Conference abstract booklet - ANZGOG

AUSTRALIA NEW ZEALAND
GYNAECOLOGICAL ONCOLOGY GROUP
Conference abstract booklet
Sofitel, Gold Coast
Wednesday 22- Saturday 25 February 2012
Proudly sponsored by:
Platinum sponsors:
Educational/Research sponsors
Exhibitors:
Supporters:
WELCOME
Professor Michael Quinn (Chair of ANZGOG)
Welcome to ANZGOG 2012 which brings together national and international experts in medical radiation and surgical oncology. Our
focus is on clinical trials. The programme is varied, challenging and exciting. We hope you go away from this meeting with up to
date information on current and future trials in gynaecological oncology and with a clearer understanding of how targeted therapies
are going to fit into the care of our patients in the near future.
Organising Committee
Prof Andreas Obermair – Chair ASM Meeting Committee
Dr Julie Martyn
Prof Michael Quinn – Chair of ANZGOG
Dr Jeffery Goh
Prof Michael Friedlander – Director of Research
Dr Pearly Khaw
Dr Alison Brand – Chair Program Committee
Ms Pauline Tanner
Ms Karen Livingstone
Ms Judy Eddy
Ms Sue Brew
Dr Clare Scott
Ms Alison Evans – Executive Officer ANZGOG
Mrs Kate Murphy
Secretariat
The registration desk will be open throughout the conference to
answer any questions you may have.
Wednesday 22nd February
2.00pm – 6.00pm Lobby
Thursday 23rd February
7.30am – 5.00pm
Friday 24th February
7.30am – 4.00pm
Saturday 25th February
7.30am – 11.45pm
Kate Murphy and Mary Sparksman
YRD (Aust) Pty Ltd
PO Box 717
Indooroopilly Q 4068
Ph: + 61 7 3368 2422
Fax: + 61 7 3368 2433
Mobile: 0408 732 277 / 0418 877 279
Keynote Speakers
ANZGOG is pleased to welcome the conference international keynote speakers:
Prof Gillian Thomas
Professor of Radiation Oncology and Obstetrics and Gynaecology, University of Toronto, Consultant Radiation Oncologist Odette
Sunnybrook Cancer Center.
Prof Rob Coleman
Professor, Department of Gynaecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center,
Houston, TX
Dr Pedro Ramirez
Associate Professor, Department of Gynaecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Continuing Professional Development Program
This meeting has been approved as a RANZCOG Approved O&G Meeting. Eligible Fellows of this College will earn 7 CPD points for their
attendance.
Social Functions
Welcome Reception/Trade Networking Function
Wednesday 22nd February
7:00pm – 9:00pm
Sofitel Poolside
Conference Dinner
Friday 24th February
7:00pm - 11.00pm Sofitel Poolside
Disclaimer:
The Australian and New Zealand Gynaecological Oncology Group (ANZGOG) make no representations about the content and suitability of ANZGOG materials presented for
any purpose. Specifically, ANZGOG does not warrant, guarantee or make any representations regarding the correctness, accuracy, reliability, currency, or any other aspect
regarding characteristics or use of the information presented in ANZGOG materials. The user accepts sole responsibility and risk associated with the use and results of ANZGOG
materials, irrespective of the purpose to which such use or results are applied. In no event shall ANZGOG be liable for any special, indirect or consequential damages or any
damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or tort, rising out of or in connection with the use or performance
of ANZGOG.
This program is correct at the time of printing however the committee has the right to make changes
AUSTRALIA NEW ZEALAND
GYNAECOLOGICAL ONCOLOGY GROUP
ANZGOG 2012 Program
Individualized Gynaecological Cancer Medicine
WEDNESDAY 22 February
12.15-2.45 pm
RAC Meeting 1
Paradise 1
2.00-6.30 pm
Registration Open
3.00-5.00 pm
Radiation Oncology Workshop: Gillian Thomas
Chair: Pearly Khaw
Sovereign
3.00-6.00 pm
ANZGOG Board Meeting
Paradise 1
7.00 – 9.00 pm
Welcome reception of trade networking function
Poolside Level 3
THURSDAY 23 February
8.00 – 8.45am
Keynote Gillian Thomas
Key unanswered questions in radiation treatment of gynaecological oncology
Sponsored by:
Chair: Michael Quinn
Ballroom Level 1
8.45-11.00am
Scientific Session 1: Case Based Session (Tailored for real life situations):
Sponsored by:
Chair: Michael Quinn and Pearly Khaw
1. IP therapy
2. Dose dense therapy in Ovarian Cancer.
3. High risk node neg endometriod endometrial cancer
4. Serous cancer of the endometrium
5. Early stage vulvar cancer
6. Early stage cervix cancer
Panel: Radiation Oncology: Gillian Thomas Gynaecological Oncology : Rob Coleman Nurse Care: Judy Eddy
Ballroom Level 1
11.00–11.30am Morning tea
continued over...
Surgical Oncology: Pedro Ramirez
Medical Ethics: Conor Brophy
THURSDAY 23 February
11.30–12.30pm Trials Update
Chair: Julie Martyn
Ballroom Level 1
12.30–1.30pm
Lunch/Poster session
Paradise 1&2
Nurses Special Interest Group
Fundraising Committee Meeting
Chair: Judy Eddy
Sovereign 2
Chair: David Bernshaw
Ballroom 1
1.00–3.30pm
Investigator Site roles and responsibilities training workshop
Are the right people doing the right things?–Eleanor Allan
Sovereign 1
1.30–3.30pm
Scientific Session2/Free Abstract
Chair: Andreas Obermair
Presenter
Title
Andreas Hackethal Triaging ovarian masses: Discriminating stage I ovarian cancer vs. benign ovarian lesions.
Aung Ko Win
Risks of primary cancers following endometrial cancer in Lynch syndrome
Esther Moss
Neuroendocrine carcinoma of the cervix: a review of clinical management and survival
George Au-Yeung
Radiation with or without cisplatin or carboplatin for locally advanced cervix cancer: a
single institution experience
Amanda Spurdle
Genetic approaches to assess shared aetiology of endometriosis and endometrial cancer.
Alik Zakaria
Is conservative surgery an option in borderline ovarian tumours?
Anna DeFazio
Patterns of treatment and response for relapsed ovarian cancer
Yen Tan
Under referral of women with hereditary endometrial cancer to genetic services in
Queensland: Suggestions to facilitate referral of patients at increased risk of Lynch
syndrome
Sandi Hayes
Factors associated with occurrence of lymphoedema following treatment for
gynaecological cancer
Ballroom Level 1
3.30-4.00 pm
“Afternoon Teal” 4.00-5.00 pm
Debate 1 CA125 should be routinely measured in Ovarian Cancer follow-up: “Battle of the Sexes”
Sponsored by:
Chair: Michelle Vaughan
Affirmative Team: Michael Friedlander, Jim Nicklin
Ballroom Level 1
5.00-7.00pm
Negative Team: Linda Mileshkin, Sumitra Ananda
Consumer /Nurses workshop: What do consumers want/ What do they get?
