Society of Gynecologic Oncologists Conference this week: any abstracts on UPSC?

An abstract related to UPSC at the 2011 SGO Conference
Abstract 11
Uterine Serous Papillary Carcinomas Overexpress
Human Trophoblast Cell Surface Marker
(Trop-2) and are Highly Sensitive to Immunotherapy
with hRS7, A Humanized Anti-Trop-2 Monoclonal
Antibody

A. Santin 1, S. Bellone 1, J. Varughese 1, E. Cocco1, E. Ratner 1, D. Silasi 1, T Rutherford 1, P. Schwartz 1, M. Azodin 1, S. Pecorelli 2

1 Yale University School of Medicine, New Haven, CT, 2 University of Brescia, Brescia, Italy.

Discussant: R. Alvarez, The University of Alabama

evertheoptimist said:

yes, I just found this one
yes, I just found this one also by going through the conference PDF file. I was not able to get an abstract.

Did you get a content?

Sorry, I can't find content
No, I did not. However, I noticed Peter Schwartz's name. He was one of the oncologists involved in the 2005 Yale study that led to the first-line treatment for UPSC: 6 rounds of carboplatin/taxol. Following the development of the Yale protocol, women with UPSC fared much better than they had previously.

paris11 said:

SGO: Sandwich Tx


SGO: 'Sandwich' Tx Helps in Rare Endometrial Ca

By Charles Bankhead, Staff Writer, MedPage Today
Published: March 08, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

Explain that a therapeutic "sandwich" of radiation and chemotherapy, in which chemotherapy is given first and then followed by radiation therapy and then additional chemotherapy, has led to encouraging disease-free survival in patients with uterine papillary serous carcinoma.
ORLANDO -- A therapeutic "sandwich" of radiation and chemotherapy has led to encouraging disease-free survival (DFS) in patients with uterine papillary serous carcinoma (UPSC), data from a single-center experience showed.
Patients with stage III-IV UPSC had a three-year DFS of 54% when treated with six cycles of combination chemotherapy interrupted by two types of radiation therapy. By comparison, historical data have shown a five-year DFS of 5% to 20% in the same type of patients.

Thank you
for this content, Paris. Where did you find it?

Rewriter said:

Thanks, Ever, for pointing out the flaws
I'm not a researcher, but I know enough about the differences in DFS pre- and post-2005 and the atypical populations used in earlier studies to recognize that there are huge holes in this conclusion.

We need more research
We need more research. MD Anderson is working on some. It is slow and not well funded. When the weather warms up We should walk naked down the street with our IV bags and scarred bellies. We need help. Diane

paris11 said:

SGO: Sandwich Tx Opps...
The entire article did not copy. Go to www.kevinmd.com to read. Connie

SGO: Sandwich Tx Opps...still not complete

By Charles Bankhead, Staff Writer, MedPage Today
Published: March 08, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Earn CME/CE credit
for reading medical news

Action Points
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.


Explain that a therapeutic "sandwich" of radiation and chemotherapy, in which chemotherapy is given first and then followed by radiation therapy and then additional chemotherapy, has led to encouraging disease-free survival in patients with uterine papillary serous carcinoma.
ORLANDO -- A therapeutic "sandwich" of radiation and chemotherapy has led to encouraging disease-free survival (DFS) in patients with uterine papillary serous carcinoma (UPSC), data from a single-center experience showed.
Patients with stage III-IV UPSC had a three-year DFS of 54% when treated with six cycles of combination chemotherapy interrupted by two types of radiation therapy. By comparison, historical data have shown a five-year DFS of 5% to 20% in the same type of patients.

"Toxicities were uncommon and manageable and most occurred after radiation therapy," Mark H. Einstein, MD, of Montefiore Medical Center in New York, said here at the Society of Gynecologic Oncology meeting.

"This regimen should be considered as an arm in future phase III trials in patients with completely resected uterine papillary serous carcinoma."

UPSC accounts for 10% of all endometrial cancers but 40% of deaths from the disease (Curr Opin Obstet Gynecol 2010; 22: 21-29).

Patients with stage I-II endometrioid endometrial cancer have a five-year DFS of 86%, declining to 40% to 50% for stage III and 15% to 20% for stage IV. By contrast, five-year DFS is 74% in patients with stage I-II UPSC, 20% in stage III, and 5% to 10% in stage IV (Gynecol Oncol 2010; 119: 299-304).

