Judy Knapp, Ph.D., MSW, gynecologic social worker at the University of Pittsburgh Cancer Institute and EyesOnThePrize.org board member, summarizes important research findings in gynecologic oncology.
The risk of recurrent or persistent uterine cancer for women with advanced disease is high. For this reason, the search for beneficial treatment approaches remains a priority in clinical research. In a recent issue of the journal Gynecologic Oncology, Dr. Maurie Markman and Dr. Jeffrey Fowler provide three case reports of women who received weekly infusions of low-dose Taxol after several other chemotherapy and/or radiation therapy regimens had failed to stop the progression of their disease. For these women, weekly Taxol treatments brought about improvement in both subjective symptoms and biological markers of cancer activity, i.e. CA-125 levels. Tumor response in these patients lasted for several months and afforded them satisfactory quality of life.
Because this regimen is well-tolerated and less likely to produce significant side effects than most others, it may be a good choice for women who have diminished functional status due to previous therapy and/or disease status. The authors call for a Phase 2 clinical trial of weekly, low-dose Taxol therapy to more carefully evaluate its effects, both positive and negative. Additionally, they suggest that this might be a reasonable way of treating women with recurrent uterine cancer outside of a clinical research study.
An abstract of this paper is available online without cost at http:/www.sciencedirect.com as a guest user. Full text can be found in the January 2004 issue of Gynecologic Oncology, pages 180-182.
Using HPV testing in addition to routine pap smear to diagnose pre-malignant changes in cervical cells
Ongoing investigations into the relationship between certain strains of human papillomavirus and cervical cancer have estimated that HPV is probably a causal factor in over 90% of cases. A review of several large screening studies on this topic appeared in Archives of Pathology and Laboratory Medicine in August of 2003. This review was conducted by Attila Lorincz, PhD, a scientist from Digene Corporation which developed the DNA test for HPV, and Richard Richart, MD, a physician from Columbia University. These investigators looked at 12 international and domestic studies ranging in sample size from 1,365 to nearly 21,000 women.
Statistical analyses of data from these studies indicated that DNA testing for presence and type of HPV is a better indicator of cervical intraepitheal neoplasia 3 (CIN 3) than is any form of Pap smear currently available. CIN 3 is the grade of change in the cervical cells that is most likely to become malignant. For this reason, accurate diagnosis of this condition is of utmost importance in efforts to identify women who need medical intervention to potentially prevent cervical cancer. Using both Pap smear and HPV testing produced almost 100% sensitivity, meaning that nearly every woman who tested positive for CIN 3 actually had the condition. The authors conclude that the dual approach to diagnosis will support effective identification and management of these women, as well as those who have developed overt malignancy of the cervix.
The full study report can be located online on the ARPA Web site http://arpa.allenpress.com/arpaonline/?request=index-html .