Teal Journal

Letter from the CEO

teal_admin — Tue, 04 Oct 2011 15:24:58 +0000

September is National Ovarian Cancer Awareness Month, a time of year that brings this disease to the attention of many Americans who might otherwise not know about ovarian cancer. Women and men learning about ovarian cancer for the first time often ask similar questions: Am I at risk? What can I do to prevent this disease? Isn’t there some screening test that would help women be diagnosed earlier?This issue of The Teal Journal answers many of those questions. We’ve compiled the latest information from several screening studies, as well as information about new tests that may help doctors diagnosis women. Dr. Michael Seiden of Fox Chase Cancer Center joined us to talk about prevention—whether a woman has average or elevated risk. The Affordable Care Act requires insurance companies to cover women’s preventive health services without co-pays; as our Report from Capitol Hill notes, the covered services are a mixed bag for women at high risk of developing ovarian cancer.September also brings questions about what is new and exciting in ovarian cancer research. Many experts agree that genetics are one of the most promising areas in modern oncology. In this issue, we highlight one scientist working in the field of genetics. Dr. R. Stephanie Huang is using data from the Cancer Genome Atlas to explore how a woman’s genetic makeup and the genes found in her tumors could pinpoint the most effective therapies for her ovarian cancer.As always, we welcome your comments and suggestions. Email us at editor@ovariancancer.org or post your question on The Teal Journal Facebook page.Sincerely yours, Karen Orloff Kaplan, MSW, MPH, ScD Chief Executive Officer, Ovarian Cancer National Alliance

Lab Tour: How Genetics Could Transform Ovarian Cancer Treatment

teal_admin — Tue, 04 Oct 2011 15:21:40 +0000

Dr. R. Stephanie Huang University of Chicago Department of MedicineAs a pharmacist, Dr. R. Stephanie Huang’s main concern is how drugs affect patients. Currently, Dr. Huang is exploring how genetics determine why some people respond to certain types of chemotherapy while others do not. For example, one-quarter of women with ovarian cancer develop a platinum resistant cancer. The reason that some people, or some tumors, are resistant to platinum therapies may have its roots in genetics. This area of personalized medicine is expanding as genetic sequencing technology becomes faster and cheaper.When studying the effect of genetics on anti-cancer treatments, two types of genetic variations need to be considered. The first, germline variations, encompass a person’s genetic code including any heritable mutations. The second, somatic variations, are mutations that are not heritable, such as genetic changes caused by exposure to chemicals. Dr. Huang’s research is focusing on the germline genetic variations, since these may predispose an individual to various treatment-related toxicities. Furthermore, since all cancer cells derive from normal cells, certain germline variations could be linked to both the likelihood of developing ovarian cancer and response to treatments.“One challenge is to differentiate between what we know and what we can do about it. I’m working to make genetics useful in terms of making fully informed decision about what works for each patient,” says Dr. Huang.Dr. Huang recently published a paper looking for differences among individuals in their normal DNA code, known as germline genetic variations, that predicted platinum sensitivity in women with ovarian cancer. To do this, she utilized hundreds of cell lines (specific cells bred in a laboratory and able to duplicate indefinitely so that they can be used for research purposes) evaluated by the International HapMap Consortium. This international collaboration is aimed at obtaining all common genetic variations in the world’s human populations and making them publicly available for research. Each of the cell lines is derived from an individual’s blood; information about their ethnicity is captured as well. The cell lines were treated in her lab with various chemotherapeutic agents to determine each individual’s sensitivity to drugs. Dr. Huang then did genetic analyses between each person’s genomic code and his or her sensitivity to the drug. Her goal was to identify germline genetic variations that could be used to predict chemotherapy response. These cell-based findings were then evaluated in 400 women with ovarian cancer who had undergone the related drug treatment. She found that there may be some genetic variations that affect overall survival, progression free survival or response to chemotherapy. Unfortunately, the data was not able to be validated in a larger scale analysis, but leaves the door open for continued research.The Huang lab is also examining the differences in germline variations and somatic mutations to see which of those are cancer-related. To do so, Dr. Huang and her collaborators are utilizing data from the Cancer Genome Atlas (TCGA).TCGA is a multi-year, multi-cancer study funded by the National Cancer Institute to understand the genetics of certain cancers, including ovarian. Preliminary ovarian cancer results were released earlier this year, showing that there are multiple genetic mutations in each case of ovarian cancer, and that each tumor may contain a unique combination of mutations. This poses a significant challenge for individualized ovarian cancer management.Dr. Huang is working with a team to use TCGA’s information in her research. She is looking at the difference between a person’s genetic code and that of their tumor to establish links between germline genetic variation and somatic mutations in the tumor. Then she can determine genome markers. For example, we know that germline mutations in the BRCA mutations increase a woman’s risk for breast and ovarian cancer. Those women are also more responsive to certain drugs, like PARP inhibitors.There may be other genetic markers that will help providers understand a woman’s sensitivity to drugs. In the future, each woman may receive a personalized cocktail of drugs intended to target her tumor’s specific mix of genetic mutations. Researchers like Dr. Huang are trying to determine which genetic variations respond best to a particular treatment.In order to validate any treatment protocols, researchers would need to find the exact genetic variation as well as understand the patient’s overall genetic makeup. Then researchers would collect the patient’s blood, establish cell lines and link the patient’s treatment, outcome, genetics and tumor genetics to determine which treatments will work best. Currently, Dr. Huang is doing this for toxicity to chemotherapy in head, neck and ovarian tumors, and is seeing some patterns.“The technology in genomic sequencing is fairly mature, but it’s going to get faster and cheaper,” says Dr. Huang. “We will soon have the ability to look at every individual’s genome. Our challenge is to translate scientific discovery into implementation, which takes a lot of data, and a lot of patient participation.” As this field evolves, so might treatment options for women with ovarian cancer.

