meeting of the International Gynecologic Cancer Society.

A retrospective cohort study of 25 patients who underwent a simple vaginal trachelectomy to remove the cervix after a diagnosis of cervical cancer found that 6 of the 10 patients who declared an intention to conceive were successful in doing so.

“The radical trachelectomy procedures [resulted in] a pregnancy rate between 70% and 80%, so we think the simple trachelectomy will do quite well,” said lead author Dr. Shamitha Kathurusinghe, an obstetrics/gynecology trainee at Royal Women’s Hospital, Melbourne.“We had 10 people with the intention to conceive, and we had 10 pregnancies in 6 patients, and our intention to conceive was about 50%,” she said in an interview.

While the majority of patients in the study sought assisted reproductive technologies, some also conceived naturally.

All pregnancies were treated as high risk, and all patients delivered via cesarean section. Two pregnancies were achieved via a surrogate; there was one first-trimester miscarriage; one ectopic pregnancy; and one second-trimester miscarriage, but the cause was unknown.”

Researchers found no incidence of cancer recurrence during the median 54-month follow-up period, among a group of patients which included 7 with stage IA1 disease, 5 with stage IA2, 11 with stage IB1 disease, and 2 with stage IB2 disease.

The study group included 7 cases of squamous cell carcinoma, 10 adenocarcinomas, 4 adenosquamous tumors, 2 adenosarcomas, and 2 neuroendocrine tumors. In all, 48% of patients were nulliparous prior to the procedure.

Dr. Kathurusinghe said surgical treatments for cervical cancer seemed to be shifting away from more radical toward more conservative approaches.

“What we’ve noticed over time is that the gold standard management is a radical hysterectomy, but we’ve gone back from that and said, maybe we can get away without that, let’s do a radical trachelectomy,” Dr. Kathurusinghe said.

“Now we’re slowly going back and saying we can be a little bit less radical and leave a bit more behind.”

While the study included women with stage IB2 tumors, Dr. Kathurusinghe said the general advice would be to use the more conservative procedure up to stage IB1 tumors only.

“Every patient should be considered on an individual basis by a specialist that’s in that area. Sit down with the patient and decide, does this patient need radical therapy? Is this woman still of a childbearing age, [who] would want to preserve their fertility; and can this be an option for that patient?”

Researchers also found that 15 patients actually had no residual disease on the final histopathology, echoing similar findings from an earlier study.

There were no conflicts of interest declared.

[email protected]

MELBOURNE – Residents of the mountain region of the United States are significantly less likely to receive postoperative treatment for advanced endometrial cancer, compared with residents of the Northeast or Midwest, according to an oral presentation made at the biennial meeting of the International Gynecologic Cancer Society.

Retrospective analysis of data from 228,511 patients registered in the National Cancer Data Base – 15.5% of whom were stage III or IV – showed that women living in the mountain region and the Midwest were also significantly more likely to be diagnosed with advanced stage disease than those living in the South (hazard ratio 1.29 and 1.27 respectively, P < .0001)

Researchers also found having Medicaid insurance significantly increased the likelihood of being diagnosed with stage III-IV endometrial cancer (HR 1.51, P < .0001) and decreased overall survival, compared with individuals with private insurance or in managed care (HR 0.85).

“The aim of this study was to estimate the contribution of race and ethnicity, socioeconomic factors such as education and income, as well as place of residence on eventual cancer outcome,” said Dr. Sean Dowdy, professor and chair of gynecologic surgery at the Mayo Clinic.

“Specifically we looked at three questions: one was the factors that are associated with advanced stage at diagnosis, stage III-IV; whether patients received postsurgical treatment when they had advanced disease; and also their overall survival,” Dr. Dowdy told the conference.

While the study initially found that African American women were significantly more likely to be diagnosed with advanced disease than white women, this difference was no longer statistically significant after adjusting for other factors, such as the fourfold higher incidence of serous cancer in African American women.

