Alfa-epoietin and anaemia in gynaecological cancer

The incidence and severity of anaemia in gynaecological cancer patients depends on several factors including age, histology and tumor stage, site of neoplasm and treatment. At present, two principal opinions are available for the management of chronic anaemia in cancer patients: blood transfusions and treatment with recombinant human Erythropoietin (rHuEPO). Clinical studies showed that rHuEPO can ameliorate chronic and chemotherapy-induced anaemia and reduce transfusions in patients with various malignant diseases. In this review we discuss the role of alfa-epoetin in the management of gynaecological and breast cancers.

Preliminary results of monitoring research on zearalenone presence in blood of women with neoplastic lesions in reproductive system

The aim of the monitoring of zearalenone presence in the blood plasma of women with neoplastic lesions in the reproductive tract was to asses whether the phytosteride is noted in the patients blood and whether the correlation exists between its presence and the incidence of particular neoplasm. The presence of zearalenone or its metabolite--alpha-zearalenole, was noted in 13.51% of the examined women. In 60% of the patients with the confirmed presence of the xenobiotic it was noted in the lowest concentrations. These patients had neoplastic lesions of Carcinoma corpus uteri type.

Viability of gynecological malignant cultured cells after 4 degrees C storage in citrate-phosphate-dextrose solution

For the surgery of gynecological malignant tumors, a predeposit type of autologous blood transfusion has been widely used. However, using molecular biologic techniques, malignant cells have been found in the peripheral blood of cancer patients. Therefore, to evaluate the utility of presurgical blood deposits, we studied the survival of gynecological malignant cultured cells after 4 degrees C storage in citrate-phosphate-dextrose solution. Ten cultured cell lines derived from gynecological malignant tumors were used. Mixtures of 1 x 105 cells, culture medium, and citrate-phosphate-dextrose (CPD) solution were stored at 4 degrees C. After 0, 1, 4, 8, 15, or 22 days of storage, cells were placed in 96-well microtiter plates in culture medium with 1 x 104 cells/100 micro l/well. After 24 h culture in the incubator, the survival rate was calculated from the optical density by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide (MTT) assay. More than 10% of surviving cells were seen in nine cell lines after 4 days of storage, in seven cell lines after 8 days, in three cell lines after 15 days, and in two cell lines after 22 days. Cancer cells in presurgical blood deposits may survive a 3-week storage period at 4 degrees C in CPD solution.

[Tumor markers in gynecological and breast cancer]

Serum tumor markers are useful in diagnosis and follow-up for patients with gynecological malignancy or breast cancer. In epithelial ovarian cancer, CA125 has been identified as the most sensitive marker. Unfortunately, CA125 detection in the serum of patients with minimal malignant tumor has not been possible. Many nonmalignant conditions including endometriosis, menstruation and massive ascites may elevate the CA125, and almost 50% of patients with clear cell adenocarcinoma do not show CA125 elevated above 100 U/ml. To improve sensitivity and specificity in the diagnosis of ovarian cancer, the use of multiple tumor markers and the simultaneous use of image diagnosis should be employed. The value of tumor markers in the screening for cervical cancer and endometrial cancer has received little attention. However, the utility of serum SCC as a marker for monitoring cervical squamous cell carcinoma has been established. Since hCG is produced by gestational trophoblastic neoplasia and is a sensitive marker of trophoblastic cells in the body, patients with choriocarcinoma or invasive mole must be followed closely for this parameter. The improvement of the hCG detection technique has reduced the mortality rate from trophoblastic neoplasia. In breast cancer, many markers including CEA and CA15-3 are used, and they are reported to be useful as markers for monitoring.

Circadian periodicity of plasma lipid peroxides and other anti-oxidants as putative markers in gynecological malignancies

BACKGROUND

The chronome (from chronos, time, and nomos, rule), or time structure, of lipid peroxidation and anti-oxidant defense mechanisms may relate to prevention and curative chronochemotherapeutic efficacy and management.