Ovarian Cancer Tests and Screening: An Overview

teal_admin — Tue, 04 Oct 2011 15:20:39 +0000

When people hear how deadly ovarian cancer is, they are often shocked and want to take action. Some begin to urge that all women be screened annually for ovarian cancer. While these statements may be made with the best of intentions, we do not currently have the tools to screen average risk women for this disease.Following is an overview of the latest studies and data on ovarian cancer screening. ScreeningScreening refers to testing the general population, or at least those who appear well, for a disease or condition. This type of screening does not take into account risk factors or exposure to pathogens. Early detection is also frequently included in the common use of the word screening. Surveillance or selective screening is a way of singling out a sub-population to test or watch for a specific disease. Often, women at high risk of developing ovarian cancer will take part in selective screening or be monitored by their health care provider.In order to be effective at a population level, a screening test needs to identify a disease correctly. In the case of ovarian cancer, false positives can lead to complications from unnecessary surgery, while false negatives could allow the disease to spread before it is correctly identified.There are no known screening tests for ovarian cancer, however three trials are using currently available tests to try to develop a method for screening women. Conclusions based on the results of major studies vary significantly. United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)This trial, currently underway in the United Kingdom, is examining the impact of screening for ovarian cancer on mortality. More than 200,000 women are enrolled in the study. Of those women, 50,000 will receive an annual CA-125 blood test and 50,000 will receive a transvaginal ultrasound. The other 100,000 women are the control group—they will get the standard of care, which means no screening. Women from the experimental arm who have an abnormal result will be tested further with ultrasound and blood tests. If those tests are abnormal the woman will be referred to a gynecologic oncologist. The trial will continue gathering data through at least 2014. United States arm of UKCTOCSA small-scale screening study was presented at the 2010 meeting of the American Society of Clinical Oncology (ASCO), which lent support to the development of a screening method for ovarian cancer. The study, authored by Dr. Karen Lu of MD Anderson Cancer Center, followed more than 3,000 women for eight years, measuring their CA-125 levels annually. These women were aged 50 to 74, and had an average risk of developing ovarian cancer. Those women whose CA-125 levels were rising over a number of years were given an ultrasound, and if the ultrasound showed positive results (i.e., presence of a tumor), underwent surgery. Of the 3,328 women, 85 had an ultrasound and eight had surgery. The surgeries led to diagnosing five ovarian cancers—three invasive and two borderline—all in early stage (1-2). Two patients had benign ovarian tumors and a third had an endometrial cancer. Two women with borderline ovarian cancer were diagnosed through other methods.This study shows that monitoring CA-125 levels over time in women of average risk for ovarian cancer is feasible and requires no more than three operations for each case of cancer diagnosed. The US arm is a small study; we await the results of the large scale UKCTOCS study to provide more definitive information. However, these results contradict the results of the PLCO study described below. Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO)Results of this large screening trial were presented at the 2011 ASCO meeting. More than 78,000 women were randomized between normal care and screening arms. Women in the screening arm were given an annual CA-125 test for six years and a transvaginal ultrasound for four years. The study was designed to show the effect of screening on overall survival by following patients for 13 years. The study showed that women in the screening arm of the study were more likely to be diagnosed, but were also more likely to die of ovarian cancer. Additionally, more than 3,000 women had surgery based on false positive results, leading to more than 160 women with serious complications. Screening with this particular protocol did not reduce ovarian cancer mortality. Diagnosis/ReferralIn addition to the tests we already have, two new tools have been developed to help triage and diagnose women who may have ovarian cancer.The first tool, Ova1, is an FDA-cleared test to help determine if a woman’s pelvic mass is malignant or benign. This blood test evaluates five biomarkers and will tell a physician if the mass is likely to be malignant. If it is, the woman should be referred to a gynecologic oncologist for surgery. A test that accurately predicts whether a pelvic mass is malignant could help doctors determine whether to operate on a woman, since all surgery carries the risk of complications.Another new test is the HE4 blood marker, which is FDA-approved to monitor recurrence in women with ovarian cancer. The FDA recently approved the use of the CA-125 with the HE4 blood test to determine the likelihood that a pelvic mass is malignant. Three-quarters of women with ovarian cancer will experience a recurrence of the disease, which makes ongoing monitoring an important issue.SymptomsAlthough there is no early detection test for ovarian cancer, women with the disease do experience symptoms: bloating; pelvic or abdominal pain; difficulty eating or feeling full quickly; and urinary frequency or urgency. Data show that women with ovarian cancer experience these symptoms more often than the general population.To help women track the four relevant symptoms, the Ovarian Cancer National Alliance will release an interactive symptom diary app this fall. The app can be used on a smartphone or computer to learn about risk factors associated with ovarian cancer and track symptoms. Women without a smartphone can download a print version of the symptom diary at www.ovariancancer.org/diary. Both the app and printable diary are available free of charge on the Alliance website.

