Strategic Approaches to Improving Gynecologic Cancer Diagnosis and Treatment
September / October 2006
Clinical advances and research offer methods to potentially extend cancer
survival and reduce mortality.
A recent study by the Gynecologic Oncology Group (NEJM 2006;
354:
34-43) suggested that intraperitoneal chemotherapy offers
a clinical
advantage in the treatment of ovarian cancer,
potentially increasing survival of women with advanced ovarian
cancer. In
the multi-center study, overall survival for 205 women with
surgically
debulked stage III ovarian cancer that were treated with
a combination of
intraperitoneal and intravenous chemotherapy was a median
of 65.6 months – 25
percent longer than the 210 women who only received chemotherapy
intravenously.
As a result of these findings, the National
Cancer Institute
has issued a clinical announcement recommending a combination
of intravenous
and intraperitoneal chemotherapy for advanced ovarian
cancer
treatment after surgical debulking.
This is just one example of the
clinical advances available for the
treatment of gynecologic cancers at the University of Pennsylvania
Health
System. "Penn physicians have been involved in intraperitoneal
chemotherapy
for 20 years," says Stephen
C. Rubin, MD, Chief of
the Division of
Gynecologic Oncology at the University of Pennsylvania Health
System. "Our
team is at the forefront of this type of research, offering
many advanced
clinical treatments before they are available at other hospitals
in the
area."
Staffed by nationally and internationally recognized
physicians, Penn's
gynecologic oncology program further provides advanced staging
procedures,
global planning and prophylactic
interventions. "We've worked with many very informed
and experienced
referring physicians," says Dr. Rubin. "By partnering
with us, we're able to
provide them with a whole range of treatment options and
a great deal of
experience that can ultimately benefit their patients."
Advanced laparoscopic surgery is also among the options
available. This
procedure can be used to manage early stage cancers of the
uterus, cervix
and ovaries. Recently, Penn physicians have been examining
the effectiveness
of laparoscopic surgery in morbidly obese patients. "The
previous paradigm
for morbidly obese uterine cancer patients was not to use
laparoscopic
surgery,"
says Thomas
Randall, MD, Director
of Gynecologic Oncology programs
for the Joan Karnell Cancer Center
at Pennsylvania Hospital.
"In our
work, we've found that we can offer comparable surgeries
for women with body
mass indexes as high as 58.
The surgical time increases with a
larger patient but the hospital stay is
still shorter than with open surgery;
85 percent of the patients in our
series were discharged by the second
surgical day."
Successful laparoscopic surgery is unusual in this patient
group but Penn is
achieving success along with very high levels of patient
satisfaction. "The
vast majority of patients are actually good candidates for
laparoscopic
surgery,"
says Dr. Randall. "Our approach is to begin with a
laparoscopic assessment
of the tumor. If it can be resected laparoscopically, we'll
move forward
with that approach. If resection isn't possible laparoscopically,
we can
easily shift into open surgery."
An additional patient benefit is Penn's Gynecologic
Oncology Research
Program, the only one of its kind in the Philadelphia region
and one of only
a handful in the country with a dedicated gynecologic oncology
laboratory.
Here, groundbreaking clinical and basic science research
is performed to
develop new treatments for recurrent and advanced cancer
as well as new
approaches for
cancer detection and prevention.
"Our research led us to the discovery that ovarian
cancer is amenable to
immunotherapy," says George
Coukos, MD, PhD, Director
of the Gynecologic
Oncology Research Program for the University of Pennsylvania
Health System. "These findings have allowed
us to launch the first vaccine trial for
ovarian cancer. We are also pursuing ongoing research into
biomarkers for
early cancer diagnosis and through these new approaches we
hope to dramatically reduce mortality from ovarian cancer."
Additional
therapies are under
development in Dr. Coukos' laboratory including whole
tumor antigen
vaccines, T-cell therapies and combination therapies. Dr.
Coukos anticipates
that in the future, immunotherapy in combination with
surgery and chemotherapy will become a standard of care
for ovarian cancer.
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