Gynecology & obstetrics (Sunnyvale, Calif.)最新文献

{"title":"To PARPI or Not to PARPI BRCA Mutated Ovarian Cancer Following First-line Chemotherapy, That is the Question?","authors":"Peter G Rose, Laura M Chambers, Michelle Kuznicki","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":89928,"journal":{"name":"Gynecology & obstetrics (Sunnyvale, Calif.)","volume":"11 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c1/7c/nihms-1744220.PMC8681040.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39616381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Overtreatment and Cost Effectiveness of Primary <i>versus</i> Secondary Maintenance Therapy with Poly-Adenosine Ribose Phosphate Inhibitors (PARPi) for Epithelial Ovarian Cancer (EOC).","authors":"Peter G Rose,&nbsp;Meng Yao,&nbsp;Laura M Chambers,&nbsp;Lin Mei,&nbsp;Phuc Le","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>No data exist to suggest PARP inhibitor (PARPi) therapy as first-line maintenance is superior to PARPi therapy as second-line maintenance.</p><p><strong>Objective: </strong>To determine the efficacy and cost of primary versus secondary olaparib or niraparib maintenance in Epithelial Ovarian Cancer (EOC).</p><p><strong>Methods: </strong>A retrospective cohort study was performed in women with EOC to determine the survival following primary or secondary PARPi maintenance. We modeled the costs of olaparib and niraparib based on previously published costs and duration of therapy based on the Solo 1/Solo 2 and Prima and Nova trials, respectively.</p><p><strong>Results: </strong>Among 40 patients treated with PARPi as primary or secondary maintenance there was no difference in overall survival (p=0.97). Among 166 women with stage III/IV germ-line BRCA mutated EOC, 28.8% were disease free for >3 years (18.6% never recurred and 10.2% recurred >3 years after chemotherapy). Since 29% of the BRCA mutated patients did not recur within 3 years, primary olaparib maintenance therapy was significantly more expensive than secondary olaparib maintenance therapy by 260%. Primary niraparib maintenance therapy was slightly more expensive than secondary niraparib maintenance therapy by 4%, 51%, and 15% for BRCA mutated, HR deficient, and HR proficient patients, respectively. By eliminating the overtreatment of patients with primary PARPi therapy, the cost savings for 100 women with EOC with BRCA mutations would be $37,335,360 for olaparib and $8,197,592 for niraparib.</p><p><strong>Conclusion: </strong>Up to 29% of BRCA mutated patients may be overtreated with primary PARPi maintenance with significantly increased treatment costs.</p>","PeriodicalId":89928,"journal":{"name":"Gynecology & obstetrics (Sunnyvale, Calif.)","volume":"11 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8681231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39616383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chemotherapy for Elderly Ovarian Cancer Patients","authors":"Sivraj Muralikrishnan, C. Hatzis, A. Katz, A. Santin, P. Schwartz, M. Abu-Khalaf","doi":"10.4172/2161-0932.1000397","DOIUrl":"https://doi.org/10.4172/2161-0932.1000397","url":null,"abstract":"Objective Ovarian cancer is the most lethal cancer involving the female pelvic reproductive system. Its incidence increases with age and with an aging population, its prevalence should also increase. The goal of our retrospective study is to report our experience in treating women over 65 years of age, with a diagnosis of primary ovarian cancer, using standard intravenous chemotherapy. Methods The medical records of 78 patients>65 years of age diagnosed with primary ovarian cancer at the Yale Cancer Center between 1996–2006 were retrospectively reviewed and included in our analysis. Patients had stage I–IV disease (stage I n=5, stage II n=8, stage III n=36, stage IV n=25, unknown n=4). Results Sixty-three of 78 women (80.8%) completed the prescribed regimen; and 62 women did not require a dose reduction or chemotherapy discontinuation. The most common reason for a dose reduction or treatment discontinuation was fatigue (6.4%), neutropenia (2.6%), patient preference (2.6%), and multiple co-morbidities (2.6%). The most commonly used regimen was paclitaxel 175mg/m2 and carboplatin AUC 5. The hazard ratio for PFS and OS for patients who had dose reduction/discontinuation versus those who completed the prescribed dose was 1.3 (95% CI 0.51–3.26) and 0.63 (95% CI 0.17–2.33), respectively. Conclusions Our findings illustrate that elderly women are able to tolerate standard chemotherapy with relatively few significant adverse effects. While different treatment modalities in ovarian cancer are continually being evaluated, additional prospective studies are required to better understand the tolerability and efficacy of such treatment in the elderly population.","PeriodicalId":89928,"journal":{"name":"Gynecology & obstetrics (Sunnyvale, Calif.)","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85241443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exosomes in Plasma of Patients with Ovarian Carcinoma: Potential Biomarkers of Tumor Progression and Response to Therapy.","authors":"Marta Szajnik,&nbsp;Magdalena Derbis,&nbsp;Michal Lach,&nbsp;Paulina Patalas,&nbsp;Marcin Michalak,&nbsp;Hanna Drzewiecka,&nbsp;Dariusz Szpurek,&nbsp;Andrzej Nowakowski,&nbsp;Marek Spaczynski,&nbsp;Włodzimierz Baranowski,&nbsp;Theresa L Whiteside","doi":"10.4172/2161-0932.S4-003","DOIUrl":"https://doi.org/10.4172/2161-0932.S4-003","url":null,"abstract":"<p><strong>Background: </strong>In patients with Ovarian Cancer (OvCa) exosomes released by tumor cells are present in the plasma and could be involved in tumor progression. This study examines the association between the exosome presence/protein content in plasma of OvCa patients and disease outcome, response to standard therapy and/or tumorresistance to therapies in patients studied at diagnosis and also serially during and after therapy.</p><p><strong>Design and methods: </strong>Exosomes were purified from OvCa patients' plasma (n=22), patients with benign tumors (n=10) or (n=10) healthy controls (NC) using ultracentrifugation. Exosomes were visualized by scanning electron microscopy. Their protein content was measured. The presence of MAGE 3/6 and TGF-β1 in exosomes was evaluated in Western blots.</p><p><strong>Results: </strong>The OvCa patients' plasma contained higher levels of exosomal proteins (p<0.05) compared to those isolated from plasma of patients with benign tumors or NC. Exosomes isolated from OvCa patients's plasma carried TGF-β1 and MAGE3/6, which distinguished OvCa patients from those with benign tumors and NC. High protein levels of exosomes were seen in newly diagnosed patients; however in advanced stages of OvCa patients the protein content of isolated exosomes was significantly higher than that of early stages. The exosome levels variably changed during/after chemotherapy, and correlations between the changes in exosomal protein levels and clinical data suggested that the protein content of exosomes might be useful in predicting responses to therapy and prognosis in OvCa patients.</p><p><strong>Conclusion: </strong>Analysis of plasma exosomes levels offers a novel approach to diagnosis and monitoring response to therapies in OvCa patients.</p>","PeriodicalId":89928,"journal":{"name":"Gynecology & obstetrics (Sunnyvale, Calif.)","volume":"Suppl 4 ","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2013-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899646/pdf/nihms-538823.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32065556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal Hypothyroidism and Pregnancy Loss: Awaiting Firm Recommendations on Testing and Treatment.","authors":"Jennifer Lovegreen,&nbsp;Danny J Schust","doi":"10.4172/2161-0932.1000142","DOIUrl":"https://doi.org/10.4172/2161-0932.1000142","url":null,"abstract":"Since up to 75% of fertilized ova and at least 15% of clinicallyrecognized pregnancies do not survive to birth, spontaneous loss is the most common complication of human pregnancy. The majority of pregnancy losses occur prior to clinical detection. Set against this startlingly high background, spontaneous loss of two pregnancies occurs in approximately 1% of pregnancies and loss of three or more pregnancies in 1 in 300 couples. Although isolated fetal aneuploidy is certainly etiologic in many pre-clinical and clinical losses, other causes have been suggested. In the last 15 years, there has been an increasing interest in the role of thyroid dysfunction and in thyroid autoimmunity in patients with pregnancy wastage and many clinicians have instituted thyroid-related testing and treatment protocols based on this growing body of literature. It is important to re-examine the evidence for these interventions and to consider risk: benefit balances in acting on the existing literature. The physiologic and metabolic demands of pregnancy require increased production of thyroid hormone from the maternal gland and the positive linear relationship reported between maternal TSH levels and pregnancy loss [1] suggests that inadequate response to these demands may be problematic. It might follow that thyroid hormone supplementation for those women who may suffer adverse alterations in thyroid function during pregnancy may help to avert pregnancy loss. Several questions immediately arise, including: 1) Which women should be screened and 2) At what TSH levels should supplementation be recommended. This topic was systematically reviewed within the past 12 months and the meta-analysis presented indicated that use of levothyroxine to treat clinical hypothyroidism significantly decreased pregnancy loss rates (RR: 0.19; CI: 0.08-0.39) [2]. The same study could not definitively determine whether treatment of subclinical hypothyroidism improves pregnancy maintenance [2]. Note that the investigators in this study