African American women also had a reduced overall survival, compared with white women, although the study did not find any significant impact of race on treatment rates or the likelihood of being treated at a high-volume facility.

“I expected African Americans to have worse access, and to be diagnosed with advanced-stage disease, and I thought that that would be the reason for their reduced survival, but we actually didn’t see that,” Dr. Dowdy said in an interview.

“The other possibility is, there is something unique about African Americans, about their tumors or about their host response, so maybe their immunological response or something like that may impact their survival.”

The study also observed reduced survival among patients treated at low-volume facilities – although this represented a relatively small number of patients – and noted a twofold increase in reduced survival among patients aged over 80 years.

“In the age category, it’s not surprising that patients were less likely to be treated, but it’s surprising the magnitude of this, so patients that were 90 years were ten times less likely to be treated than patients who were in their 50s,” Dr. Dowdy told the audience.

Commenting on the negative impact of Medicaid and Medicare insurance, Dr. Dowdy pointed out that the study predated the introduction of the Affordable Care Act, and it was too early to tell what impact that might have on the outcomes for those patients without private insurance.

However he also called for more research into the racial disparities in overall survival.

“If the problem is access, then we need to put money into education, and we need to maybe change the system so that it’s more accessible,” Dr. Dowdy said.

“If it’s a biology thing then we need to figure out what that is and figure out whether there are specific treatments that we should be using in these patients.”

The study was supported by the Mayo Clinic, and there were no conflicts of interest declared.

MELBOURNE – Residents of the mountain region of the United States are significantly less likely to receive postoperative treatment for advanced endometrial cancer, compared with residents of the Northeast or Midwest, according to an oral presentation made at the biennial meeting of the International Gynecologic Cancer Society.

Retrospective analysis of data from 228,511 patients registered in the National Cancer Data Base – 15.5% of whom were stage III or IV – showed that women living in the mountain region and the Midwest were also significantly more likely to be diagnosed with advanced stage disease than those living in the South (hazard ratio 1.29 and 1.27 respectively, P < .0001)

Researchers also found having Medicaid insurance significantly increased the likelihood of being diagnosed with stage III-IV endometrial cancer (HR 1.51, P < .0001) and decreased overall survival, compared with individuals with private insurance or in managed care (HR 0.85).

“The aim of this study was to estimate the contribution of race and ethnicity, socioeconomic factors such as education and income, as well as place of residence on eventual cancer outcome,” said Dr. Sean Dowdy, professor and chair of gynecologic surgery at the Mayo Clinic.

“Specifically we looked at three questions: one was the factors that are associated with advanced stage at diagnosis, stage III-IV; whether patients received postsurgical treatment when they had advanced disease; and also their overall survival,” Dr. Dowdy told the conference.

While the study initially found that African American women were significantly more likely to be diagnosed with advanced disease than white women, this difference was no longer statistically significant after adjusting for other factors, such as the fourfold higher incidence of serous cancer in African American women.

African American women also had a reduced overall survival, compared with white women, although the study did not find any significant impact of race on treatment rates or the likelihood of being treated at a high-volume facility.

“I expected African Americans to have worse access, and to be diagnosed with advanced-stage disease, and I thought that that would be the reason for their reduced survival, but we actually didn’t see that,” Dr. Dowdy said in an interview.

“The other possibility is, there is something unique about African Americans, about their tumors or about their host response, so maybe their immunological response or something like that may impact their survival.”

The study also observed reduced survival among patients treated at low-volume facilities – although this represented a relatively small number of patients – and noted a twofold increase in reduced survival among patients aged over 80 years.

“In the age category, it’s not surprising that patients were less likely to be treated, but it’s surprising the magnitude of this, so patients that were 90 years were ten times less likely to be treated than patients who were in their 50s,” Dr. Dowdy told the audience.

Commenting on the negative impact of Medicaid and Medicare insurance, Dr. Dowdy pointed out that the study predated the introduction of the Affordable Care Act, and it was too early to tell what impact that might have on the outcomes for those patients without private insurance.