Ask the Expert: Discussing Diet, Exercise and Risk

teal_admin — Tue, 04 Oct 2011 15:19:05 +0000

Michael Seiden, MD, PhD President & CEO Fox Chase Cancer Center, Ovarian Cancer National Alliance Scientific and Medical Advisory BoardQ: How do I know if I am at high risk for developing ovarian cancer? There are three basic groups of risk stratification: - High risk - Moderate risk - Normal riskPeople who are in the high risk category are those who were born with a BRCA1 or BRCA2 mutations. A BRCA1 mutation increases your lifetime chances of developing ovarian cancer to 40 – 50 percent, compared to a 1.5 percent chance in the general population. A BRCA2 mutation increases that lifetime risk to 25 – 30 percent.There also is a group of women who have a lifetime risk around two or three percent—still an increased risk, but a moderate one. Those women may have a high body mass index, a personal history of breast cancer, a family history of breast cancer (without a BRCA mutation) or Lynch syndrome. Other modest risk factors include never having children or using talcum powder in the genital area.If you know you’re at high risk or are worried about ovarian cancer, there is good evidence that using birth control pills reduces your risk of ovarian cancer. Learn more about risk factors associated with ovarian cancer. Q: If my risk of developing ovarian cancer is higher than average, should I be screened for the disease? Are there any new screening tools, like biomarkers, that will help detect ovarian cancer in the early stages?Even for women at markedly elevated risk, the data suggests that there is no adequate screening protocol. Anecdotally, there are some women in trials who are at high risk and keep their ovaries. These women have been followed closely with the tools we have (ultrasounds, CA-125 blood tests and pelvic exams). Even under very careful surveillance, as expected some of these high risk women have developed ovarian cancer with many presenting in late stage (IIIC), not unlike women in the general population who are not screened. Also, the recent NCI-sponsored PLCO trial demonstrated that yearly CA-125 with pelvic ultrasound did not reduce the incidence or death rate associated with ovarian cancer. What this means is that we just don’t have very good screening tools for ovarian cancer at the current time.Although pelvic exams and ultrasounds are not good screening tools, in slender women we can feel the ovaries, which is one more benefit of having a body mass index in the normal range. Recent research looked at the blood samples of women one year before they were diagnosed with ovarian cancer. These women had normal CA-125 levels at that time. The researchers looked at a number of other biomarkers in the blood of these women, and with very few exceptions they were all in the normal range one year before diagnosis. So there’s no evidence, currently, that any known biomarker will rise significantly ahead of the disease.Q: Who should have a risk-reducing salpingo-oophorectomy (removal of the fallopian tubes and ovaries)? When?A risk reducing salpingo-oophorectomy (RRSO) should be strongly considered in women who have BRCA mutations and probably should be considered in women with Lynch syndrome. It can be safely postponed for most women until after childbirth. For women with a BRCA1 mutation it is uncommon to have ovarian cancer before age 40, and for women with the BRCA2 mutation it is uncommon before 50. However, some physicians recommend surgery 10 years before the youngest family member with ovarian cancer developed their cancer—so if your mother had ovarian cancer at 63, and you have a BRCA mutation, you should consider an RRSO prior to age 53.There is data suggesting that the fallopian tube may serve as the origin of “ovarian cancer.” When a woman ovulates, a wound is formed on the ovary. Cancerous cells from the fallopian tube can fall into that wound, and we think that the ovary might be a nutrient-rich place where these cells grow quickly.There are trials underway where the fallopian tube is removed and the ovary is left intact; however, this surgery is still experimental and there is no proof yet that this protects a woman from cancer. Anyone interested in considering this option should do it as part of a clinical trial.RRSO reduces the risk of ovarian cancer by up to 85 percent, but it is still possible to develop peritoneal cancer which resembles ovarian cancer.Q: Are there any specific foods or supplements I can take to reduce the risk of developing ovarian cancer? Are there any foods I should avoid to reduce the risk of developing ovarian cancer?There are no diets or foods that we know of that will prevent ovarian cancer. There’s no good data on it, and there’s only a moderate amount of data on the topic. There is very good data on diet and exercise reducing the risk of breast cancer, but we can’t extrapolate that to ovarian cancer.There is data showing a potential link between ovarian cancer and some types of painkillers, and ovarian cancer and dairy products. Likewise there are studies looking at teas, fruits, vegetables, fish and omega-3 fatty acids. Most of the studies show no link, although a few have shown associations with some of the foods listed above. However, these links are weak and there is no data to suggest that if you actively change your diet you can appreciably alter your risk of getting ovarian cancer.There are data showing that women who have lower body mass index have lower risk of ovarian cancer. Those women likely have a diet high in vegetables and a lifestyle that includes exercise.There are other health benefits to eating a diet low in fats and high in fruits and vegetables in association with regular aerobic exercise. Although once again there is no evidence that this will reduce the risk of getting ovarian cancer.Q: Is getting a lot of exercise a good way to prevent ovarian cancer? Are there specific non-traditional interventions I can take to reduce my risk of developing ovarian cancer (e.g. reducing stress, yoga, meditation, acupuncture)?There is some evidence that relaxation techniques like meditation can affect brain processes which control the immune system. There is a growing body of data to show that chronic over-activation of the immune system has some link to heart disease and some link to cancer. Therefore, things that reduce stress might help reduce the risk of cancer. However, there is no proof that any specific intervention directly affects the risk of ovarian cancer.It should be noted that there is a growing body of research that demonstrates that moderate aerobic exercise for 45 minutes, three or more times per week, lowers your risk of breast cancer. There is no equivalent data yet for ovarian cancer.That said, it’s pretty hard to come up with a reason not to eat healthily, exercise and reduce stress. These are really good lifestyle choices. The only problem we have is that these lifestyle choices aren’t a substitute for medical interventions—just because you do yoga doesn’t mean you shouldn’t consider traditional approaches.