PATIENTS AND METHODS

Newly diagnosed women with gynecological malignancies (N = 30), 30-60 years of age, and age-matched clinically healthy women (N = 35) provided blood samples every 6 hours for 24 hours under standardized conditions. Plasma malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and glutathione reductase (GR) activities, and serum ascorbate, urate and high-density lipoprotein cholesterol (HDL-C) concentrations were determined.

RESULTS

Each variable underwent circadian variation (p < or = 0.002). Patients differed from controls by their overall chronome-adjusted mean value (MESOR) and by the circadian dynamics in the spectral element of their chronome.

CONCLUSION

Chronomes of putative anti- and pro-oxidants should be mapped to explore their putative chemotherapeutic role as markers in cancer chronoprevention and management of established disease.

Carboplatin plus paclitaxel combination chemotherapy: impact of sequence of drug administration on treatment-induced neutropenia

OBJECTIVE

While the importance of the sequence of administration of cisplatin and paclitaxel on the degree of observed neutropenia has been documented, there is limited information available in the oncology literature to determine whether there exists sequence-dependent toxicity for the combination of carboplatin plus paclitaxel.

METHODS

Patients with advanced gynecologic malignancies were randomized to receive either carboplatin (AUC 6), followed by paclitaxel (175 mg/m(2) over 3 h) (C-P), or the same doses of the agents delivered in the opposite sequence (P-C). The primary endpoint was the degree of neutropenia experienced during the initial treatment course.

RESULTS

A total of 40 patients (median age: 63) entered this trial, of whom 27 had complete pretreatment and nadir counts available for course 1 and 24 for both course 1 and course 2. By random chance, patients initially receiving P-C began therapy with a higher baseline ANC than those treated with C-P. During course 1, the P-C population was noted to have a greater reduction, from baseline, in ANC (P = 0.02), but no difference in absolute nadir counts (ignoring the baseline value) (P = 0.64). There was no difference between P-C, followed by C-P, versus C-P, followed by P-C in the severity of neutropenia experienced during course 2 (P = 0.38).

CONCLUSIONS

The sequence of carboplatin/paclitaxel administration does not exert a significant influence on the level of observed neutropenia. This finding leads to the suggestion that the sequence of drug delivery can be modified, as necessary, to satisfy unique requirements of individual patients and to establish the optimal drug delivery strategy of an innovative investigational treatment regimen.

Prognostic significance of epithelial cells in the blood of patients with gynaecological malignancies

BACKGROUND

Some studies have shown that the detection of epithelial cells in peripheral blood indicates minimal residual disease status. There is a lack of data concerning the prognostic relevance of the detection of epithelial cells in the blood of patients with solid tumors. Therefore, we conducted the present study to analyse the relationship between the detection of epithelial cells in the blood, "conventional" prognosis factors and overall survival in patients with gynaecological malignancies.

MATERIALS AND METHODS

In a prospective study we investigated blood samples of patients with benign and malignant gynaecologic diseases from 11/97 to 03/99. We used an immunocytochemical approach using cytokeratin-directed antibodies CK 8-18 in 135 and A45-B/B3 in another 123 patients for detection of epithelial cells. Follow-up was obtained by checking the local tumor register and contact with all patients included in the study.

RESULTS

There was no significant correlation between detection rate and tumour stage, grading or lymph node status. The median time of follow-up was 45.9 (range 0.7-63) months. There was no significant correlation between the detection rate of positive epithelial cells (method A + B) and overall survival.

CONCLUSION

The results of this study underline the need to further investigate the role of disseminated tumor cells in the blood and bone marrow of patients with gynaecological malignancies.

[Reactive oxygen species as an inducing factor of neoplasms of female reproductive organs ]

AIM

In our study we measured selenium concentration in the blood of women with diagnosed cancer and benign tumors. The results were compared with healthy women. Some other parameters of the antioxidant system in all studied groups were also investigated, namely, activity of glutatione peroxidase, superoxide dismutase, as well as the levels of glutathione and malondialdehyde.