However he also called for more research into the racial disparities in overall survival.

“If the problem is access, then we need to put money into education, and we need to maybe change the system so that it’s more accessible,” Dr. Dowdy said.

“If it’s a biology thing then we need to figure out what that is and figure out whether there are specific treatments that we should be using in these patients.”

The study was supported by the Mayo Clinic, and there were no conflicts of interest declared.

MELBOURNE – Residents of the mountain region of the United States are significantly less likely to receive postoperative treatment for advanced endometrial cancer, compared with residents of the Northeast or Midwest, according to an oral presentation made at the biennial meeting of the International Gynecologic Cancer Society.

Retrospective analysis of data from 228,511 patients registered in the National Cancer Data Base – 15.5% of whom were stage III or IV – showed that women living in the mountain region and the Midwest were also significantly more likely to be diagnosed with advanced stage disease than those living in the South (hazard ratio 1.29 and 1.27 respectively, P < .0001)

Researchers also found having Medicaid insurance significantly increased the likelihood of being diagnosed with stage III-IV endometrial cancer (HR 1.51, P < .0001) and decreased overall survival, compared with individuals with private insurance or in managed care (HR 0.85).

“The aim of this study was to estimate the contribution of race and ethnicity, socioeconomic factors such as education and income, as well as place of residence on eventual cancer outcome,” said Dr. Sean Dowdy, professor and chair of gynecologic surgery at the Mayo Clinic.

“Specifically we looked at three questions: one was the factors that are associated with advanced stage at diagnosis, stage III-IV; whether patients received postsurgical treatment when they had advanced disease; and also their overall survival,” Dr. Dowdy told the conference.

While the study initially found that African American women were significantly more likely to be diagnosed with advanced disease than white women, this difference was no longer statistically significant after adjusting for other factors, such as the fourfold higher incidence of serous cancer in African American women.

African American women also had a reduced overall survival, compared with white women, although the study did not find any significant impact of race on treatment rates or the likelihood of being treated at a high-volume facility.

“I expected African Americans to have worse access, and to be diagnosed with advanced-stage disease, and I thought that that would be the reason for their reduced survival, but we actually didn’t see that,” Dr. Dowdy said in an interview.

“The other possibility is, there is something unique about African Americans, about their tumors or about their host response, so maybe their immunological response or something like that may impact their survival.”

The study also observed reduced survival among patients treated at low-volume facilities – although this represented a relatively small number of patients – and noted a twofold increase in reduced survival among patients aged over 80 years.

“In the age category, it’s not surprising that patients were less likely to be treated, but it’s surprising the magnitude of this, so patients that were 90 years were ten times less likely to be treated than patients who were in their 50s,” Dr. Dowdy told the audience.

Commenting on the negative impact of Medicaid and Medicare insurance, Dr. Dowdy pointed out that the study predated the introduction of the Affordable Care Act, and it was too early to tell what impact that might have on the outcomes for those patients without private insurance.

However he also called for more research into the racial disparities in overall survival.

“If the problem is access, then we need to put money into education, and we need to maybe change the system so that it’s more accessible,” Dr. Dowdy said.

“If it’s a biology thing then we need to figure out what that is and figure out whether there are specific treatments that we should be using in these patients.”

The study was supported by the Mayo Clinic, and there were no conflicts of interest declared.

MELBOURNE – The combination of the antiangiogenesis drug bevacizumab and the vascular-disrupting agent fosbretabulin is superior to bevacizumab alone in the treatment of recurrent ovarian, tubal, and peritoneal cancer, according to an oral presentation made at the biennial meeting of the International Gynecologic Cancer Society.

A randomized, open-label, phase II study in 107 patients found a significant improvement in progression-free survival among patients treated with the combination of bevacizumab and fosbretabulin versus bevacizumab alone (hazard ratio, 0.685; P = .049), with a median improvement of 2.5 months.