Report from Capitol Hill: High Risk Women and Health Insurance Reform

teal_admin — Tue, 04 Oct 2011 15:17:05 +0000

The average woman has a one in 71 chance of developing ovarian cancer. Some women, however, are at increased risk due to genetic mutations or a family history of the disease. Many of these women are interested in ways to reduce their risk, and whether those preventive measures will be covered by their insurance.There are two primary ways for a woman to reduce her risk of ovarian cancer: 1) prophylactic risk reducing bilateral salpingo-oophorectomy (RRSO) and 2) oral contraceptives. Both RRSO and oral contraceptives have been shown to significantly reduce the risk of ovarian cancer. For oral contraceptives, the reduction in risk is approximately 50 percent if taken for five or more years.The Patient Protection and Affordable Care Act—the health reform bill—included a provision requiring insurance companies to cover women’s preventive services without co-pay. A committee organized by the Institute of Medicine (IOM) was charged with researching which services should be covered as preventive care for women. The committee then passed its recommendations on to the Department of Health and Human Services (HHS). Because of their impact on ovarian cancer, especially for women at increased risk, the Ovarian Cancer National Alliance urged the government to include both oral contraceptives and RRSO in the list of preventive services covered under the act.This summer, the IOM committee released its recommendations regarding women’s preventive health services. Shortly thereafter, HHS issued regulations defining the services that will be covered as preventive care for women under the Patient Protection and Affordable Care Act. Covered services will include all forms of birth control, HPV testing, counseling for sexually transmitted infections, well-woman visits, breastfeeding support and screening for domestic violence and HIV.The recommendations are mixed with respect to ovarian cancer. While birth control is included, the rationale for this decision did not mention the known risk-reducing effects for this disease. Preventive surgeries, including both RRSO and mastectomy, were not included. Their inclusion would have benefited women at high risk of developing ovarian cancer, as preventive surgeries are not covered by Medicare and are covered by only some insurance companies.The Alliance continues to fight for coverage of preventive surgery for women at high risk of developing ovarian cancer. We are working with Medicare, champions on the Hill and advocates to require coverage for preventive surgeries when medically appropriate.

Letter from the CEO

teal_admin — Tue, 14 Jun 2011 13:14:29 +0000

This issue of The Teal Journal is going to press just a few days after the 2011 meeting of the American Society of Clinical Oncology concluded. The meeting included many briefings, presentations and posters relevant to the ovarian cancer community. Progress in the development of targeted therapies was particularly attention-grabbing. This month, The Teal Journal includes summaries of several of the meeting’s presentations that were most noteworthy for anyone touched by ovarian cancer.The Teal Journal strives to highlight what is new and exciting in cancer research, whether that is a report from the ASCO meeting or an article about a potential new cancer treatment. This issue takes you inside two labs to learn about an FDA-approved vaccine for prostate cancer and development of a similar treatment for ovarian cancer.Bringing science to the ovarian cancer community has always been a priority for the Ovarian Cancer National Alliance, and is a key focus of our 14^th Annual Conference. I hope you will join us in Washington, DC, July 9-12, to learn about the origins of ovarian cancer in the fallopian tubes, the drug approval process and the state of cancer research.The conference concludes with our annual Advocacy Day on Capitol Hill. We saw the importance of advocacy clearly during the 13-month battle over appropriations for fiscal year 2011. Ultimately, Congress set aside $20 million for the Department of Defense Ovarian Cancer Research Program, but that would not have happened without pressure from the ovarian cancer community.Readers of The Teal Journal often pose questions about the role nutrition plays in cancer treatment. In this issue, we invited Dr. Moshe Shike, a board-certified gastroenterologist, internist and nutritionist, to answer your questions. Did we overlook one of your questions? Email us at editor@ovariancancer.org or post your question on the Teal Journal Facebook page.Sincerely yours, Karen Orloff Kaplan, MSW, MPH, ScD Chief Executive Officer, Ovarian Cancer National Alliance