MATERIAL AND METHODS

All parameters were determined in peripheral blood of (a) 47 women with diagnosed cancer (b) 46 women with diagnosed benign tumors, and (c) 20 healthy women (control group). Statistical analysis of the results was performed using "Statistica" software.

RESULTS

Our results showed lower selenium concentration in the whole blood and plasma of cancer and benign tumor patients as compared to healthy women. An activity of glutathione peroxidase in erythrocytes and plasma were also lower in both patients' groups than in the control group. Statistical analysis of data revealed a positive correlation between selenium concentration and glutathione peroxidase activity in plasma. Lower activity of superoxide dismutase and increased concentration of malondialdehyde was noted in plasma of cancer patients as compared to healthy women.

CONCLUSIONS

1. A status of antioxidant systems plays an important role in carcinogenesis. 2. The antioxidant system of the women suffering from cancer is deficient. 3. A capacity of that system depends greatly on the concentration of antioxidants and activity of antioxidant enzymes, among them glutathione peroxidase.

Haptoglobin-alpha subunit as potential serum biomarker in ovarian cancer: identification and characterization using proteomic profiling and mass spectrometry

PURPOSE

The objective of this study was to identify and characterize new serum biomarkers in ovarian cancer patients using mass spectrometric protein profiling and specific immunological assays.

EXPERIMENTAL DESIGN

Serum samples from 80 cancer patients and 91 healthy women were analyzed by surface enhanced laser desorption and ionization-mass spectrometry (MS) profiling. A candidate biomarker was purified by affinity chromatography, and its sequence was determined by liquid chromatography-tandem MS. An antibody was generated from the synthesized peptide for quantitative validation in the cases and controls. CA125 was determined and compared with the same set of specimens.

RESULTS

Using surface enhanced laser desorption and ionization, we found a serum biomarker at approximately 11700 Da, which had peak intensity significantly higher in cases (1.366) compared with controls (0.208, P = 0.002), and subsequently identified this as the alpha chain of haptoglobin. ELISA indicated that Hp-alpha was </=2-fold higher in cancer serum compared with normal, benign tumor, and other gynecological cancers (P < 0.05) and had 64% sensitivity at 90% specificity alone and 91% sensitivity and 95% specificity if combined with CA125.

CONCLUSIONS

Haptoglobin-derived alpha subunit is a potential marker for ovarian cancer that is complementary to CA125. MS-based protein profiling is a valuable tool for screening protein markers and useful to detect post-translational modification of tumor-associated proteins or abnormal metabolic products. However, confirmation of protein identity with specific antibodies is crucial for clinical application and functional studies.

Quantitative analysis of acyl-lysophosphatidic acid in plasma using negative ionization tandem mass spectrometry

Analysis of acyl-lysophosphatidic acids (LPAs) has clinical importance as a potential biomarker for ovarian and other gynecological cancers or obesity from the point of view of prevention. Here we report a simple sample preparation and analytical method with high sensitivity and specificity for the early detection of gynecological cancers to improve the overall outcome of this disease. We established a novel quantification method for acyl-LPAs in plasma by electrospray negative ionization tandem mass spectrometry (MS-MS) using multiple reaction monitoring mode without conventional TLC step. Protein-bound lipids, acyl-LPAs in plasma were extracted with methanol/chloroform (2:1) containing LPA C(14:0) as internal standard under acidic conditions. Following back-extraction with chloroform and water, the centrifuged lower phase was evaporated and reconstituted in methanol and then analyzed. Using ESI-MS-MS with negative ionization MRM mode, all the species of LPAs were completely separated from plasma matrix without severe interference. For MRM mode, Q1 ions selected were m/z 409, 433, 435, 437 and 457 which corresponds to molecular mass [M-H](-) of C(16:0), C(18:2), C(18:1), C(18:0) and C(20:4) LPA, respectively. Q2 ions selected for MRM was m/z 79, phosphoryl product. Using MS-MS with MRM mode, all the species of LPAs were completely separated from plasma matrix without severe interference. This method allowed simultaneous detection and quantification of different species of LPAs in plasma over a linear dynamic range of 0.01-25 micromol/l. The method detection limit was 0.3 pmol/ml with correlation coefficient of 0.9983 in most LPAs analyzed. When applied to plasma from normal and gynecological cancer patients, this new method differentiated two different groups by way of total LPA level.