Chairs: Judy Eddy & Helene O’Neill
Sovereign 1
Free Evening
Working Dinner for Nurses/Consumers/Study Coordinators
FRIDAY 24 February
7:30–8:15am
Clinical Trials-A Consumer Perspective (the consumers invite you for a healthy breakfast)
Ballroom Level 1
8.30–10.15am
Scientific Session 3: The Cutting Edge
Chair: Clare Scott
1. Future Direction in Minimally Invasive Trial design: Pedro Ramirez
2. Is Histopathology dead in ovarian trials? : Nik Zeps
3. Should Molecular Imaging be the standard imaging for gyn cancer trials?: Paul Thomas
4. What trials need to be done assessing IMRT in gynaecological cancer? : Gillian Thomas
5. Maintenance Therapy: Trial design and assessment and clinical trial design based around biomarkers: Chee Lee
Ballroom Level 1
10.15–10.45am Morning tea
10.45–12.45pm Scientific Session 4 – New Trial Concepts
1. Michael Friedlander A phase 2 study to evaluate the efficacy of Nintedanib (BIBF1120) in controlling ascites
in patients with platinum resistant carcinoma of the ovary
2. Vivek Arora
National registry for complex atypical hyperplasia of endometrium
3. Alison Brand
Randomised Phase II pilot study of the use of vaginal oestrogen to prevent vaginal
stenosis in patients treated with pelvic radiotherapy for gynaecological malignancies
4. Michael Friedlander A Phase 2 open label study of Nintedanib (BIBF1120) in asymptomatic patients with
CA125 progression after 1st line or 2nd line chemotherapy for ovarian cancer
5. Huda Ismail
Carboplatin administration with prophylactic premedication in patients with recurrent
cancer of Ovary, Fallopian Tube and Peritoneal Cancer
6. Linda Mileshkin
A Survey of Symptoms and Concerns in Ovarian Cancer Survivors following
Chemotherapy Treatment
7. Michael Friedlander
Prospective pilot study to evaluate the utility of the MOST questionnaire to detect
symptoms of recurrent ovarian cancer in patients in follow up after 1st line
chemotherapy as well as to document the incidence, severity and duration of adverse
effects after completion of treatment
Chair: Linda Mileshkin
Ballroom Level 1
11.45-12.45
Consumer and Community Meeting
Chair: Karen Livingstone
Sovereign 1
12.45 – 1.30pm Lunch/Poster/Trade session
Quality Assurance Committee
Meeting (working Lunch)
Study Coordinator Committee
Meeting (working Lunch)
Chair: Jeff Goh
Sovereign 1
Chair: Sue Brew
Sovereign 2
1.30 – 3.30pm
Scientific Session 5 - Panel Discussion Personalised treatments in Gynaecological Malignancies – lessons from
other malignancies
Advances in melanoma: Mark ShackletonBreast: Nicole McCarthy
Lung: Ben Solomon
GI Malignancies: Matt Burge
Primo BioMed & Cvac™:: Neil Frazer
Chair: Jeff Goh
Ballroom Level 1
3.30-4.00pm
Afternoon Tea
4.00-4.45pm
ANZGOG AGM
Ballroom Level 1
4.45-5.45pm
Political Landscape of Medical Research: Doug Hilton
Chair: Clare Scott
Ballroom Level 1
7.00 – 11.00pm Conference Dinner: Sofitel
Poolside Level 3
Sponsored by:
SATURDAY 25 February
7.30-8.45am
RAC 2 Meeting
Ballroom Level 1
7.30-8.30am
Breakfast Symposium
Angiogenesis in Ovarian Cancer–Rob Coleman
Ballroom Level 1
9.00-9.30am
Scientific Session 6
How to best assess quality life in clinical trials–Martin Stockler
Ballroom Level 1
9.30-10.30am
Keynote
Maintenance therapy: can we afford it?–Rob Coleman
The evolution of cervical cancer surgery.–Pedro Ramirez
Sponsored by
Sponsored by
Chair: Ken Jaaback
Ballroom Level 1
10.30-10.45pm
Morning Tea
10.45-11.45pm
Scientific Session 7
Chair: Alison Brand
Are Clinical Trial outcomes relevant to elderly patients?
Surgical : Geoff Otton Radiation: Gillian Thomas Medical: Christopher Steer
Ballroom Level 1
11.45-12.45pm
Lunch
12.05pm
Bus transfer to Gold Coast Airport departs the Sofitel
1.00-3.30pm
Community Engagement-Consumer Information Session
Sorrento Room
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Session:
Wednesday 22nd February 3.00pm – 5.00pm
Presenter:
Gillian Thomas
Session chair:
Pearly Khaw
Topic:
Radiation Oncology Workshop
Abstract:
This session will provide radiation oncologists with the opportunity to discuss and explore areas of interest in the management of Gynaecological
Malignancies. For the inaugural event, Professor Gillian Thomas has offered to present and discuss those controversial clinical management
cases. This will be an open session focusing on difficult technical radiation issues, e.g. vaginal recurrence of endometrial cancer after pelvic RT
- how would you treat? Brachytherapy (how?) More EBRT? Both? Bring along your questions and be prepared for an informative and challenging
discussion.
Notes:
7.00pm – 9.00pm Welcome reception of trade networking function
Session:
Thursday 23rd February
8.00am – 8.45am
Presenter:
Gillian Thomas
Session chair: Michael Quinn
Topics:
Key unanswered questions in radiation treatment of gynaecological oncology
Sponsored by:
Constant curiosity and vigilance is required in the use of radiation (RT) including situations considered “standard of care” e.g., definitive
treatment of advanced cervical cancer, adjuvant treatment of high-risk endometrial cancer, and in palliation.
In advanced cervical cancer: How to improve outcomes? Will adjuvant treatments with standard or molecular targeting agents be
beneficial? Should loco-regional treatments be intensified? What gains in using highly conformal techniques? What is optimal treatment for
stage 1B2? What of prophylactic irradiation to para aortic nodes? How to best palliate with RT?
In endometrial cancer: What is the role of adjuvant radiation and using what technique in clinically early “high-risk” disease and of radiation
in FIGO stage III disease of all sub-types?
Many of the key questions posed cannot be answered with level 1 evidence from randomized clinical trials.
Notes:
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Session:
Thursday 23rd February
8.45am – 11.00am
Panel:
Gillian Thomas (Radiation Oncology), Pedro Ramirez (Surgical Oncology), Rob Coleman (Gynaecological Oncology),
Conor Brophy (Medical Ethics) & Judy Eddy (Nurse Care)
Session chair: Co-ord Michael Quinn and Pearly Khaw
Topics:
Scientific Session 1 - Case Based Session (Tailored for real life situation)
1. IP therapy
2. Dose dense therapy in Ovarian Cancer
3. High risk node neg endometriod endometrial cancer
4. Serous cancer of the endometrium
5. Early stage vulvar cancer
6. Early stage cervix cancer
Sponsored by:
Notes:
Session:
Thursday 23rd February
11.30am - 12.30pm
Session chair:
Topic:
Notes:
Julie Martyn
Trials Update
Session:
Thursday 23rd February
12:30pm – 1:30pm
Topic:
Lunch/Poster/Trade
Presenter
Title
1
Bei Zhiang
Anticancer effects of salinomycin on human ovarian cancer cells are associated with modulating IkB-a and
p38 MAPK
2
Cassie Riley
Step by Step: the journey to an ovarian cancer diagnosis and treatment
3
Catherine Bettington
Long-term control of Aggressive Angiomyxoma treated with pelvic radiotherapy: a report of 3 cases
4
Donal Brennan
RBM3-Regulated genes promote DNA integrity and affect clinical outcome in epithelial ovarian cancer
5
George Au-Yeung
Impact of obesity on ovarian cancer and chemotherapy dosing
6
Huda Ismail
Adjuvant Chemotherapy for Epithelial Ovarian Cancer– What Is Happening In Routine Practice?
7
Taryn Robinson
Audit of Usual Care provided at Australian radiotherapy treatment centres for women with gynaecological
cancer.
Notes:
Session:
Thursday 23rd February
12:30pm – 1:30pm
Session chair:
Topic:
Judy Eddy
Nurses Special Interest Group
Abstracts:
QCGC has developed referral guidelines to ensure all women with diagnosed Gynaecologic Cancer or suspected cancer have access to a
dedicated service for the right care at the right time and with the right team. All patients are presented at the Multi Disciplinary Team Meeting
(MDTM) to ensure the most appropriate evidenced based care with the best outcome for individual patients is planned and implemented.