Ask the Expert

teal_admin — Tue, 14 Jun 2011 13:14:01 +0000

Moshe Shike, MD Director of Clinical Nutrition, Memorial Sloan-Kettering Cancer CenterIs there a connection between food and cancer? Google the two words together and 12,800,000 links appear. Individuals are not the only ones looking for complementary additions to traditional medical therapies; researchers and doctors at the leading universities/cancer centers across the globe are also exploring this topic. Even chefs have been brought into the conversation. For example, Dan Barber, a chef who writes on food and agricultural policies to create consciousness about the effects of everyday food choices, serves as a member of President Obama’s Council on Physical Fitness, Sports, and Nutrition and is a member of the Advisory Board to the Harvard Medical School Center for Health and The Global Environment.Because so many of you, our Teal Journal readers, have raised questions about food and nutrition as they relate to cancer, and specifically ovarian cancer, for this issue of the Journal, we asked an expert nutritionist to serve as our guest editor for the “Ask the Expert” column.Dr. Moshe Shike, a board-certified gastroenterologist, internist and nutritionist, is Director of Clinical Nutrition at Memorial Sloan-Kettering Cancer Center in New York City. His work and interest in the area of cancer prevention includes the role that nutrition plays in the prevention and early detection of cancer. He studies the role that diet and specific dietary factors play in the stages of cancer development, as well as ways to best provide nutritional support to cancer patients. Dr. Shike is an author and editor of a number of books, including Modern Nutrition in Health and Disease (2005) and Cancer Free: the Comprehensive Cancer Prevention Program (1996). We asked Dr. Shike your questions: Q. After chemotherapy treatments I sometimes crave Chinese food and then it makes me very ill. What other foods could I substitute that would not make me ill?A. The reaction to foods eaten during chemotherapy varies. There is no indication that specific foods cause symptoms. Food aversion during chemotherapy usually arises because patients associate the side effects of chemo (nausea, vomiting and lack of appetite) with foods they have eaten at the time of the treatment. Thus it is not a specific food, but rather the side effects of chemo and their association with specific foods consumed. I often recommend that when a patient is given a chemo treatment they do not eat their favorite foods during the days of anticipated side effects. For example, in pediatric oncology, children who eat ice cream when they are receiving chemo often develop an aversion to ice cream because they associate it with the side effects. In addition, it is advisable to avoid fatty foods as they tend to delay the emptying of the stomach and thus aggravate the side effects of the chemo treatments. Q. Before undergoing radiation and chemo I was on a daily regimen of vitamins and supplements. When I started my chemo treatments I was told I could not take vitamins. Why? A. As a general statement, I recommend that people do not take vitamin supplements, unless it is for a specific deficiency identified by a doctor. A healthy diet can usually provide all the necessary vitamins (except for vitamin D in some people). When you are receiving chemo or radiation treatments, vitamins can interfere with the treatments and reduce their effects. Therefore oncologists ask their patients to avoid taking vitamins during treatment.Q. Is it true that a higher intake of dairy products may be linked to ovarian cancer because of the breakdown of the milk sugar lactose?A. There have been conflicting epidemiological studies. Some support this hypothesis and others do not. My recommendation is to consume dairy products in moderation. There is not enough evidence to support not consuming dairy and many of the benefits are important to a balanced and healthy diet.Q. In a number of journals and popular magazines, one reads that a vegetarian and fruit diet reduces one’s risk of cancer. Has this been proven through research?A. Fruits and vegetables are important constituents of a healthy diet. Many studies, both in the United States and internationally, show that a diet rich in fruits and vegetables is associated with reduced risk of cancer, as well as other diseases. However there is no clear proof that a specific diet can prevent cancer.Q. Is it true that women who eat plenty of vegetables, particularly carrots, tomatoes and other foods high in carotene and lycopene, have a lower rate of ovarian cancer? A. Flavonoid is a phytonutrient (plant compound) known for its high antioxidant activity. Antioxidants are recognized as removing cell-damaging free radicals from the body. Flavonoids include apigenin, kaempferol, luteolin, myricetin and quercetin. The bulk of these antioxidants in women’s diets come from tea, apples, blueberries, celery, kale, lettuce, oranges and tomato sauce. Some epidemiological studies bolstered by laboratory experiments suggest that flavonoids, and particularly apigenin, can lower the risk of ovarian cancer. Q. I am almost through my treatment for ovarian cancer—what should my diet be going forward?A. Going forward you should maintain a healthy diet—control calories, monitor weight and avoid obesity. A good balanced diet includes fruits, vegetables, grains, legumes, lots of fiber, fish and chicken. Avoid eating too much red meat and fat. Occasionally red meat is okay. The principle is: moderation.In addition to a healthy diet it is important to maintain a good weight and engage in physical activity. Even for people who are not overweight, physical activity is essential for good health. I advise patients to be physically active and the best way to do it is to incorporate physical activity throughout the day. Walk to the store, take the stairs rather than the elevator if your work is sedentary, and try to periodically engage in some physical effort.People usually consume the same diet day in and day out, they are used to it and they like it. If your diet is unhealthy now and you switch to a healthy diet, you may have problems for a few months but eventually you will learn to like the new diet and will get used to it.Q. There are so many books and articles with conflicting advice about diet and nutrition—how do I know which book to read and which diet to follow? A. That‘s a tough question as there are so many books on the market. Investigate the credentials of the person who wrote the book and find out whether the discussions and recommendations are scientifically based. Many medical centers publish brochures and online information regarding healthy diets and dietary guidelines for specific diseases. The information in these publications usually is based on science and recommendations from credible sources. If you are not sure how to choose a healthy diet or a disease-specific diet, consult with a certified dietician/nutritionist. Q. At what point in my treatment do I consult with a nutritionist and how do I find one? A. All hospitals have dietician/nutritionists. If you are not sure what diet to follow, consult the professionals from the very beginning of your treatment. They can advise you on food choices and also guide and help you during the treatment.Dr. Shike joined Memorial Sloan-Kettering Cancer Center in 1981. He received his MD degree from Tel Aviv University School of Medicine, and completed residencies at Harvard University and the University of Toronto. Dr. Shike is the director of clinical nutrition at Memorial Sloan-Kettering. Dr. Shike also is a professor of medicine at Weill Cornell Medical College.