What is the role of interval blood testing in the management of chemotherapy for gynecologic malignancies

PURPOSE

To determine the safety of omitting routine interval laboratory assessments, dietary restrictions, and isolation precautions between cycles of chemotherapy for gynecologic malignancies.

METHODS

Data were retrospectively obtained from the records of women receiving chemotherapy for gynecologic cancer from July 1999-June 2000. Routine nadir determinations were not performed between treatment cycles; social interaction was encouraged, and pathogen-free diet recommendations were not provided.

RESULTS

Eighty women received 449 cycles of chemotherapy. Four (5%) patients developed neutropenic fevers, and one of these women succumbed to sepsis. Eighteen (22.5%) women had 29 cycles delayed due to persistent myelosuppression when the ensuing chemotherapy infusion was to be administered. Hematopoietic growth factors overcame these delays during subsequent cycles in all but two patients.

CONCLUSION

Omitting scheduled interval laboratory monitoring, dietary restrictions, and isolation precautions between chemotherapy cycles is convenient for patients, likely cost-effective, and does not increase morbidity in the gynecologic oncology population.

Detection of epithelial carcinoma cells in the blood of patients with gynaecological malignancies

BACKGROUND

Some investigations have shown that evidence of epithelial tumor cells in bone marrow is a relevant prognostic factor in various solid tumors. However there is a lack of data concerning the value of detection methods for epithelial cells in the serum of cancer patients.

MATERIALS AND METHODS

In a prospective study we investigated the blood samples of patients with benign and malignant gynaecological diseases from November 1997 to March 1999. We used an immunocytochemical approach with cytokeratin-directed antibodies CK 8-18 in 135 and A45-13/133 in another 123 patients for detection of epithelial cells.

RESULTS

There was no significant correlation between the detection rate and tumour stage, grading or lymph node status. The CK8-18 antibody had a higher detection rate for epithelial cells than A45-B/B3 (52% vs. 10%).

CONCLUSION

Both methods showed a low sensitivity and a high specificity. Further studies are needed to determine the prognostic value of epithelial cells in the blood of patients with gynaecological malignancies.

Preoperative determination of CASA (Cancer Associated Serum Antigen) and CA-125 for the discrimination between benign and malignant pelvic tumor mass: a prospective study

BACKGROUND

CA-125 is the most important tumor marker in epithelial ovarian cancer. Due to its low specificity, a combination with CASA may improve the clinical discrimination between benign and malignant adnexal masses.

MATERIALS AND METHODS

In a prospective study CA-125 and CASA were analyzed in blood specimens of 153 patients, including 29 ovarian cancer.

RESULTS

The median levels of both markers were significantly higher in ovarian cancer than in benign diseases. The sensitivity of CA-125 was 90%, while the specificity was 79%. PPV and NPV were 50% and 97%. In comparison, the sensitivity of CASA was lower (38%), while the specificity was slightly higher (86%). PPV and NPV were 39% and 86%. When both markers were used together, the specificity could be increased to 96% but the sensitivity remained at only 38%. The PPV and NPV was 69% and 87%.

CONCLUSION

The combination of CA-125 and CASA can improve the detection of patients with suspected ovarian cancer.

Increase of regulatory T cells in the peripheral blood of cancer patients

PURPOSE

T cells constitutively expressing both CD4 and CD25are essential for maintenance of self-tolerance and therefore have been referred to as regulatory T cells (Treg). Experimental tumor models in mice revealed that Tregs are potent inhibitors of an antitumor immune response. The current study was designed to determine whether cancer patients exhibit an expanded Treg pool.