collected well over 7000 relevant articles for consideration but only 11 could be included in their meta-analysis. Like much of the other literature in the pregnancy loss field, there is a dearth of well-designed investigations on this topic. The same Dutch group published another meta-analysis about a year prior that addressed the effects of subclinical hypothyroidism on pregnancy maintenance and found a positive association with perinatal mortality (OR 2.7; 95% CI: 1.6-4.7) [3]. They also extended this investigation to include an assessment of the effects of thyroid auto antibodies on adverse pregnancy outcomes and found a positive relationship between the presence of anti-Thyroglobulin (anti-TG) and anti-Thyroidperoxidase (anti-TPO) antibodies and isolated (OR 3.7; 95% CI: 1.8-7.6) and recurrent (OR 2.3; 95% CI: 1.5-3.5) pregnancy loss [3]. This latter study did not address treatment paradigms, but again only a very small proportion of the existing literature ","PeriodicalId":89928,"journal":{"name":"Gynecology & obstetrics (Sunnyvale, Calif.)","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825520/pdf/nihms455479.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31868568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-examining Sonographic Cut-off Values for Diagnosing Early Pregnancy Loss.","authors":"Jennifer Bickhaus,&nbsp;Erin Perry,&nbsp;Danny J Schust","doi":"10.4172/2161-0932.1000141","DOIUrl":"https://doi.org/10.4172/2161-0932.1000141","url":null,"abstract":"Early pregnancy loss is the most common complication of human pregnancy [1]. Such commonality requires dependable evaluation tools and informed, standardized criteria for accurate diagnosis. A brief perusal of the data on which most of the practitioners who treat women who are newly pregnant have based their recommendations for the sonographic diagnosis of a non-viable pregnancy raises significant concern since most of these data are based on relatively small patient numbers [2–5]. Further, recent studies have shown that the measurements used to determine historically-accepted criteria have fairly wide patient-to-patient, hyphenate intra-observer and interobserver variability [6]. This makes the inclusion of investigations based upon small patient numbers even more problematic. This unfortunate combination poses an important problem because the diagnosis of failed pregnancy has immense implications to the physical health of the mother and to the emotional well-being of the mother, her partner, her family and her close friends. The criteria for diagnosing a non-viable pregnancy must have a specificity that is as close to 100% as possible. Still, using commonly accepted historical sonographic criteria, authors have shown that between 1 in 100 and 4 in 100 viable pregnancies might be erroneously deemed non-viable [7,8]. If these incorrect diagnoses lead to immediate interventions, some pregnancies will be inadvertently terminated. Such outcomes are unacceptable. There should be near zero tolerance for misdiagnosis. Increased awareness of this too common problem has led to efforts to improve our diagnostic accuracy and has required a stringent re-evaluation of historical diagnostic criteria using investigations that include much larger study populations that have been evaluated using the most sensitive, commonly-available diagnostic modalities. In this case, the most sensitive ultrasonographic technique available for diagnosing an early, non-viable pregnancy is transvaginal sonography.","PeriodicalId":89928,"journal":{"name":"Gynecology & obstetrics (Sunnyvale, Calif.)","volume":"3 1","pages":"141"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102315/pdf/nihms455472.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32520876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular Strategies of Deoxynucleotide Triphosphate Supply Inhibition Used in the Treatment of Gynecologic Malignancies.","authors":"Charles A Kunos,&nbsp;Tomas Radivoyevitch","doi":"10.4172/2161-0932.s4-001","DOIUrl":"https://doi.org/10.4172/2161-0932.s4-001","url":null,"abstract":"<p><p>Chemotherapies targeting deoxynucleotide triphosphate synthesis are of high medical interest in the treatment of gynecologic malignancies. In this article, we focus on targeted inhibitors of ribonucleotide reductase, an enzyme in charge of ribonucleotide reduction to their corresponding deoxyribonucleotide to be used as the building blocks of DNA. We also discuss human clinical trials have utilized ribonucleotide reductase subunit-specific inhibitors, particularly trials for women with cervical cancer.</p>","PeriodicalId":89928,"journal":{"name":"Gynecology & obstetrics (Sunnyvale, Calif.)","volume":"Suppl 4 ","pages":"001"},"PeriodicalIF":0.0,"publicationDate":"2011-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226428/pdf/nihms484285.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32811624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}