Notes:
Session:
Thursday 23rd February
12:30pm – 1:30pm
Session chair:
Topic:
Notes:
David Bernshaw
Fundraising Committee Meeting
Session:
Thursday 23rd February
1.00pm – 3.30pm
Session chair:
Topic:
Eleanor Allan
Investigator Site roles and responsibilities training workshop
Responsibilities in Research – Are the Right People Doing the Right Things?
Abstract:
One of the most common findings by international regulators is a failure by the Principal Investigator to supervise the conduct of the clinical trial
adequately. How can you make sure that this is not an issue for your site?
This interactive workshop, aimed at Study Coordinators and Investigators, address two common conundrums in clinical trials: what is adequate
oversight and what is appropriate delegation? The workshop will explore the roles and responsibilities of the different site staff and the
limitations on these roles. We will examine how you can work with Sponsor representatives to better meet your responsibilities and how to
delegate effectively. What activities cannot be delegated by a PI? We will deal with issues such as over-delegation and lack of successful
communication between the monitor and investigators.
Finally the workshop will examine the need for site staff to be “qualified, trained and experienced”. What does this mean? What topics need to be
covered and what types of training will be most suitable for your site? How do you demonstrate to an auditor that the right people are doing the
right things?
Notes:
Session:
Thursday 23rd February
1.30pm – 3.30pm
Session Chair:
Topic:
Andreas Obermair
Free Abstract
Presenter
Title
1
Andreas Hackethal
Triaging ovarian masses: Discriminating stage I ovarian cancer vs. benign ovarian lesions.
2
Aung Ko Win
Risks of primary cancers following endometrial cancer in Lynch syndrome
3
Esther Moss
Neuroendocrine carcinoma of the cervix: a review of clinical management and survival
4
George Au-Yeung
Radiation with or without cisplatin or carboplatin for locally advanced cervix cancer: a single institution
experience
5
Amanda Spurdle
Genetic approaches to assess shared aetiology of endometriosis and endometrial cancer.
6
Alik Zakaria
Is conservative surgery an option in borderline ovarian tumours?
7
Anna DeFazio
Patterns of treatment and response for relapsed ovarian cancer
8
Yen Tan
Under referral of women with hereditary endometrial cancer to genetic services in Queensland: Suggestions
to facilitate referral of patients at increased risk of Lynch syndrome
9
Sandi Hayes
Factors associated with occurrence of lymphoedema following treatment for gynaecological cancer
1. Triaging ovarian masses: Discriminating stage I ovarian cancer vs. benign ovarian lesions.
Authors:
Andreas Hackethal, Srinivas Kondalsamy-Chennakesavan, Andreas Obermair,
Abstract:
Introduction: Whilst premenopausal women often present with functional cysts of the ovaries, the risk for malignancy increases with age.
Non-surgical discrimination between benign and early malignant changes are insufficient. Therefore, definite diagnosis of ovarian masses can
only be achieved by histological evaluation. We present Human Epididymal Protein 4 (HE4) antigen in combination with other markers as a new
approach for evaluating these findings to enhance non surgical diagnosis and compare these findings to the previously suggested Risk of Ovarian
Malignancy Algorithm (ROMA) score.
Material & Methods: This study is based on an analysis of prospectively collected biospecimens held by the Australian Ovarian Cancer Study
(AOCS). Enrolled in this study were female patients, 25 years of age or older who underwent surgery for a pelvic mass and were confirmed as
stage 1 ovarian cancer or as a benign condition. Retrieved serum blood samples were measured by two-step immunoassay for the quantitative
determination of HE4 antigen. The findings were compared to previous estimated CA-125 II and CEA concentrations.
Results: A total of 158 patients with proven stage 1 epithelial ovarian cancer (n=57) or a benign pelvic mass (n=101) were included. HE4 levels
were significantly elevated among post-menopausal women when compared to premenopausal women (p=0.001) whereas CA125 and CEA
levels did not differ between these groups. The median levels of HE4 and CA125 were significantly higher among patients with malignancy
(p<0.001 for both) whereas CEA levels did not differ (p=0.587). All three biomarkers along with age at the time of diagnosis showed significantly
higher area under the ROC curve when compared to the ROMA model HE4+CA125+CEA+Age AUC of 0.823 (95% CI: 0.734 to 0.911).
Discussion: Different algorithms have been proposed previously to enhance the differential diagnosis of ovarian masses. Today, still no
conservative tool is available to securely differentiate between benign and malignant changes and therefore, surgery continuous to be the gold
standard for securing diagnosis.
The combination of HE4, current tumour markers and age has a higher prognostic value compared to the standard ROMA algorithm or CA125
alone. It should therefore be considered for continuous evaluation in patients with adnexal masses.
Notes:
2. Risks of primary cancers following endometrial cancer in Lynch syndrome
Authors:
Aung Ko Win1, Noralane M. Lindor2, Robert W. Haile3, Polly A. Newcomb4, Loic Le Marchand5, Steven Gallinger6,7, John L. Hopper1,
Mark A. Jenkins1
Affiliations
1 Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Parkville, Victoria, Australia
2 Department of Medical Genetics, Mayo Clinic, Rochester, Minnesota, USA
3 Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
4 Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
5 University of Hawaii Cancer Center, Honolulu, Hawaii, USA
6 Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
7 Cancer Care Ontario, Toronto, Ontario, Canada
Abstract:
Background: Lynch syndrome is an autosomal dominantly inherited disorder of cancer caused by germline mutations in DNA mismatch repair
genes. Previous studies have shown that mismatch repair gene mutation carriers are at increased risk of first primary colorectal, endometrial and
several additional cancers.
Objective: To estimate the risks of primary cancers following endometrial cancer for mutation carriers to determine if those with initial
endometrial cancer might have higher subsequent risks for new primary cancers.
Methods: We obtained data from the Colon Cancer Family Registry for a cohort of 99 women carrying a pathogenic mutation in a mismatch
repair gene (35 MLH1, 58 MSH2, 4 MSH6 and 2 PMS2) who had a previous diagnosis of primary endometrial cancer. We estimated the age-,
sex-, country- and calendar period-specific standardized incidence ratios (SIRs) of subsequent primary cancers following endometrial cancer,
compared with the general population. Kaplan-Meier method was used to estimate 10- and 20-year cumulative risk (penetrance) for each cancer.
Results: For carriers of mismatch repair gene mutations who had a previous diagnosis of endometrial cancer, we observed significant increased
risks of colorectal cancer (SIR 49.35; 95% confidence interval 34.15-70.37, p<0.001), small intestinal cancer (43.85, 5.31-158.40, p<0.001),
urinary bladder cancer (26.18, 10.53-53.94, p<0.001), renal cancer (15.96, 5.18-37.24, p<0.001), hepatobiliary cancer (19.45, 5.30-49.81,
p<0.001), and breast cancer (2.97, 1.58-5.08, p<0.001). The cumulative risks at 10-year after diagnosis of endometrial cancer were as follow:
colorectal cancer (26%, 95% confidence interval 18-38%), urinary bladder cancer (3%, 1-9%), renal cancer (1%, 0.2-7%), and breast cancer
(8%, 4-17%).
Conclusions: For Lynch syndrome patients, the estimated risks of subsequent primary cancers may inform appropriate cancer screening and risk
reducing strategies following an endometrial cancer diagnosis.