Researchers observed a greater improvement in progression-free survival among patients with platinum-resistant disease, with a 3.3-month improvement (HR, 0.57; P = .01), but the difference in platinum-sensitive patients failed to reach statistical significance.

Patients in the combination arm also showed a higher response rate than those in the single-therapy arm.

Presenter Dr. Bradley Monk said the challenge with using antiangiogenesis agents alone was that they only dealt with new blood vessel growth.

“The Achilles’ heel of angiogenesis is, what about the blood vessels that are already there?” said Dr. Monk, director of gynecological oncology at the University of Arizona Cancer Center and Dignity Health, both in Phoenix.

Dr. Monk said antivascular agents such as fosbretabulin collapse the established tumor blood vessels, causing mechanistic obstructions that lead to tumor necrosis, and because of their tolerability, they can be combined with chemotherapy and antiangiogenesis agents.

While this approach has been considered before, not all vascular-disrupting agents were suitable.

“There are different types of vascular-disrupting agents. They’re not all the same, and, in fact, there are vascular-disrupting agents that have not worked,” Dr. Monk said in an interview.

He told the conference that fosbretabulin is a potent and reversible tubulin depolymerizing agent, targeting the tubulin cytoskeleton that is so important in tumor-associated blood vessels, which lack smooth muscle and pericyte coverage and rely on tubulin to maintain their structure.

The combination approach was associated with a significantly higher incidence of adverse events, compared with bevacizumab alone, and 16.7% of patients in the combination arm came off the study because of adverse events, compared with 5.7% of patients in the monotherapy arm.

There were more cases of grade 3 hypertension in the combination arm than in the monotherapy arm, which Dr. Monk said was a known side effect of fosbretabulin.

There was one grade 4 hypertension event in the combination arm, and one grade 4 metabolism-related adverse event in the bevacizumab-alone arm.

Data on overall survival were not mature, but Dr. Monk said that based on these results, the combination of fosbretabulin and bevacizumab warranted further study in ovarian cancer.

The study was sponsored by the National Cancer Institute. One author is an employee of fosbretabulin manufacturer Oxigene. The presenter declared expenses, consultancies, and research funding from several pharmaceutical companies, including Oxigene.

*Correction, 11/10/2014: A previous version of the headline did not clearly state that the improvement was in progression free survival.

MELBOURNE – The combination of the antiangiogenesis drug bevacizumab and the vascular-disrupting agent fosbretabulin is superior to bevacizumab alone in the treatment of recurrent ovarian, tubal, and peritoneal cancer, according to an oral presentation made at the biennial meeting of the International Gynecologic Cancer Society.

A randomized, open-label, phase II study in 107 patients found a significant improvement in progression-free survival among patients treated with the combination of bevacizumab and fosbretabulin versus bevacizumab alone (hazard ratio, 0.685; P = .049), with a median improvement of 2.5 months.

Researchers observed a greater improvement in progression-free survival among patients with platinum-resistant disease, with a 3.3-month improvement (HR, 0.57; P = .01), but the difference in platinum-sensitive patients failed to reach statistical significance.

Patients in the combination arm also showed a higher response rate than those in the single-therapy arm.

Presenter Dr. Bradley Monk said the challenge with using antiangiogenesis agents alone was that they only dealt with new blood vessel growth.

“The Achilles’ heel of angiogenesis is, what about the blood vessels that are already there?” said Dr. Monk, director of gynecological oncology at the University of Arizona Cancer Center and Dignity Health, both in Phoenix.

Dr. Monk said antivascular agents such as fosbretabulin collapse the established tumor blood vessels, causing mechanistic obstructions that lead to tumor necrosis, and because of their tolerability, they can be combined with chemotherapy and antiangiogenesis agents.

While this approach has been considered before, not all vascular-disrupting agents were suitable.

“There are different types of vascular-disrupting agents. They’re not all the same, and, in fact, there are vascular-disrupting agents that have not worked,” Dr. Monk said in an interview.