EXPERIMENTAL DESIGN

The frequency of Tregs in the peripheral blood of 42 patients suffering from epithelial malignancies and from 34 healthy controls was determined by flow cytometry. The immunoregulatory properties of CD4(+)CD25(+) and CD4(+)CD25(-) T cells were characterized by proliferation and suppression assays. Cocultures with natural killer (NK) cells were performed to determine the impact of Tregs on NK-mediated cytotoxicity.

RESULTS

Patients with epithelial malignancies show an increase of CD4(+)CD25(+) T cells in the peripheral blood with characteristics of Tregs, i.e., they are CD45RA(-), CTLA-4(+), and transforming growth factor beta(+). Notably, CD4(+) T cells from cancer patients are characterized by an impaired proliferative capacity, which is restored to the extend of CD25-depleted CD4(+) T cells from control persons by prior removal of CD25(+) T cells. In contrast to CD4(+)CD25(-) T cells, isolated CD4(+)CD25(+) T cells from cancer patients were anergic towards T cell receptor stimulation. In addition, CD4(+)CD25(+) T cells suppressed the proliferation of CD4(+)CD25(-) T cells. When cultured together with CD56(+) NK-cells, CD4(+)CD25(+) T cells from cancer patients effectively inhibited NK-cell-mediated cytotoxicity.

CONCLUSIONS

Thus, we provide evidence of an increased pool of CD4(+)CD25(+) regulatory T cells in the peripheral blood of cancer patients with potent immunosuppressive features. These findings should be considered for the design of immunomodulatory therapies such as dendritic cell vaccination.

[Assessment of variables relative to prethrombotic state after operation in patients with gynecological malignancies]

OBJECTIVE

To study the changes in the variables in patients with gynecological malignancies after operation.

METHOD

Platelet alphagranule membrane protein (GMP-140), von Willebrand Factor (vWF), antithrombin III activity (AT-III), protein C-dependent partial thromboplastin activation time, plasminogen activity (PLG), the activity of tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI), D-Dimer were examined in 20 normal non-pregnant women and 38 patients after operation with gynecological malignancies.

RESULTS

vWF, GMP-140, PLG, D-Dimer, and PAI of patients with malignancies before operation were obviously higher than those of the healthy women (P<0.01). After operation the parameters were obviously elevated in the patients (P<0.01). AT-III and partial thromboplastin activation time were significantly reduced in comparison with the healthy subjects (P<0.01). t-PA showed no significant difference between the groups (P>0.05).

CONCLUSIONS

Obvious prethrombotic state characterizes the patients with gynecological malignancies after operation.

[Oncologic risk factors in papillomavirus infection]

Cytological screening is essential for adequate diagnosis of gynecological cancer. Moreover, every effort should be made to identify such risks of cancer as viruses (HPV, Herpes simplex, cytomegalovirus, Epstein-Barr virus, etc.). When high risk HPV-16 and HPV-18 are detected, diagnostic strategies should include assay of blood prolactin and prolactin/TTH ratio. Virus-related tumors and various risk groups may be studied using HPV genotyping detection of high-risk alleles of certain genes. Hence, some HPV gene variants and gene polymorphism can be investigated as potential risk factors in women.

Circulating highly fluorescent reticulocytes to predict the adequate harvesting of peripheral blood progenitor cells in platinum-based chemotherapy

We prospectively evaluated whether peripheral blood progenitor cells (PBPC) yield from a single leukapheresis could be predicted by measurement of circulating highly fluorescent reticulocytes (HFR). PBPC were collected from 46 leukaphereses in 15 patients with gynecological cancer following platinum-based chemotherapy. Once a level of at least 5.0% HFR was achieved, sufficient PBPC were collected in a single harvest in 71% of the procedures. Whereas, failure to mobilize sufficient PBPC occurred in 24 of 28 leukaphereses when the percentage of circulating HFR was less than 5.0%. In conclusion, circulating HFR may aid in the efficiency of PBPC collections in platinum-based chemotherapy.