Notes:
3. Neuroendocrine Carcinoma of the cervix: A review of clinical management and survival
Authors:
EL Moss1, P Pearmain2, S Askew 2, P Dawson2, K Singh1, KK Chan1, R Ganesan1, L Hirschowitz1
1 Pan-Birmingham Gynaecological Cancer Centre, West Midlands, UK
2 West Midlands Cancer Intelligence Unit, West Midlands, UK
Abstract:
Background: Neuroendocrine carcinomas (NEC) of the cervix are uncommon and very little has been reported on the diagnosis and clinical
management of these tumours
Methods: All patients diagnosed as having an NEC in the West Midlands between 1998-2009 were reviewed. A blinded review of all pathology
specimens and immunohistochemistry was performed to confirm the diagnosis.
Results: 45 cases were identified, 1.3% of all the cervical cancers registered in the West Midlands. Pathological review confirmed only 31/45
cases to be NECs. The median age at diagnosis was 43 years (range 22-94 years) with 25% being ≤30 years. Only 5/31 cases were stage
1 at diagnosis. Irregular vaginal bleeding was the most frequent presenting symptom (67.7%) and 18/31 cases were classified as screening
interval cancers. Chemotherapy was the most common primary treatment (64.5%). A platinum/etoposide combination was the most frequently
used regimen (70.8%), with women receiving a median of 4 cycles (range 2-8). Only 2 women underwent a hysterectomy as primary treatment
and one following chemotherapy/radiotherapy. Eighteen women (66.7%) underwent pelvic radiotherapy and 13 (41.9%) received vaginal
brachytherapy. Four women were not fit for treatment and received palliative care alone. The overall survival was very poor, 54% at 1-year and
only 8/31 women were alive at 2 years.
Conclusions: Neuroendocrine cancers of the cervix are not typically detected through cervical screening and present with advanced disease.
Despite multi-modal therapy the long-term prognosis is very poor. Research needs to be focused on new therapies to try and improve the
outcome of this disease.
Notes:
4. Radiation with cisplatin or carboplatin for locally advanced cervix cancer: the experience of a tertiary cancer centre.
Authors:
George Au-Yeung, Linda Mileshkin, David Bernshaw, Srinivas Kondalsamy-Chennakesavan, Danny Rischin, Kailash Narayan.
Abstract:
Background: Definitive treatment with concurrent cisplatin and radiation is the standard of care for locally advanced cervix cancer. The optimal
management of patients with a contraindication to cisplatin has not been established.
Objectives:To review the impact of concurrent chemoradiation in a cohort of patients with locally advanced cervical cancer.
Methods: All patients with locally advanced cervical cancer treated with definitive radiation were entered into a prospective database.
Demographics, stage, histology, recurrence and survival were recorded. Pharmacy records were reviewed to determine concurrent chemotherapy
use. The primary endpoint was overall survival (OS), and secondary endpoints were disease free survival (DFS) and rates of primary, nodal or
distant failure. Univariate and multivariate analyses were performed.
Results: 442 patients were treated from Jan 1996 to Feb 2011. 269 patients received cisplatin, 59 received carboplatin and 114 received
no concurrent chemotherapy. OS was significantly improved with use of concurrent cisplatin compared to radiation alone (adjusted HR 0.53,
p=0.001), as was DFS and the rate of distant failure. Use of concurrent carboplatin was not associated with any significant benefit compared to
radiation alone in terms of OS or DFS on univariate or multivariate analyses.
Conclusions: The results of this audit are consistent with the known significant survival benefit with concurrent cisplatin chemoradiation.
However, concurrent carboplatin did not have a statistically significant benefit although there are potential confounding factors in this
small cohort. The available evidence in the literature favors the use of non-platinum chemotherapy rather than carboplatin in patients with
contraindications to cisplatin.
Notes:
5. Genetic approaches to assess shared aetiology of endometriosis and endometrial cancer.
Jodie Painter1, Stuart MacGregor1, Grant Montgomery1, Penny Webb1, Krina Zondervan2, Douglas Easton3, Alison Dunning3, Paul
Pharoah3, Deborah Thompson3, Nick Martin1, Rodney J Scott 4,5, Liz Holliday4,5, Mark McEvoy4,5, John Attia5, ANECS Group, SEARCH
collaborators, Amanda Spurdle1*
1 Queensland Institute of Medical Research
2 Oxford University
3 Cambridge University
4 The University of Newcastle
5 John Hunter Hospital
* Presenting author, [email protected]
Background: There is conflicting evidence regarding the relationship between report of endometriosis and endometrial cancer risk, with
traditional case-control analyses potentially confounded by bias in co-incidental diagnoses of endometriosis and endometrial cancer in cases
versus controls.
Objectives: To use existing endometriosis and endometrial cancer genome-wide association datasets to estimate the proportion of genetic
variants associated with risk of one disease that also contribute to risk of the other disease. Further, to identify specific genes that underly this
shared genetic aetiology.
Methods: Cross-disease prediction analysis was conducted to assess the proportion of the 500K genetic variants within the genome-wide
dataset that most significantly accounted for shared genetic aetiology of endometriosis and endometrial cancer. Meta-analysis of the pooled
endometriosis-endometrial cancer dataset, followed by gene-based analysis, was used to highlight specific variants and genes worthy of future
investigation.
Results: Cross-disease prediction revealed a shared genetic background between endometriosis and endometrial cancer (prediction P value <
1 x 10-8 using the top 1% of variants assayed). Meta-analysis of the two datasets revealed 8 loci of interest, captured by 20 variants at/near
genome-wide significance levels. Additional analyses that accounted for the location of variants in/near genes highlighted 7 genes of interest for
further study, each harbouring multiple variants associated with risk of both diseases. Notably, these included a logical candidate gene encoding a
hormone receptor known to be dysregulated in both diseases.
Conclusions: Cross-disease prediction analysis confirms shared genetic prediction to endometriosis and endometrial cancer, and identifies loci of
interest for future study.
Notes:
6. Is conservative surgery an option in borderline ovarian tumours?
Authors:
Zakaria AR, McNally OM, MA Quinn Oncology Unit, The Royal Women’s Hospital, Parkville, VIC 3052
Abstract:
Background: Borderline ovarian tumours (BOTs) comprise 10-15% of all ovarian cancers and recurrence rate ranges from 7-15%. There is
a growing interest in conservative surgery for fertility preservation however, this has to be balanced against the risk of tumour recurrence
associated with this approach.
Objectives: To evaluate the risk of recurrence in various types of surgery for borderline ovarian tumours (BOTs).
Material and methods: A retrospective review of 223 patients with BOTs seen in The Royal Women’s Hospital from 1994 to 2007. The
clinicopathological characteristics were evaluated for association with recurrence.
Results: Median age was 43.0 years (range, 17-93 years). The histological subtypes were serous 45.8% (n=102), mucinous 45.8% (n=102),
mixed 5.8 %( n=13), endometroid 2.2% (n=5) and others 0.4% (n=1). The majority, 93.3% (n= 208) was FIGO stage 1 where 64.1% (n=143),
5.8% (n=13) and 23.4% (n=52) were 1A, 1B and 1C respectively. 0.4% (n=1) were stage FIGO 2C; 1.8% (n=4) FIGO 3A; 0.9% (n=2) FIGO 3B and
1.8% (n=4) FIGO 3C .The remaining 1.8% of patients (n=4) were unstaged. Fertility sparing surgery was performed in 103 patients (46.2%). The
overall recurrence rate was 9.4% and the median time to recurrence was 50 months. Univariate analysis revealed that age 40 years and less
(p=0.001) and cystectomy (p=0.001) were associated with higher risk of recurrence. Bilateral salpingo-oophorectomy (p=0.001), hysterectomy
(p= 0.001) and omentectomy and/or biopsy (p=0.018) were associated with lower risk of recurrence. However, logistic regression analysis
showed none of the above factors were an independent risk factor for tumour recurrence.