Report from Capitol Hill: The Fight for Ovarian Cancer Research Funding

teal_admin — Tue, 14 Jun 2011 13:13:04 +0000

The Fiscal Year 2011 Congressional appropriations cycle was a nerve-wracking time for the ovarian cancer community. Because the federal government is the largest funder of ovarian cancer research and awareness programs, the Ovarian Cancer National Alliance continuously educates Congress about the necessity of increasing funding for research and education programs. Two key ovarian cancer programs are the Department of Defense’s (DoD) Ovarian Cancer Research Program and the Centers for Disease Control and Prevention’s (CDC) Gynecologic Cancer Education and Awareness Act, also known as Johanna’s Law.However, in a year in which elections drastically altered the composition of the House of Representatives, pressure was high for Congress to cut federal funding in all areas of government. A drastic or complete cutting of ovarian cancer programs was a strong possibility.To aid the ovarian and scientific community in understanding the efforts involved in advocating for federal funding for ovarian cancer programs, below is a month-by-month overview of the events that took place and the major players involved in the FY2011 appropriations process. The DoD Ovarian Cancer Research Program is used as an example. December 2009 Two months after the 2010 fiscal year begins, Congress passes a Continuing Resolution bill to fund the government for the remainder of FY2010. This bill cut the DoD Ovarian Cancer Research Program from $20 million to $18.75 million. The Alliance forms a coalition with the Society of Gynecologic Oncology (now the Foundation for Women’s Cancer) and the American Congress of Obstetricians and Gynecologists, and begins planning a strategy for the FY2011 appropriations cycle to restore funding for the program.March 2010 The Appropriations process for FY2011 begins. Congresswoman Rosa DeLauro and Congressman Dan Burton begin circulating a letter throughout Congress in support of $30 million dollars for the DoD Ovarian Cancer Research Program. More than 500 ovarian cancer advocates write and call, asking their representatives to sign and support the letter. As a result of this advocacy, 86 members of the House sign the letter in support of the DoD Ovarian Cancer Research Program. The letter is sent to the House Defense Appropriations Subcommittee.April 2010 A similar letter is circulated in the Senate by Senators Robert Menendez and Olympia Snowe. More than 800 messages are sent to the Senate from the Alliance advocates, resulting in 25 senators signing on in support.May 2010 The Alliance presents testimony in the House of Representatives supporting the Alliance’s request for $30 million in FY2011. Karen Mason, RN, an Ovarian Cancer Research Program peer reviewer and member of the Alliance’s Policy Committee, delivers testimony on behalf of the Alliance and answers questions from the subcommittee.June 2010 The Ovarian Cancer National Alliance presents testimony in the Senate. Karen Mason again delivers testimony on behalf of the Alliance before Defense Appropriations Subcommittee Chairman Daniel Inouye and Ranking Member Thad Cochran in support of the DoD Ovarian Cancer Research Program.July 2010 More than 100 advocates from across the nation take part in the Alliance’s annual Advocacy Day on Capitol Hill. Each advocate meets with their elected officials or their staff, sharing their experience with ovarian cancer and explaining why it is critical to support research performed through the DoD Ovarian Cancer Research Program and other ovarian cancer related federal programs. The Alliance also holds a “Virtual Advocacy Day” for those advocates unable to travel to Washington, DC.August 2010 With Congress on recess, ovarian cancer advocates from around the country attend Town Hall meetings and find other ways to keep in contact with their legislators to make sure they understand the importance of funding ovarian cancer research. Several Advocacy Day participants publish op-eds and letters to the editor in their local newspapers, sharing their Advocacy Day experiences and urging Congress to support funding for the DoD Ovarian Cancer Research Program. September 2010 The Alliance holds a briefing in the Senate to educate Capitol Hill staff about the DoD Ovarian Cancer Research Program and other federally-funded ovarian cancer programs. Dr. George Coukos, a recipient of DoD Ovarian Cancer Research Program funding and member of the Alliance’s Science and Medical Advisory Board, speaks to a packed room and answers questions about the program and importance of funding. Rima Fakih, Miss USA 2010, and Jennie McGihon, an ovarian cancer survivor and member of the Alliance’s DC Junior Committee, also speak to the audience about the importance of ovarian cancer funding. October 2010 Unable to pass a spending bill in time for the start of the new fiscal year, Congress passes a Continuing Resolution to fund the government until December 3. Under these Continuing Resolutions, the DoD Ovarian Cancer Research Program is set to receive $18.75 million. November 2010 New “Dear Colleague” letters are circulated in the House and Senate requesting that Congress support a minimum of $25 million of funding for the Ovarian Cancer Research Program. A letter signed by the Ovarian Cancer National Alliance and 57 other local and national organizations is sent to the Defense Appropriations Subcommittees in support of this funding request.December 2010 Unable to finalize the appropriations bill, Congress passes its second and third continuing resolutions, funding the government at FY2010 levels until March and allocating $18.75 million to the DoD Ovarian Cancer Research Program. January 2011 The 112th Session of Congress begins. The elections in October ousted several DoD Ovarian Cancer Research Program supporters from Congress, including Ohio’s Mary Jo Kilroy and Illinois’ Debbie Halvorson. Other previous supporters, such as Dennis Moore of Kansas, retired.February 2011 Approximately 800 advocates write to their representatives on Capitol Hill asking them to oppose any potential cuts to the DoD Ovarian Cancer Research Program.March 2011 Congress passes the fourth and fifth Continuing Resolution bills, maintaining funding for the DoD Ovarian Cancer Research Program at $18.75 million. John McCain states on the Senate floor that the cancer research programs included in the Defense Appropriations budget should be eliminated. The Washington Post publishes a letter from the Alliance defending the program.April 2011 Congress passes its sixth and seventh Continuing Resolutions bills. The seventh Continuing Resolution is the final bill for the year, funding the DoD Ovarian Cancer Research Program at $20 million for FY2011, an increase of $1.75 million from FY2010.

