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Calgary, Canada

Robson E.J.D.,Amgen | Ghatage P.,Tom Baker Cancer Center
Expert Opinion on Investigational Drugs | Year: 2011

Introduction: Ovarian cancer is the second most common gynecologic malignancy in the world with the majority of women presenting with advanced disease; whilst chemotherapeutic advances have improved progression-free survival, the increases in overall survival have been marginal. Novel biologic agents, including those designed to disrupt tumor angiogenesis, have demonstrated promising antitumor activity. Areas covered: This review evaluates AMG 386, a novel investigational angiopoietin antagonist peptide-Fc fusion protein (peptibody), which potently and selectively inhibits angiopoietin-1 and angiopoietin-2 binding to the Tie2 tyrosine kinase receptor. Preclinical and clinical studies for AMG 386 are summarized, highlighting data pertaining to ovarian cancer. The role of angiopoietins in regulating physiologic and tumorigenic angiogenesis is addressed, as well as a brief discussion of non-angiopoietin anti-angiogenic strategies, followed by a review of preclinical, Phase I and II data and ongoing clinical studies for AMG 386, all in the context of ovarian cancer. Expert opinion: AMG 386 has clinical activity and an acceptable safety profile both as monotherapy and in combination with chemotherapy. Of note, as the toxicity profiles of AMG 386 and inhibitors of the VEGF axis do not substantially overlap, AMG 386 could potentially be combined with other anti-angiogenic compounds to maximize disruption of malignant vascularization in ovarian cancer and other solid tumors. © 2011 Informa UK, Ltd.


Dunscombe P.,Tom Baker Cancer Center
Frontiers in Oncology | Year: 2012

Radiotherapy, with close to a million courses delivered per year in North America, is a very safe and effective intervention for a devastating disease. However, although rare, several deeply regrettable incidents have occurred in radiotherapy and have rightly been the subject of considerable public interest. Partly in response to reports of these incidents a variety of authoritative organizations across the globe has harnessed the expertise amongst their members in attempts to identify the measures that will make radiotherapy safer. While the intentions of all these organizations are clearly good it is challenging for the health care providers in the clinic to know where to start with so much advice coming from so many directions. Through a mapping exercise we have identified commonalities between recommendations made in seven authoritative documents and identified those issues most frequently cited. The documents reviewed contain a total of 117 recommendations. Using the 37 recommendations in "Towards Safer Radiotherapy" as the initial base layer, recommendations in the other documents were mapped, adding to the base layer to accommodate all the recommendations from the additional six documents as necessary. This mapping exercise resulted in the distillation of the original 117 recommendations down to 61 unique recommendations. Twelve topics were identified in three or more of the documents as being pertinent to the improvement of patient safety in radiotherapy. They are, in order of most to least cited: training, staffing, documentation, incident learning, communication, check lists, quality control and preventive maintenance, dosimetric audit, accreditation, minimizing interruptions, prospective risk assessment, and safety culture. This analysis provides guidance for the selection of those activities most likely to enhance safety and quality in radiotherapy based on the frequency of citation in selected recent authoritative literature. © 2012 Dunscombe.


Walker L.M.,University of Calgary | Robinson J.W.,Tom Baker Cancer Center
Qualitative Health Research | Year: 2012

More than half of all men with prostate cancer will be treated with androgen deprivation therapy (ADT) at some point during their lives. Though an effective treatment for prostate cancer, ADT results in profound changes in the man's sense of masculinity and sexuality (e.g., erectile dysfunction, loss of libido, genital atrophy and severe genital shrinkage, hot flashes, loss of muscle mass, fatigue, bodily feminization). These changes usually result in the cessation of all sexual activity. Surprisingly, some couples do find ways of continuing to have satisfying sex despite the man's castrate level of testosterone. Herein, we describe the sexual struggles that couples encounter when attempting to adapt sexually to ADT. A grounded theory methodology was used to analyze interview data. The successful strategies that couples used to overcome struggles, as well as those which seemed to exacerbate struggles, are documented. Couples adjusting to ADT might benefit from knowing which strategies are most likely to result in positive adjustment and which are not. © 2012 SAGE Publications.


Banerjee R.,Tom Baker Cancer Center | Kamrava M.,University of California at Los Angeles
International Journal of Women's Health | Year: 2014

Dramatic advances have been made in brachytherapy for cervical cancer. Radiation treatment planning has evolved from two-dimensional to three-dimensional, incorporating magnetic resonance imaging and/or computed tomography into the treatment paradigm. This allows for better delineation and coverage of the tumor, as well as improved avoidance of surrounding organs. Consequently, advanced brachytherapy can achieve very high rates of local control with a reduction in morbidity, compared with historic approaches. This review provides an overview of state-of-the-art gynecologic brachytherapy, with a focus on recent advances and their implications for women with cervical cancer. © 2014 Banerjee and Kamrava.


Kostaras X.,Guideline | Easaw J.C.,Tom Baker Cancer Center
Journal of Neuro-Oncology | Year: 2013

Medulloblastoma accounts for almost one-third of pediatric central nervous system (CNS) cancers, but is very rare in the adult population. As a result, adult patients with medulloblastoma are often treated according to therapies developed for children with similarly staged disease at diagnosis, based on the assumption that adult and pediatric tumors have similar properties. The purpose of this review was to summarize the evidence and to make recommendations for the management of recurrent disease in adult patients with medulloblastoma. We conducted a systematic literature search to find publications addressing treatment of recurrent medulloblastoma in adults. Current treatment strategies for adult patients with relapsed medulloblastoma are based on the results of retrospective case series and published consensus recommendations, and include maximal safe re-resection where possible, combined with chemotherapy and/or re-irradiation. We describe the results of 13 publications involving 66 adult patients treated with high-dose chemotherapy (HDCT) plus stem cell transplantation for recurrent medulloblastoma. HDCT with stem cell transplantation may be a treatment option for a small proportion of adult patients who are unlikely to benefit from conventional chemotherapy and who are fit and have their disease recurrence contained within the CNS. Potential cases in which stem cell transplantation is being considered should be discussed at a multidisciplinary tumor board which includes involvement by hematologic oncologists and transplant specialists. © 2013 Springer Science+Business Media New York.

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