Conclusions: In women with BOTs, hysterectomy, bilateral salpingo-oophorectomy and omentectomy and/or biopsy should be standard
management. However, in women who wish fertility preservation or with significant medical co-morbidities, less radical surgery i.e. cystectomy or
unilateral salpingo-oophorectomy can be a safe alternative.
Notes:
7: Patterns of treatment and response for relapsed ovarian cancer
Authors:
Anna DeFazio, Sian Fereday1, Catherine Emmanuel2,3, Jillian Hung2,3, Paul Harnett3,4, Debra Giles1, Nadia Traficante1, Georgia ChenevixTrench5, Penny Webb5, David Bowtell1, AOCS Study Group Dept Gynaecological Oncology, Westmead Hospital and Westmead Institute for
Cancer Research, WMI, Westmead NSW , 2145
1 Peter MacCallum Cancer Centre, Melbourne, Vic
2 Dept Gynaecological Oncology Westmead Hospital
3 Westmead Institute for Cancer Research, Uni of Sydney at WMI, Sydney, NSW
4 Dept Medical Oncology; 5Queensland Institute of Medical Research, Brisbane, Qld.
Abstract:
Background: Response to primary treatment for ovarian carcinoma is generally high, however most women relapse within 2 years. Diverse
treatment options are available at recurrence, but there are few markers to guide clinical decision-making. Recurrence <6 months after primary
treatment is associated with ‘platin-resistance’ and alternative treatments have been suggested.
Objectives: We reviewed patterns of treatment for relapsed ovarian cancer, and response, in women diagnosed between 2002-2006.
Methods (including type of data collected): Our cohort included 1454 women with ovarian, fallopian tube or primary peritoneal carcinoma
recruited to the Australian Ovarian Cancer Study. Disease progression and treatment response were determined using CA125/GCIG criteria.
Complete response (CR) was defined as CA125 normalisation from an elevated pre-treatment level, maintained for ≥28 days.
Results: Overall, 795 patients (55%) progressed and were treated with chemotherapy. The most common second-line treatments were
carboplatin regimens (n=435, 55%) and CR ranged from 38 to 76% of evaluable cases, for different combinations. The most common single
agent treatment was liposomal doxorubicin (n=216, 27%) and response was generally low (CR, 11/165 (7%) evaluable cases).
Chemotherapy response was lower in patients that relapsed early (<6 months after treatment). However, importantly, 16% (10/61) of patients
with early progression had a CR to platin re-treatment compared with CR in only 6% (10/164) women who received a non-platin regimen.
Conclusions: Our data suggests better responses to platin-regimens compared with non-platins at first relapse, regardless of the progressionfree interval. Although response to non-platins was generally low, subsets of patients responded well, highlighting the need for molecular and
clinical markers to help select treatments most likely to succeed in individual patients.
Notes:
8. Under-referral of women with hereditary endometrial cancer to genetic services: suggestions to facilitate referral of patients at increased
risk of lynch syndrome.
Authors:
Yen Y. Tan1,3,4, Julie McGaughran1,2, Kaltin Ferguson4, Michael D. Walsh1,4, Daniel D. Buchanan4, ANECS Group, Joanne P. Young4, Penelope
M. Webb4, Andreas Obermair1,3, Amanda B. Spurdle4
1 The University of Queensland School of Medicine, Brisbane, Queensland, Australia.
2 Genetic Health Queensland, Brisbane, Queensland, Australia.
3 Queensland Centre for Gynecological Cancer Research, Royal Brisbane & Women’s Hospital, Brisbane, Queensland, Australia.
4 Genetics Department, Cancer Program, Queensland Institute of Medical Research, Brisbane, Queensland, Australia.
Abstract
Purpose: Current evidence suggests many individuals at risk of carrying an inherited mutation in a cancer-associated gene based on their
personal/family history of cancer are not referred for genetic assessment. This study evaluated the rates and patterns of referral of women
diagnosed with endometrial cancer to genetic services in Queensland, Australia.
Methods: For women diagnosed with endometrial cancer between May 2005 and December 2007, data were linked from three sources: a
research study with detailed family history information; a major public hospital clinical database; and the public genetic service provider referral
database. We determined the percentage of women who could have been referred to genetic services based on hereditary cancer syndrome
criteria, and the percentage of women who were referred and who attended their scheduled appointments.
Results: Clinical records were identified for 397 endometrial cancer patients. Research data indicated that 236 (59%) had a personal/family
history of cancer, including 45 (11%) who fulfilled Amsterdam II Lynch syndrome criteria indicative of hereditary cancer. However, any form of
family history was noted in the hospital records of only 61 (15%) women, including 22 (6%) of those meeting Lynch criteria. Only 13 (3%) patients
(4 meeting Lynch criteria) were referred for genetic assessment, and all 12 patients remaining alive attended their appointments. Most referrals
(39%) were by general practitioners.
Conclusions: Clinical records indicate poor recognition of family history and referral to genetic services for women with endometrial cancer.
Application of research methods to document family history may facilitate automated referral for genetic assessment.
Notes:
9. Factors associated with occurrence of lymphoedema following treatment for gynaecological cancer
Authors:
S.C. Hayes1, M. Janda1, H. Reul-Hirche2, L. Ward3, A. Obermair4
1 School of Public Health, Queensland University of Technology
2 Royal Brisbane and Women’s Hospital, Physiotherapy
3 Physiology, University of Queensland
4 Royal Brisbane and Women’s Hospital, Queensland Centre of Gynaecological Research, Brisbane, QLD, Australia
Background: Lower limb lymphoedema is a serious and feared sequelae after treatment for gynaecological cancer. Given limited prospective data
on incidence of and risk factors for lymphoedema after treatment for gynaecological cancer we intitiated a prospective cohort study in 2008.
Methods: Overall, 672 women were assessed before treatment and at regular intervals after treatment for two years. Logistic regression was
used to assess risk of developing lymphoedema measured by 5% increase in sum of leg circumference (SOC)/weight from baseline among
different cancer groups; 419 patients with follow-up SOC/weight measurements were included.
Results: Proportions of patients and estimated odds ratios for developing lymphoedema in each cancer type group (reference benign) are shown
in Table1.
Conclusions: Patients with vulval cancer and those receiving adjuvant therapy appear most at risk of developing lymphoedema following
gynaecological cancer treatment.
Table1: Risk of developing lymphoedema measured by 5% increase in SOC*/weight ratio, age-adjusted
95% CI
N(%) with
LE**
Age
Odds ratio
Lower limit
Upper limit
P value
1.023
1.003
1.044
0.023
New cancer type categories by treatment:
Benign
LND‡ (%)
0.005
20/103 (19%) 1.000
-
-
-
22%
-
-
-
-
86%
2.104
0.578
7.653
0.259
77%
Surgery only 4/9 (44%)
2.887
0.697
11.951
0.144
56%
Surgery + chemo or radiotherapy 5/7 (71%)
9.960
1.788
55.498
0.009
100%
Stage I or II 13/35 (37%)
2.240
0.957
5.241
0.063
49%
Stage III or IV 20/46 (43%)
2.615
1.198
5.710
0.016
28%
Surgery only without LN dissection 14/43 (33%)
1.593
0.695
3.650
0.271
0%
Surgery only with LN dissection 10/31 (32%)
1.531
0.606
3.867
0.367
100%
<0.0001
52%
Cervical
Surgery only -/7 (0%)
Surgery + chemo or radiotherapy 4/13 (31%)
Vulval
Ovarian
Endometrial
Surgery + chemo or radiotherapy 65/125 (52%) 3.726
2.001
6.937
*sum of circumferences **lymphoedema measured by 5% increase in SOC/weight ratio from baseline
‡Proportion in each cancer type category that had lymph node dissection performed
†Odds ratio estimation not possible as no patients in this group developed lymphoedema
Notes
3.30-4.00pm Afternoon Teal
Session:
Thursday 23rd February
4.00pm – 5.00pm
Session chair:
Michelle Vaughan
Presenter:
Con – Linda Mileshkin, Sumitra Ananda
Pro – Michael Friedlander, Jim Nicklin
Topic:
Notes:
Debate: CA125 should be routinely measured in Ovarian Cancer follow-up: “Battle of the Sexes”
Session:
Thursday 23rd February
5.00pm – 7.00pm
Session chair:
Judy Eddy & Helene O’Neill
Presenters: Penny Schofield, Cassie Riley, Glynis Cumming, Merran Williams:
Topic:
Consumer/ Nurses workshop
Intensive training methods for Nurses and Peer volunteers who deliver a complex, psychosocial intervention in a Phase III trial.
