Gynecologic oncology
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Gynecologic oncology · Sep 2011
ReviewAdjuvant treatment for stage IIIC endometrial cancer: options and controversies.
Endometrial cancer is the most common gynecologic malignancy. Locally advanced and high risk endometrial cancer encompasses a heterogeneous group of patients and optimal treatment for various sub-groups of these patients remains controversial. ⋯ Areas of controversy are also discussed to assist clinicians in identifying the most effective adjuvant treatment regimens for patients with locally advanced disease. On-going randomized trials are briefly discussed.
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Most collaborative studies for the treatment of primary and recurrent ovarian cancer have grouped all epithelial ovarian cancers together, leading to a common therapeutic approach to all the different subtypes. Emerging data, however, support the hypothesis that primary mucinous ovarian cancers are unique histologically, molecularly, and clinically from other epithelial subtypes. The objective of our review was to identify and synthesize the most current information on mucinous ovarian carcinoma with regard to pathologic, molecular, and clinical distinctions. ⋯ Primary mucinous ovarian cancer should be considered separate from the other epithelial ovarian cancers. Ongoing clinical trials in this disease will likely offer improvements in chemotherapeutic agents used to treat women with primary and recurrent mucinous ovarian cancer.
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Gynecologic oncology · May 2010
ReviewGlobal implementation of human papillomavirus (HPV) vaccine: lessons from hepatitis B vaccine.
Development of safe and effective vaccines against human papillomavirus (HPV)-the second vaccine against a major human cancer-is one of the most important medical and public health achievements of this century. As with all new vaccines, HPV is currently expensive and this cost precludes its use in the developing world, which has the greatest burden of disease from HPV-related cancers. Hepatitis B (HB) virus vaccine, which prevents chronic HB infection and related cirrhosis and liver cancer, has been successfully introduced as a routine vaccine for children in 89% of countries, including the poorest. ⋯ Global funding support will be needed to make control a reality for the poorest countries, and the program to accomplish this, the Global Alliance for Vaccines and Immunization (GAVI), has already expressed great interest in including HPV vaccine. For this to occur, the manufacturers will need to dramatically reduce the vaccine price for the poorest developing countries, and tier prices for wealthier developing countries not eligible for GAVI support. Countries will need to decide on the priority of HPV control in the context of other important new vaccines against pneumococcal pneumonia and rotavirus diarrhea.
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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.