2011 Annual Conference: Turning Promise Into Action

teal_admin — Tue, 14 Jun 2011 13:12:35 +0000

The Ovarian Cancer National Alliance Annual Conference is one of the most important ways the Alliance bridges the gap between survivors and science. The conference brings the latest scientific discoveries and research to the ovarian cancer community, and brings our community to Capitol Hill to advocate for federal funding that supports further research in the field.

Patricia Goldman, a board member of the Alliance, has seen that dynamic play out at past conferences: “Since they were initiated in 1998, the Ovarian Cancer National Alliance Annual Conferences have provided the ovarian community the opportunity to learn the latest about ovarian cancer research from those conducting that research on our behalf. It has also provided a forum for the research leaders to hear about the practical issues with which the survivors are trying to deal. It is this partnership that will further progress.”

The 14^th Ovarian Cancer National Alliance Annual Conference, scheduled for July 9-12 in Washington, DC, will continue this tradition by providing an invigorating setting for dialogue between researchers and survivors.

At one highly-anticipated session, Drs. Sarah Finlayson and Jessica McAlpine will present the results of their 2009 study, which showed that most serious cases of ovarian cancer begin in the fallopian tubes. This groundbreaking discovery could give women at high risk of developing the disease another option for prevention. In a previous issue of The Teal Journal, Elisabeth Ross of Ovarian Cancer Canada noted: “This research breakthrough holds great promise towards the goal to overcome ovarian cancer and is without a doubt the best news about ovarian cancer which has come out in a long time.”

Speakers from the Food and Drug Administration (FDA) and Biotechnology Industry Organization (BIO) will illuminate the approval process for drugs and answer questions about why it takes so long for a new drug to reach the market. Vicki Seyfert-Margolis of the FDA and Andrew J. Emmett, from BIO, will discuss the series of tests and evaluations cancer drugs must go through before patients can use them.

In addition to these presentations, Dr. Richard Barakat, Chief of Gynecology Service at Memorial Sloan Kettering Cancer Center, will speak about surgical advances during this year’s Mello-Abrams Lectureship.

Researchers and women with ovarian cancer will have a chance to interact in our Exhibit Hall Marketplace. The marketplace provides a forum for women to speak with individual companies and researchers conducting clinical trials. Attendees can learn about current trials, ask questions and find out whether they are eligible to participate. And this year, the Alliance is presenting its first research grant!

On the last day of the conference, July 12, the Alliance will host the only annual Advocacy Day for ovarian cancer. Since 1997, the Alliance has trained hundreds of women and men affected by ovarian cancer to advocate for federal funding and laws that benefit women with this disease. As seen in the Report from Capitol Hill, also in this issue, advocates from the ovarian cancer community are critical to maintaining federal research funding.

Click here to register for the Ovarian Cancer National Alliance Annual Conference or to view a detailed agenda.