Darbepoetin alfa administered every 2 weeks alleviates anemia in cancer patients receiving chemotherapy

The objectives of this study were to assess the safety and efficacy of darbepoetin alfa (Aranesp) administered every 2 weeks in anemic patients with solid tumors receiving chemotherapy. This was an open-label, randomized, active-controlled, multicenter dose-finding study evaluating a range of every-2-week darbepoetin alfa doses. The active control arm received epoetin alfa (Epogen, Procrit) at 40,000 U weekly with a dose increase to 60,000 U weekly for subjects with an inadequate response. The lowest clinically effective doses of darbepoetin alfa in this study were 3.0 and 5.0 microg/kg every 2 weeks, with no additional benefit observed at higher doses. The percentage of patients who achieved a hematopoietic response in the 3.0- and 5.0-microg/kg groups was 66% (95% confidence interval [CI] = 46%-86%) and 84% (95% CI = 67%-100%), respectively, compared with 63% (95% CI = 46%-81%) in the epoetin alfa group. Darbepoetin alfa administered at a dose of 3.0 microg/kg every 2 weeks is safe and effective for treating anemia in patients with solid tumors on chemotherapy, and is comparable to epoetin alfa. A dose increase to 5.0 microg/kg of darbepoetin alfa administered every 2 weeks may be appropriate in patients with an inadequate initial response.

Clinical trial simulation of a 200-microg fixed dose of darbepoetin alfa in chemotherapy-induced anemia

Our objective was to assess, using clinical trial simulation, the feasibility of a fixed 200-microg dose of darbepoetin alfa (Aranesp) administered every 2 weeks in chemotherapy-induced anemia. A pharmacokinetic/pharmacodynamic model was developed using clinical data from 547 cancer patients who received darbepoetin alfa at various doses and schedules. Monte Carlo simulations were performed for weight-based (3 microg/kg every 2 weeks) and fixed-dose (200 microg every 2 weeks) regimens and were compared with observed clinical data. Mean hemoglobin changes from baseline to end of treatment were +1.61 g/dL, +1.83 g/dL, and +1.79 g/dL for observed data, the weight-based simulation, and the fixed-dose simulation, respectively. The rates of required transfusions (hemoglobin < or = 8 g/dL) were also similar between groups. For patients between 45 and 95 kg (over 90% of the population), the impact of a fixed dose on mean hemoglobin change was negligible. There was a slight weight effect at body weight extremes (< 45 kg and > 95 kg). Clinical outcomes from simulations of weight-based andfixed dosing of darbepoetin alfa were similar to those of observed weight-based data. Given the weight distribution of a typical cancer population, the majority would be expected to benefit equally from weight-based and fixed-dose darbepoetin alfa in the amelioration of chemotherapy-induced anemia.

The differential diagnostic potential of a panel of tumor markers (CA 125, CA 15-3, and CA 72-4 antigens) in patients with a pelvic mass

OBJECTIVE

The purpose of this study was to assess the differential diagnostic potential of a combination of CA 125, CA 15-3, and CA 72-4 antigens in the definition of malignant disease, especially ovarian carcinoma in patients with a pelvic mass.

STUDY DESIGN

A total of 412 patients were evaluated in a multicenter, retrospective study.

