Gynecologic oncology
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Gynecologic oncology · Mar 2010
The prophylactic conversion to an extended infusion schedule and use of premedication to prevent hypersensitivity reactions in ovarian cancer patients during carboplatin retreatment.
Repeated exposure to carboplatin can lead to hypersensitivity reactions during retreatment with carboplatin. This may prevent its further use in platinum-sensitive ovarian cancer patients. At our institution, an increasing proportion of patients are prophylactically converted to an extended schedule of infusion after 8 cycles of carboplatin. We sought to determine whether an incrementally increasing, extended 3-hour infusion of carboplatin with appropriate premedication was associated with a lower rate of hypersensitivity reactions compared to the standard 30-minute schedule in sequentially treated patients. ⋯ Our data suggest appropriate premedication and prophylactic conversion to an extended infusion during carboplatin retreatment may reduce hypersensitivity reactions.
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The vast number of novel targeted therapies available for testing in the United States dictates that a more efficient system aimed at identifying promising agents for phase III testing needs to be developed. Alternatives to traditional phase II trial design including alternative end points, randomized designs, biomarkers, and imaging tools are discussed. ⋯ Alternatives to traditional phase II trial design including alternative end points, randomized designs, biomarkers, and imaging tools should allow ineffective agents to be discarded and promising agents to undergo further investigation.
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Gynecologic oncology · Feb 2010
ReviewNIH and NCI support for development of novel therapeutics in gynecologic cancer: a user's guide.
The development of novel therapeutics is a lengthy and often tortuous process. It frequently spans the identification of new targets, preclinical validation, discovery and refinement of novel therapies, safety studies, phase O, 1, 2, and 3 trials, and reverse translation. NIH and NCI provide via web sites a variety of resources and research tools of great value to investigators. ⋯ The NCI's effective partnership with industry and academia, as well as the ongoing NCI-supported clinical trials network, facilitates clinical development of novel therapeutics. Specialized NCI programs focused on cancer imaging, radiation research, and complementary and alternative medicine, also assist the development of novel agents. Finally, the NIH and the NCI sponsor a variety of grant mechanisms, supporting institutions, consortia, and individuals, which investigators seeking to develop novel therapeutics should make themselves familiar.
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Adenocarcinoma of the cervix constitutes only approximately 20% of all cervical carcinomas; therefore, specific Level 1 evidence to guide patient management is lacking. Most trials have included this histologic subtype but in insufficient numbers to do more than generate hypotheses from subset analyses. ⋯ The purpose of this review was to give an overview of the current knowledge on adenocarcinoma of the cervix and its differences from squamous cell carcinoma with regard to risk factors, prognosis, survival rates, patterns of recurrence, and response to treatment. This article will focus on possible specific therapeutic directions to explore in the management of locally advanced adenocarcinomas.
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Gynecologic oncology · Dec 2009
HPV vaccination against cervical cancer in women above 25 years of age: key considerations and current perspectives.
Vaccination of young women (15-25 years of age) against human papillomavirus (HPV) has been shown to be very efficacious in preventing the development of moderate or severe cervical precancerous lesions associated with HPV-16 or -18. As the highest rates of new infections with high-risk (i.e., oncogenic) HPV types occur in the first years following sexual debut, most existing guidelines and recommendations advise on vaccinating young girls. We consider oncogenic HPV infection and the risk of developing cervical cancer in women over 25 years of age and whether they would also benefit from vaccination against HPV. ⋯ The priority of routine vaccination programmes must be to target girls and young women, with catch-up programmes that extend to age 25/26 when resources allow. For sexually active women over the age of 25, HPV vaccination can be considered on an individual basis, as most will have the potential to benefit from vaccination.