Penelope Schofield1, Ilona Juraskova2, Rebecca Bergin1, Trish Waters3, Suzi Grogan1, Kate White2, Stella Bu2, Annette Beattie4,
Rachel Murray1, Meinir Krishnasamy1, Alison Hocking1, Taryn Robinson1, Sanchia Aranda1.5
1 Peter MacCallum Cancer Centre, Melbourne, Australia
2
3 Cancer Council Victoria, Melbourne Australia, 4Cancer Council NSW, Sydney Australia
5 Cancer Institute NSW
Department of Psychology, University of Sydney, Sydney, Australia
Background: All clinical trials require strict adherence to study protocol and processes. Non-pharmacological, complex intervention trials can
only be successful if the intervention is delivered in a standard manner and according to protocol. This can be achieved by selecting appropriate
individuals and providing comprehensive, evidence-based training and ongoing supervision.
Objective: To describe an intensive program of recruitment, training and supervision of nurses and peers (survivors of gynaecological cancer)
delivering a complex, psychosocial intervention in PENTAGON, a national Phase III trial.
Methods: Two standardised manuals were developed for both nurses and peers specifying (a) the intervention content and (b) the training
and supervision procedures. Nurses and potential peer volunteers were identified via the gynaecological multidisciplinary team at each site.
Potential peers were sent invitation letters, interviewed by Cancer Council experts and those identified as appropriate were invited to attend
training. Both nurses and peers attended separate two-day training workshops which incorporated evidence-based modules on gynaecological
cancer treatment and side-effects, psychosexual issues, promoting adherence, communication skills and motivational interviewing (nurses only).
Training, which was facilitated by experts, emphasised adherence to protocol, prevention of intervention diffusion and, for peers, confidentiality,
boundaries and self-care. Interactive discussion, audio or video taped examples of intervention delivery and facilitated group role-play with
simulated patients were used to deliver the training. Expectation and evaluation forms assessed perceived improvement in key skills and provide
feedback on workshop delivery and content. Post-workshop nurse and peers completed practice phone calls with a simulated patient. A
communications skills expert provided written and verbal feedback. Ongoing supervision of intervention sessions is being provided.
Results: In total, 9 nurses and 15 peers have completed training. Workshop participants reported improvement in skills, high approval of
facilitators, no aspects of the workshops were identified as ‘least valuable’ and the peers particularly, enjoyed meeting other participants. Expert
assessment of practice calls demonstrated use of communication skills, general adherence to study processes and correct completion of
documentation.
Conclusions: A rigorous, multi-stage process of recruitment, training and supervision for individuals delivering a psychosocial intervention was
designed and found to be acceptable and effective. Such programs underpin standardizing the delivery of complex interventions and are critical
to the success these types of trials.
Notes:
What do consumers want, what do they get?– Cassie Riley
• Overview of the patient’s journey through the system in Western Australia
• Discuss the challenges within the WA system & the future direction of gynae oncology
• Partnerships in care - how can consumers & medical teams work together to influence the future direction of cancer care.
Notes:
Glynis Cumming
In New Zealand in 2008 there were 987 gynaecological cancers registered, accounting for approximately 10% of all cancer cases and 10%
of all cancer deaths. Gynae-oncology services operate within 21 districts health boards (DHBs) in New Zealand and access for women with
gynaecological cancer to evidence-based multidisciplinary care is inconsistent. Other challenges to providing optimal gynae-oncology services
include work force shortages and lack of formal referral processes. Nurses play a vital key role in coordinating care between departments and
regional services. The specialist gynaecological cancer nursing workforce in New Zealand is small and in this presentation I will discuss the role
of the Gynaecological Oncology Clinical Nurse Specialist (GOCNS) in New Zealand
Notes:
Merran Williams:
I was diagnosed with Stage 3B epithelial ovarian cancer in December 2008, an incidental finding, and underwent radical surgery followed by 6
cycles of chemotherapy. At the time, I was working full time as a quality clinical nurse consultant at Prince Charles Hospital, in Brisbane.
Being both an experienced nurse as well as a gynaecological cancer survivor, has led me on a most interesting and rewarding journey. I have had
to adjust to a new sense of what is “normal”, and have learned to actively include wellness activities into my daily routine. I have to manage late
side effects from my surgery (lymphoedema) as well as numbness from chemotherapy. Striking the right work/life balance has been a challenge.
In 2011 I was awarded a Churchill Fellowship and visited several premier cancer services in America, examining their survivor models of care. In
my presentation, I will discuss how we could incorporate aspects of these models to fill gaps in current gynae cancer service delivery.
Notes:
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Free Evening
7.15pm
Working Dinner for Nurses/Consumers/Study Coordinator
Mario’s Restaurant, Oasis Shopping Centre
Session:
Friday 24th February
7.30am-8.15am
Topic:
Notes:
Working Breakfast: Clinical Trials – A Consumer Perspective
Session:
Friday 24th February
8.30am – 10.15am
Session chair:
Clare Scott
Presenter:
Pedro Ramirez, Nik Zeps, Paul Thomas, Gillian Thomas & Chee Lee
Topic:
Scientific Session 3 – The Cutting Edge
Future Direction in Minimally Invasive Trial design : Pedro Ramirez
Abstract:
The presentation will focus on the importance of surgical research in the field of gynecologic oncology and the current lack of major prospective
randomized trials with a surgical focus. An overview of the barriers to developing, implementing, and completing surgical trials will be discussed.
Emphasis on protocol requirements for collaborative trials will be reviewed as well as important end-points of such surgical trials. An update will
be provided on the progress of an important multi-institutional trial comparing laparotomy to minimally invasive surgery in the management of
patients with early-stage cervical cancer undergoing radical hysterectomy.
Notes:
Is Histopathology dead in ovarian trials? : Nik Zeps
Abstract:
Whilst the death knell for the role of histopathology has been sounding since the first molecular portraits were painted back in the late 90’s,
the reality has been somewhat different. Despite some encouraging initial results in breast cancer and lymphoma the use of molecular, rather
than classical histological and clinical, criteria has been somewhat underwhelming. Nevertheless, the introduction of targeted therapies such as
herceptin and erbitux has led to the use of companion molecular diagnostic tools to stratify patients both for trials and in clinical practice. Most
recently, so called next generation sequencing technologies (better regarded as massively parallel sequencing), has led to a huge reduction in
sequencing cost and time. The promise of sub $1000 whole human genomes within the next 5 years hints at a possibility that such analyses
will be within reach of routine diagnostics in the very near future. Will this be the revolution we have been waiting for or will it be like expression
arrays, more of a curiosity than core business? What will it mean for how we do clinical trials? Will the histopathologist really be able to hang up
the microscope?