Cancer Vaccines at the Vanguard of Treatment

teal_admin — Tue, 14 Jun 2011 13:11:40 +0000

Cancer is fundamentally a disease of genes gone awry and escaping the immune system. Cancer cells, rapidly dividing, can form lumps, spread and halt functioning of important biological systems.Many treatments in use today target rapidly dividing cells, including cancer cells, as well as hair growth and other non-malignant processes. One treatment option used to trigger the immune system to recognize that cancer is an enemy are therapeutic vaccines—a potential revolution in cancer treatment.Vaccines have long been used to train immune systems to fight specific pathogens. The theory of vaccination was developed when it was seen that women who were around cows, which had cowpox, did not get smallpox. Because their bodies had learned to recognize and fight cowpox, these young women’s bodies could fight smallpox easily. Vaccines in use today are based on this same theory.Cancer is not caused by a specific virus, but based on the vaccine theory, some companies and academics are trying to train the body to fight cancer by provoking an immune response. To learn more about this treatment, The Teal Journal visited Dendreon, a biotechnology company that makes Provenge, a vaccine used to treat prostate cancer.Provenge is the first, and at this writing only, FDA approved cancer vaccine. To create Provenge, white blood cells are taken from a patient and shipped by courier to Dendreon’s New Jersey facility. There, in the words of Dendreon employees, the cells are “trained” to recognize prostate cancer cells. Propriety technology is used to expose the white blood cells to a recombinant antigen consisting of prostatic acid phosphatase—an antigen expressed in more than 95 percent of prostate tumors. This teaches the cells to recognize, and then fight, prostate cancer in the body. The cells are shipped back to the prescribing doctor’s office, via courier, and infused. Patients require three rounds of infusions, usually two weeks apart.The cost of Provenge, and Medicare’s decision to cover it, has garnered much press. The vaccine costs approximately $93,000 and provides a median improvement in overall survival of 4.1 months compared to chemotherapy. Some say this cost is not worth the benefit. However, Dendreon counters that the cost of all treatments associated with chemotherapy—including the cost of care—is approximately the same as the cost of treatment with Provenge. Many were surprised that the Centers for Medicare and Medicaid Services considered coverage—never before had an FDA-approved cancer therapy undergone this process.There are striking similarities between the prostate cancer patients treated by Provenge and ovarian cancer patients. Men who use Provenge have already gone through surgery, radiation, chemotherapy and hormonal castration. If prostate cancer returns, as evidenced by a rising PSA, then a patient is eligible for Provenge. Ovarian cancer patients, too, often undergo surgery and numerous rounds of chemotherapy, and their tumors may become resistant to platinum-based therapies.Given these similarities, Dr. George Coukos and his team at the University of Pennsylvania are developing an approach that uses a patient’s tumor tissue, obtained at the time of surgery, to create a personalized vaccine. Since it is believed that each ovarian tumor is unique, and has numerous mutations, using a patient’s own tumor will produce a unique set of proteins applicable to that particular tumor. Unlike men using Provenge, platinum sensitivity is irrelevant for ovarian cancer patients participating in these trials. As long as the tumor tissue is collected at time of surgery and stored in the right manner, a patient can always have tissue available to enroll in a vaccine clinical trial.In an interview with Dr. Coukos and Dr. Lana Kandalaft, they noted that the opportunity to create a personalized ovarian cancer vaccine was formerly restricted to patients who had their surgery performed at the University of Pennsylvania. Recently, researchers at the Penn Ovarian Cancer Research Center have extended their program to all patients. The researchers found a way to ship a tumor from the patient’s own institution, at the time of her surgery, to Penn for storage in a viable manner, so it can be available if the patient decides to enroll in a vaccine trial in the future.Dr. Coukos’ team is currently conducting three trials with ovarian cancer vaccines. One trial protocol uses a patient’s own dendritic cells (immune cells found in blood) and her own tumor tissue to create an autologous vaccine—that is, a vaccine that uses the patient’s own biological material (UPCC-19809). The dendritic cells are loaded with the unique combination of proteins and injected into two of the patient’s lymph nodes. This trial also involves treatment with bevacizumab (Avastin) every two weeks. The second trial (UPCC-29810) uses a similar method of preparing the tumor lysate but introduces the vaccine in combination with an adjuvant directly into the skin, to stimulate the dendritic cells already found there. The third trial (UPCC-26810) is for patients who have participated in the vaccine trial where they have undergone collection of vaccine primed T-cells. These T cells are stored, expanded and re-infused in the patient followed by a dose of her own vaccine in combination with bevacizumab.The recent FDA approval of Provenge proves the efficacy of this vaccine and encourages researchers to pursue additional immune-therapeutics. Researchers recognize that much remains to be done to improve vaccines’ efficacy. One current focus is to increase vaccines’ immunogenicity so that the immune system starts “seeing” cancer cells as dangerous or foreign, as it generally does with microbes. A second priority for research is to render the immune responses powerful enough to overcome the barriers that cancer cells use to protect themselves. Major institutes around the United States are investigating these issues.In addition to improving efficacy, one of the remaining questions about these vaccines is measuring their efficacy. Research shows how long a person’s cancer remains at bay and how long a person lives after receiving the vaccine. We can even measure the patient’s immune response. But the vaccine’s precise mechanism of action remains unknown and therefore not amenable to measurement. Researchers note that uncertainty about how these vaccines work doesn’t preclude their use. The key is the endpoint—usually progression free survival or overall survival.Staff at Dendreon and the Penn Ovarian Cancer Research Center all call autologous vaccines the wave of the future. These are the epitome of personalized medicine—a person’s own unique tumor profile and her own immune system, tweaked and re-injected to fight her specific disease.Our thanks to Kevin Bellew, Scott Riccio, and Drs. George Coukos, Lana Kandalaft and Neal Shore for their insight and assistance with this article.