He told the conference that fosbretabulin is a potent and reversible tubulin depolymerizing agent, targeting the tubulin cytoskeleton that is so important in tumor-associated blood vessels, which lack smooth muscle and pericyte coverage and rely on tubulin to maintain their structure.

The combination approach was associated with a significantly higher incidence of adverse events, compared with bevacizumab alone, and 16.7% of patients in the combination arm came off the study because of adverse events, compared with 5.7% of patients in the monotherapy arm.

There were more cases of grade 3 hypertension in the combination arm than in the monotherapy arm, which Dr. Monk said was a known side effect of fosbretabulin.

There was one grade 4 hypertension event in the combination arm, and one grade 4 metabolism-related adverse event in the bevacizumab-alone arm.

Data on overall survival were not mature, but Dr. Monk said that based on these results, the combination of fosbretabulin and bevacizumab warranted further study in ovarian cancer.

The study was sponsored by the National Cancer Institute. One author is an employee of fosbretabulin manufacturer Oxigene. The presenter declared expenses, consultancies, and research funding from several pharmaceutical companies, including Oxigene.

*Correction, 11/10/2014: A previous version of the headline did not clearly state that the improvement was in progression free survival.

MELBOURNE – The combination of the antiangiogenesis drug bevacizumab and the vascular-disrupting agent fosbretabulin is superior to bevacizumab alone in the treatment of recurrent ovarian, tubal, and peritoneal cancer, according to an oral presentation made at the biennial meeting of the International Gynecologic Cancer Society.

A randomized, open-label, phase II study in 107 patients found a significant improvement in progression-free survival among patients treated with the combination of bevacizumab and fosbretabulin versus bevacizumab alone (hazard ratio, 0.685; P = .049), with a median improvement of 2.5 months.

Researchers observed a greater improvement in progression-free survival among patients with platinum-resistant disease, with a 3.3-month improvement (HR, 0.57; P = .01), but the difference in platinum-sensitive patients failed to reach statistical significance.

Patients in the combination arm also showed a higher response rate than those in the single-therapy arm.

Presenter Dr. Bradley Monk said the challenge with using antiangiogenesis agents alone was that they only dealt with new blood vessel growth.

“The Achilles’ heel of angiogenesis is, what about the blood vessels that are already there?” said Dr. Monk, director of gynecological oncology at the University of Arizona Cancer Center and Dignity Health, both in Phoenix.

Dr. Monk said antivascular agents such as fosbretabulin collapse the established tumor blood vessels, causing mechanistic obstructions that lead to tumor necrosis, and because of their tolerability, they can be combined with chemotherapy and antiangiogenesis agents.

While this approach has been considered before, not all vascular-disrupting agents were suitable.

“There are different types of vascular-disrupting agents. They’re not all the same, and, in fact, there are vascular-disrupting agents that have not worked,” Dr. Monk said in an interview.

He told the conference that fosbretabulin is a potent and reversible tubulin depolymerizing agent, targeting the tubulin cytoskeleton that is so important in tumor-associated blood vessels, which lack smooth muscle and pericyte coverage and rely on tubulin to maintain their structure.

The combination approach was associated with a significantly higher incidence of adverse events, compared with bevacizumab alone, and 16.7% of patients in the combination arm came off the study because of adverse events, compared with 5.7% of patients in the monotherapy arm.

There were more cases of grade 3 hypertension in the combination arm than in the monotherapy arm, which Dr. Monk said was a known side effect of fosbretabulin.

There was one grade 4 hypertension event in the combination arm, and one grade 4 metabolism-related adverse event in the bevacizumab-alone arm.

Data on overall survival were not mature, but Dr. Monk said that based on these results, the combination of fosbretabulin and bevacizumab warranted further study in ovarian cancer.

The study was sponsored by the National Cancer Institute. One author is an employee of fosbretabulin manufacturer Oxigene. The presenter declared expenses, consultancies, and research funding from several pharmaceutical companies, including Oxigene.

*Correction, 11/10/2014: A previous version of the headline did not clearly state that the improvement was in progression free survival.