Notes:
Should Molecular Imaging be the standard imaging for gynaecological cancer trials? : Paul Thomas
Abstract:
PET imaging is increasingly used in a variety of malignancies as standard clinical practice. In gynaecologic malignancies, FDG-PET/CT can
improve staging (particularly in the detection of more distant metastases), is sensitive for the early detection of recurrence, and may provide
earlier response assessment than conventional imaging. These PET characteristics could reduce the cost and length of clinical trials by providing
surrogate outcome and response markers. In addition, a variety of non-FDG PET tracers can provide insights into tumour biology, such as hypoxia,
proliferation, apoptosis and angiogenesis.
Notes:
What trials need to be done assessing IMRT in gynaecological cancer? : Gillian Thomas
Abstract:
Conformal radiation techniques for all cancers have become “soup de jour”. Technologically focuses publications overwhelm our specialty. To
quote Winston Churchill “However beautiful the strategy, you should occasionally look at the results.” Theoretically diminishing complications by
applying tight margins around tumours using inaccurate imaging may actually compromise outcomes.
Barriers to implementing controlled clinical trials of IMRT include appropriate quality assurance (QA) measures, routine uptake of IMRT based only
on dosimetric studies, unlikely patient acceptance of randomization and low event rates. The limitations of current guidelines for adjuvant postoperative IMRT for endometrial and cervix cancers and delivery of IMRT to the intact cervix will be discussed.
If IMRT is used how should it be and are QA measures sufficiently stringent to incorporate it into clinical trials?
Notes:
Maintenance Therapy: Trial design and assessment and clinical trial design based around biomarkers. : Chee Lee
Abstract:
Patients with a particular gynaecological cancer are a heterogeneous group with variable prognosis and response to anti-neoplastic treatments.
Recent advancement in the understanding of tumour biology potentially enables the genetic makeup of the tumour and the genotype of the
patient to guide patient-specific treatment selection. The use of molecular biomarkers to supplement or replace conventional clinico-pathological
factors has the potential to transform the practice of medicine by creating new opportunities for developing and tailoring treatments to individual
patients. However, evidence from randomized clinical trials (RCTs) is required to demonstrate the clinical utility of molecular biomarkers before
these medical advances could be implemented into clinical practice. In order to guide design and interpretation of RCTs that evaluate biomarkers,
a brief overview commonly used trial designs will be presented. The theoretical considerations and the practical challenges of these designs will
also be discussed.
Notes:
Session:
Friday 24th February
10.45am – 12.45pm
Session chair:
Linda Mileshkin
Presenters:
Michael Friedlander, Vivek Arora, Alison Brand, Huda Ismail, Linda Mileshkin
Topic:
New Trial Concepts
1. Michael Friedlander
A phase 2 study to evaluate the efficacy of Nintedanib (BIBF1120) in controlling ascites in patients with
platinum resistant carcinoma of the ovary
2. Vivek Arora
National registry for complex atypical hyperplasia of endometrium
3. Alison Brand
Randomised Phase II pilot study of the use of vaginal oestrogen to prevent vaginal stenosis in patients treated
with pelvic radiotherapy for gynaecological malignancies
4. Michael Friedlander
A Phase 2 open label study of Nintedanib (BIBF1120) in asymptomatic patients with CA125 progression after
1st line or 2nd line chemotherapy for ovarian cancer
5. Huda Ismail
Carboplatin administration with prophylactic premedication in patients with recurrent cancer of Ovary,
Fallopian Tube and Peritoneal Cancer
6. Linda Mileshkin
A Survey of Symptoms and Concerns in Ovarian Cancer Survivors following Chemotherapy Treatment
7. Michael Friedlander
Prospective pilot study to evaluate the utility of the MOST questionnaire to detect symptoms of recurrent
ovarian cancer in patients in follow up after 1st line chemotherapy as well as to document the incidence,
severity and duration of adverse effects after completion of treatment
Notes:
Session:
Friday 24th February
11.45-12.45pm
Session chair:
Karen Livingstone
Topic:
Consumer and Community Meeting
Notes:
12:45pm – 1:30pmLunch/Poster/Trade Networking
Session:
Friday 24th February Session:
12.45pm-1.30pm Friday 24th February
12.45pm-1.30pm
Session chair:
Jeff Goh
Sue Brew
Topic:
Notes:
Quality Assurance Committee Meeting
Session chair:
Topic:
Study Coordinators Committee Meeting
Session:
Friday 24th February
1.30pm – 3.30pm
Session chair:
Jeff Goh
Presenters:
Mark Shackleton, Nicole McCarthy, Ben Solomon, Matt Burge
Topic:
Personalised treatments in Gynaecological Malignancies - Lessons from other Cancers
Advances in melonoma–Mark Shackleton
Abstract:
The management of cancer is undergoing revolutionary change. In the melanoma field, this is based on dramatically improved understanding of
the molecular basis of melanoma formation and progression, such as the key role played by specific, targetable oncogenes, including BRAF. This
progress has resulted from the convergence of advances in genomics technologies, the banking of clinically annotated human tumors, and the
development of pre-clinical modelling tools. Underpinned by these resources and to the great benefit of melanoma patients, the pace continues to
increase astoundingly of progress from melanoma gene discovery to clinical application of new therapies.
Notes:
Lessons from breast cancer–Nicole McCarthy
Abstract:
Standard breast cancer histopathology provides prognostic and predictive information including the hormone receptor and HER2 status. This
information helps direct systemic therapies. Sadly, metastatic breast cancer remains an incurable disease and this drives the need for more
effective treatment The original hormonal therapies including ovarian ablation and tamoxifen are effective and incremental survival improvements
have been seen with the aromatase inhibitors and more recently the incorporation of a mTOR inhibitor.
Trastuzumab is a vital component of the HER2 positive breast cancer treatment algorithm. Optimisation of anti-HER2 therapy is being achieved
by combining trastuzumab with newer agents such as lapatinib and pertuzumab and new anti-Her2 agents such as T-DM1 are also becoming
available.
Notes:
Lessons from lung malignancies–Ben Solomon
Abstract:
Non-small cell lung cancer is not one disease but a collection of distinct clinico-pathological entities with frequently identifiable molecular drivers.
The efficacy of identifying and therapeutically targeting molecularly-defined subsets of NSCLC has been provided in tumors driven in tumors
driven by EGFR mutations or ALK gene rearrangement. Additional molecular targets for which drugs are in various stages of clinical development
have been identified in subsets of both adenocarcinoma and squamous cell carcinoma in non-smokers and smokers. Current challenges include
identification of molecular targets which may be present in small subsets of tumours and overcoming acquired resistance to targeted agents.
Notes:
Lessons from GI malignancies –Matt Burge
Abstract:
Survival times have significantly increased over the past 10 years with the introduction of new agents to clinical practice, including oxaliplatin,
irinotecan, bevacizumab, cetuximab, panitumumab and, most recently, aflibercept and regorafenib. With this has come a burgeoning complexity
in treatment algorithms. However, there is a broad range of outcomes experienced by individual patients when exposed to these drugs.
Determinants of the predictors of an individuals benefit (or lack thereof) to a specific therapy (predictive biomarker) have been intensively
researched in mCRC in recent years. This lecture will summarise current knowledge as it impacts clinical practice and highlight the major
challenges which lie ahead to advance the goal of individualised care in metastatic colorectal cancer.
Notes:
Session:
Friday 24th February
3.15pm – 3.30pm
Session chair:
Jeff Goh
Presenter:
Neil Frazer
Topic:
Primo BioMed & Cvac™
Primo BioMed & Cvac™ –Neil Frazer
Abstract:
Interest in revitalizing the immune system to attack malignancies has increased substantially in recent years. With the approval of Provenge
® to treat hormone refractory prostatic malignancy, the concept of cellular immune therapeutics has been validated. Several products are in
development based on tumor lysate, or other antigens to treat ovarian cancer. Cvac™ autologous cell vaccine is in advanced research, with
first patients being recruited in the Phase III CANVAS (CANcer VAccine Study) double blind placebo controlled study globally in Q1 2012. This
talk will address the concept of autologous cell therapy, and will compare and contrast different therapeutic approaches to immune therapy for
gynaecological malignancies.
