Clinical relevance of cancer stem cell chemotherapeutic assay for recurrent ovarian cancer

© 2020 Introduction: Disease recurrence and progression of ovarian cancer is common with the development of platinum-resistant or refractory disease. This is due in large part to the presence of chemo-resistant cancer stem cells (CSCs) that contribute to tumor propagation, maintenance, and treatment resistance. We developed a CSCs drug cytotoxicity assay (ChemoID) to identify the most effective chemotherapy treatment from a panel of FDA approved chemotherapies. Methods: Ascites and pleural fluid samples were collected under physician order from 45 consecutive patients affected by 3rd-5th relapsed ovarian cancer. Test results from the assay were used to treat patients with the highest cell kill drugs, taking into consideration their health status and using dose reductions, as needed. A retrospective chart review of CT and PET scans was used to determine patients\u27 outcomes for tumor response, time to recurrence, progression-free survival (PFS), and overall survival (OS). Results: We observed that recurrent ovarian cancer patients treated with high-cell kill chemotherapy agents guided by the CSCs drug response assay had an improvement in the median PFS corresponding to 5.4 months (3rd relapse), 3.6 months (4th relapse), and 3.9 months (5th relapse) when compared to historical data. Additionally, we observed that ovarian cancer patients identified as non-responders by the CSC drug response assay had 30 times the hazard of death compared to those women that were identified as responders with respective median survivals of 6 months vs. 13 months. We also found that ChemoID treated patients on average had an incremental cost-effectiveness ratio (ICER) between -$18,421 and$7,241 per life-year saved (LYS). Conclusions: This study demonstrated improved PFS and OS for recurrent ovarian cancer patients treated with assay-guided chemotherapies while decreasing the cost of treatment

Snowdon Wildlife Refuge Folder

59 pages of subject files containing and related to Snowdon Wildlife Refug

Ultrasonographic diagnosis of catheter-induced combined subclavian and internal jugular vein thrombosis

Catheter-induced subclavian and internal jugular vein thrombosis in a patient with unresectable ovarian carcinoma was diagnosed by sonography following subtle clinical symptomatology. Ultrasonographic diagnosis of central vein thrombosis offers applicable, noninvasive bedside diagnosis. The case we describe suggests that a low threshold should be maintained for application of this technique in the diagnosis of this potentially life-threatening complication, especially with the current widespread application of invasive monitoring.</jats:p

Treatment of advanced and recurrent gynecologic cancer.

In 1986 73,400 new cases of invasive gynecologic cancer and 45,000 new cases of in situ carcinoma of the uterine cervix (about 9% of all cancers in women) were diagnosed in the US. A significant proportion of these patients die of local failure. In dealing with the wide variety of gynecologic cancers, extreme care must be used in choosing the appropriate treatment program for each problem. Therefore, the full extent of the disease at the time of initial presentation and recurrence must be determined. It is only with these data that appropriate treatment programs can be designed with the maximum potential for long-term control or cure and with the minimum in treatment complication. There are no groups of disease processes like those seen in advanced or recurrent gynecologic cancer that offer such a challenge to the clinical practitioner