RESULTS

Two hundred twenty-six malignant, 171 benign pelvic tumors (of which 129 were benign ovarian tumors), and 15 borderline tumors were evaluated. One hundred thirty-three patients had ovarian carcinoma. In 76 cases (55%), the International Federation of Gynecology and Obstetrics stage was III or IV. Borderline tumors (n = 15) were excluded from the statistical calculations. CA 125 antigen was the most sensitive marker for ovarian carcinoma (81%). The highest specificity and positive predictive value was obtained with CA 15-3 antigen (95% and 92%, respectively). Considering a concomitant elevation of all 3 markers as positive, a positive predictive value of 97% was found. However, only 28% of the patients in the total group and 41% of the patients with ovarian carcinoma had a concomitant elevation of all 3 markers. The combination of all 3 markers with levels below the cut-off resulted in a (false-positive) positive predictive value for malignancy between 12% and 36%. With the use of logistic regression analysis, we found a correct prediction in 73% of the cases. CA 15-3 antigen makes the most significant (P <.0001) contribution to the logistic model in the prediction of malignancy in the total group, with all pelvic masses with an odds ratio of 3.86.

CONCLUSION

The combination of a simultaneous elevated level of CA 125, CA 15-3, and CA 72-4 antigens was predictive for malignant disease in almost all cases. However, such concomitant elevation was found in few of the malignant masses. Logistic regression analysis revealed that CA 15-3 antigen makes the most significant contribution to a model for the prediction of malignancy in the total group. The logistic model gave a correct prediction in 73% to 83%. The present tumor marker panel seems inferior to combinations with other test modalities, which include ultrasonography and/or physical examination and/or menopausal status or age.

The impact of anemia and its treatment on patients with gynecologic malignancies

Anemia is a frequent complication of cancer and its treatment. It often impairs the functional status of patients and results in decreased functional capacity and quality of life. Its etiologies are multiple, including chronic inflammation, hemorrhage, nutritional deficiencies, hemolysis, bone marrow suppression by chemotherapy, or infiltration by tumor. It can manifest as feelings of weariness, tiredness, muscular weakness, dysphoric mood, somnolence, or impaired cognitive functioning. In gynecologic patients, the incidence of anemia has been reported to be as high as 80% depending on chemotherapy regimen. Given the various consequences of a low hemoglobin level, the importance of increasing or maintaining hemoglobin levels and ameliorating the symptoms is apparent. Clinical studies have demonstrated that the administration of recombinant human erythropoietin (rHuEPO, epoetin alfa) is effective and safe in increasing hemoglobin levels and improving the overall quality of life in patients with gynecologic cancers undergoing chemotherapy. Therefore, epoetin alfa treatment should be considered in this patient population.

The Italian gynecological consensus statement on the use of epoetin alfa in the management of anemia

A Consensus Conference on the use of recombinant human erythropoietin (rHuEPO, epoetin alfa) in gynecologic tumors was held in Rome in March 1999, and an associated consensus paper has been published in Italian. The current paper updates several discussions that took place at the 1999 meeting concerning epoetin alfa treatment in breast, ovarian, and cervical cancers; the role of epoetin alfa in mobilizing progenitor hematopoietic cells; administration of epoetin alfa in combination with granulocyte colony-stimulating factor; and the effect of hemoglobin levels on outcome of radiation or chemoradiation treatment.

[Clinical significance of vascular endothelial growth factor in sera of patients with gynaecological malignant tumors]

BACKGROUND & OBJECTIVE

Experimental and clinical evidence links tumor growth, invasion, and metastatic potential with neoangiogenesis. This process is modulated by several angiogenic growth factors, such as vascular endothelial growth factor(VEGF). Few data are currently available on serum level in patients with gynaecological malignant tumors. This study was designed to determine the serum VEGF level in the patients with gynaecological malignant tumors and its significance as a tumor marker.

MATERIAL & METHODS

Preoperative serum VEGF level were measured in 50 cervical cancer, 39 endometrial cancer, 89 ovarian cancer patients, and 80 normal healthy women; The serum VEGF levels were also measured in 3, 6, 9 months after operation and when recurrence in three curative resection patients with ovarian cancer; using commercially available enzymelinked immonosarbent assay (R & D systems Inc. Minneapolis, MN, USA). Statistical analysis was performed by using the SPSS9.0 software package. Using 5th and 95th percentage describe the variant degree.