Notes:
Session:
Friday 24th February
4.45pm – 5.45pm
Session chair:
Clare Scott
Presenter:
Doug Hilton
Topic:
Political Landscape of Medical Research
Political Landscape of Medical Research–Doug Hilton
Abstract:
In Australia, the general public ultimately funds the vast majority of health and medical research: either from taxes via state and federal
governments or from donations via charitable organisations, such as the Cancer Councils. With funding comes responsibility to spend money
wisely. The review of the health and medical research sector announced by Minister Mark Butler and chaired by 2011 Australian of the Year,
Simon McKeon provides the sector an opportunity to communicate the importance of medical research to the Australian community and to
articulate what is needed to maximize benefits that can accrue from health and medical research. I will discuss these issues.
Notes:
7.00-11.00pm Conference Dinner
Session:
Saturday 25th February
7.30am – 8.45am
Presenter:
Rob Coleman
Topic:
Angiogenesis in Ovarian Cancer
Sponsored by:
Angiogenesis in Ovarian Cancer–Rob Coleman
Abstract:
In response to mounting evidence that vascular endothelial growth factor among other pro-angiogenic cytokines play a critical role in ovarian
cancer biology, clinical investigation of agents targeting these elements was pursued and revealed promising activity in early investigation.
Subsequent phase III studies have now documented improved outcomes in several different patient cohorts. However, controversy regarding dose
and duration of therapy, subgroups likely to benefit most, toxicity, and cost linger. In addition, mechanisms for target resistance are not clear,
further clouding optimal management strategies. These topics will be presented, reviewed and discussed.
Notes:
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Contacts –
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Session:
Saturday 25th February
9.00am – 9.30am
Presenter:
Martin Stockler
Topic:
How to best assess quality life in clinical trials
How to best assess quality life in clinical trials –Martin Stockler
Abstract:
Most people agree that quality of life is a major consideration for people with cancer, and a crucial outcome of anticancer treatment. Decisions
about anticancer treatments typically involve trade-offs between beneficial effects on survival and cancer related symptoms, versus detrimental
effects of treatment toxicities and inconvenience. While contemporary trials of cancer treatments often include measures of quality of life,
their reported results often leave readers underwhelmed. This presentation will propose a more informative and clinically useful approach
to measuring, analysing and interpreting quality of life and preferences data in cancer clinical trials using examples of ongoing and previous
ANZGOG studies.
Notes:
Session:
Saturday 25th February
9.30am – 10.30am
Session chair:
Ken Jaaback
Presenters:
Rob Coleman, Pedro Ramirez
Topic:
Scientific Session 7
Maintenance therapy: can we afford it? –Rob Coleman
Abstract:
It has been well documented that advanced-stage ovarian cancer patients who achieve a complete clinical remission following surgical
cytoreduction and adjuvant chemotherapy have a high risk for subsequent relapse. In part, this is due to the insensitivity of non-invasive imaging
and biomarker clinical assessment as many patients undergoing second-look assessment procedures are found with small volume disease.
However, even patients found with pathological complete response to frontline therapy are found with subsequent relapse in up to 40% of
such cases. The reason for this phenomena is not well understood but several randomized clinical trials to reduce this risk have failed. Recent
analyses of anti-VEGF treatment trials suggest that continuous exposure of these agents may be of value. However, concerns of toxicity and cost
without clear survival impact temper enthusiasm for this approach. These issues will be presented and discussed.
Notes:
The evolution of cervical cancer surgery – Pedro Ramirez
Abstract:
The presentation will review the most current surgical approaches in the management of patients with early-stage cervical cancer. An update on
the latest literature pertaining to radical hysterectomy will be presented. The most recent information on ideal candidates and surgical outcomes
in young patients seeking fertility preservation will be reviewed, focusing both on radical trachelectomy and more conservative management.
A review of two important prospective trials evaluating conization or simple hysterectomy in select patients with stage IA2-IB1 will also be
discussed. The presentation will also focus on recent surgical trials supporting surgical staging in patients with locally-advanced cervical cancer.
Notes:
Session:
Saturday 25th February
10.45am – 11.45am
Session chair:
Alison Brand
Presenters:
Geoff Otton, Gillian Thomas, Christopher Steer
Topic:
Scientific Session 7: Are clinical trial outcomes relevant to elderly patients?
Surgical –Geoff Otton
Abstract:
The population is getting older. Currently 3-4% of women are over the age of 80 in Australia. It is likely that the health of women reaching this
age will improve with time and we will be faced with the challenge of managing older women with gynaecologic cancers. How important is age?
Is the evidence of clinical trials relevant to older women?
Surgical trials variably include women beyond the age of 80 years. Data would suggest that age alone is not best indicator of outcome. The
presence of significant comorbidities is more relevant.
Notes:
Radiation – Gillian Thomas
Abstract:
There is no widely accepted definition of what chronological age defines the “older”/“elderly” patient. The WHO definition is evolving. Default
definitions even include pensionable age (e.g., 60 or 65 years). In Africa 50 years is considered “elderly” as when active contribution to society or
social role is not possible.
Should “ageism” limit eligibility for trials? Clearly appropriate and functional definitions of “elderly” would include the use of multidisciplinary
diagnostic instruments which collect data on the medical, psychosocial and functional capacity. Quality of life and performance status are
important.
Specific clinical trials will be discussed with reference to the chronological age distribution and performance status of study patients and whether
it is representative of the distribution of disease. The predominant inclusion of younger patients with good performance status may limit the
external validity of some trials.
Notes:
Medical – Christopher Steer
Abstract:
The median age of patients at the first diagnosis of epithelial ovarian cancer (EOC) is 64 years (Yancik R., SEER data 2000-3). This data also
suggests that 47% of patients are over the age of 65 at diagnosis and 26% of patients are older than 75 years. Whilst the definition of “elderly”
remains difficult on the basis of chronological age alone, it is generally accepted that patients over the age of 70 years can be considered in this
group. The incidence of comorbidities and “geriatric syndromes” such as dementia, falls and incontinence increases after the age of 70 years.
The fact that older patients are underrepresented in clinical trials of therapy for ovarian cancer is well documented. In the ICON3 trial only 29% (n
= 591) of patients were over the age of 65 and the median age of all patients was 58.9 years. In GOG182/ICON5 17% (n=620) of patients were
over the age of 70 years and the median age was 59 years.
Whilst these data would suggest that it might be difficult to apply the results of such trials to an older population, the conundrum is made more
complex by the fact that fit elderly patients have been shown to tolerate chemotherapy as well as younger patients. Despite this, older patients
with ovarian cancer specifically have been shown to have an inferior survival even when treated as part of a clinical trial.
Thus I would conjecture that this problem needs to be dissected into different components. Due to the heterogeneous nature of the older patient
population with cancer it is impossible to provide just one answer to the question. Appropriate management of the older patient with ovarian
cancer requires individualised care; the management of a frail older patient is very different from someone who is fit. Whilst we can opine that
existing trial results cannot be applied to older adults we are really saying that we lack data to guide the therapy of frail or vulnerable individuals
regardless of age.
This problem is not restricted to gynaecological malignancies. The lack of clinical trial data in older patients is a major issue in the common
cancers of older adults – colon, lung, breast and prostate. Organisations such as SIOG (International Society for Geriatric Oncology) are acting to
highlight the issue and encourage clinical trial organisations around the globe to increase the numbers of older adults in existing trials and design
studies to provide information on the appropriate treatment of the more frail elderly patient population.
Notes:
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