Recent studies have suggested that combined therapy improves outcomes in UPSC, said Einstein. However, no consensus exists about the optimal combination strategy.

The adjuvant regimen employed at Montefiore consists of three cycles of paclitaxel-carboplatin chemotherapy, followed by a 45-Gy total dose of external beam radiation therapy (EBRT) to the pelvis, then three weekly applications of brachytherapy at a total dose of 15 Gy, and finally three more cycles of chemotherapy.

Einstein presented data for 72 patients who received at least three cycles of chemotherapy. All had no visible residual disease after surgical resection. The cohort included 65 patients who completed all prescribed therapy.

The patient population had a mean age of 67 and a mean body mass index of 30.7 and was racially and ethnically diverse. The cohort included 14 patients with stage III-IV UPSC.

Among the patients who received three cycles of chemotherapy and the EBRT, those with stage I-II disease had a progression-free survival (PFS) of 65.5 months and overall survival of 76.5 months. Patients with stage III-IV UPSC had a PFS of 25.8 months and overall survival of 35.9 months.

The three-year survival probability was 84% for stage I-II and 50% for stage III-IV.

Collectively, the patients received 435 cycles of chemotherapy. Grade III-IV hematologic toxicity occurred in 27.2% of the cycles. Grade III nonhematologic toxicity occurred in 2.8% of cycles and grade IV in 0.9%. Dose reductions were required in 6% of cycles and dose delays in 8.5%.

The trial had a number of strengths, including a diverse patient population, a high percentage of patients who completed all prescribed therapy, and robust toxicity data, said invited discussant Paola Gehrig, MD, of the University of North Carolina at Chapel Hill.

Moreover, the Montefiore investigators have accumulated one of the largest experiences with UPSC ever reported, she continued. Two Gynecologic Oncology Group phase III clinical trials of endometrial cancer had a combined total of 48 patients with UPSC.

However, Einstein and colleagues needed 10 years to accrue patients and complete the protocol, both the radiation and chemotherapy protocols varied during the course of the study, and the cohort included relatively few patients with stage III-IV disease, Gehrig noted.

"Small patient numbers can lead to underpowered and inaccurate conclusions," Gehrig cautioned.

evertheoptimist said:

this is not an apples to
this is not an apples to apples comparison. The conclusion is SO FLAWED it can't stand any scrutiny from a scientific point of view.

First of all, the DFS of 5%-20% comes from very old data - the kind of data before the era of proper treatment of UPSC. Note that the standard treatment of UPSC with carbo/taxol was not pioneered until 2005 (by Yale doctors mentioned above). And, this protocol resulted in much better outcome for UPSC patients. As such, any recent data showing improved outcome reflects reflect a myriad of better treatment options, and can't be solely attributed to this sandwich method.

Second, the original data that generated 5%-20% had a really weird population characteristics ; as in, the typical patient was 75 year old black woman. Since UPSC was not acknowledged as a separate condition till 1980's, establishment of proper sampling and patient population demographics were properly done for a while. I believe recent data and samples reflect the actual patient population base more accurately. If the earlier data had non-representative samples, and the "typical" patients were fairly old minority members, you can easily imagine that their prognosis was sub optimal compared to general population (whether we like it or not, older minority population (other than Asians) do not have as good an access to the top line medical care - it's a fact).

Third, they are comparing 3 year vs. 5 year survival numbers. Who knows, maybe a large % of women recur between the year 3-5, and thus a steep decline in DFS rate for 5 years. I am not saying this is the case. I am just pointing out all the gigantic holes in this argument.

As a former researcher, I am embarrassed for the people who are making this claim since it's so full of holes and can't withstand even a cursory scrutiny. If I were to attend a presentation like this when I was still operating as a researcher, it would be so tempting to shrewd this presentation to pieces.

Flawed study
Ev, I agree with YOUR conclusion that this sandwich "study" is flawed. Even the report itself says:

"However, Einstein and colleagues needed 10 years to accrue patients and complete the protocol, both the radiation and chemotherapy protocols varied during the course of the study, and the cohort included relatively few patients with stage III-IV disease, Gehrig noted.

"Small patient numbers can lead to underpowered and inaccurate conclusions," Gehrig cautioned."

[Gehrig was an "invited discussant" from UNC Chapel Hill.]

I know that Hopkins is doing UPSC research. My gyn-onc there told me that they have more people in their study than Stanford, Chicago, and UNC combined. You know, I always wanted to be special, but not THIS special! LOL