RESULTS

The median level of VEGF in sera of 80 healthy women was 218.50 ng/L(42.06-671.70 ng/L), while in 50 cervical cancer, 39 endometrial cancer, and 89 ovarian cancer patients were 272.00 ng/L(91.94-745.53 ng/L), 383.50 ng/L(105.67-776.50 ng/L), and 479.85 ng/L (99.47-1326.88 ng/L), respectively. The VEGF levels in endometrial cancer and ovarian cancer patients were significantly higher than that in healthy women (P < 0.0001). But in cervical cancer patients the VEGF level, was not significant diffent compare with health wanen. After operation, 3, 6, 9 months the VEGF levels in 3 ovarian cancer patients were significantly lower than that of preoperative but it ascended again when the disease was recurrent 14, 17 months later in two cases. The VEGF level was significantly higher in advanced ovarian cancer patients (stage III-IV) than that in the early stage (stage I-II) (P < 0.05).

CONCLUSION

The serum level of the VEGF may be used as a new tumor marker of endometrial cancer and ovarian cancer, for diagnoses and monitoring the progress of the disease.

[Chromosome instability in women with genital organs carcinoma]

OBJECTIVES

The aim of the current work was the assessment of the mutagen susceptibility of chromosomes of patients with carcinomas in comparison to healthy volunteers. It was interesting whether the bleomycin assay can be useful for searching for more susceptible to cancer disease individuals.

MATERIALS AND METHODS

There were 4 groups of patients analysed: controls and three test groups (patients with uterine cervix carcinoma, endometrium carcinoma and ovarian carcinoma). In total 108 female patients were examined by use of bleomycin assay. Lymphocytes were cultured in vitro and treated with bleomycin. The b/c (breaks per cell) index was evaluated by use of light microscopy.

RESULTS

Statistically significant increased test values were found in patients with uterine cervix carcinoma, endometrium carcinoma and ovarian carcinoma.

CONCLUSIONS

The assessment of chromosome instability could be a useful prognostic test in the diagnosis of carcinoma of female genital organs. The bleomycin assay is useful for searching subpopulations with higher chromosome instability and more susceptible to cancer disease.

Fatty acid composition of lysophosphatidic acid and lysophosphatidylinositol in plasma from patients with ovarian cancer and other gynecological diseases

OBJECTIVE

We previously reported that plasma levels of total lysophosphatidic acid (LPA) represented a potential biomarker for ovarian cancer and other gynecological cancers [1]. However, total LPA is composed of different LPA species with distinct fatty acid chains. The major objective of the current study, therefore, was to determine whether one or more specific fatty acid LPA species was associated with disease or disease staging. If this was determined, these species could be useful in further improving the sensitivity and/or specificity of this biomarker for the diagnosis and/or prognosis of the disease. Because lysophosphatidylinositol (LPI) co-migrates with LPA, this study represents the analysis of combined molecular species from both lysolipid classes.

METHODS

The patient population, sample collection, and analyses have been reported previously [1]. Lipids were hydrolyzed from the LPA band on thin-layer chromatography plates. The following individual fatty acid species were analyzed by gas chromatography: palmitic acid (16:0), stearic acid (18:0), oleic acid (18:1), linoleic acid (18:2), arachidonic acid (20:4), and docosahexaenoic acid (22:6). The LPA/LPI fatty acid composition levels were analyzed and compared with disease status.

RESULTS

Distinct plasma LPA/LPI fatty acid chain species were not associated with ovarian or other gynecological cancers, compared to patients with benign gynecological disease or healthy controls. However, an increased presence of unsaturated fatty acids in plasma LPA/LPI was found in patients with late-stage or recurrent ovarian cancer and possibly with other gynecological cancers.

CONCLUSIONS

Analysis of individual fatty acid species present in plasma LPA/LPI do not appear to enhance the sensitivity or specificity of total LPA/LPI as a marker for gynecological cancer detection. However, our results suggest that increased LPA/LPI species with unsaturated fatty acid chains may be associated with late-stage or recurrent ovarian cancer.