Hormone test predicts ovarian function after chemotherapy for breast cancer

ScienceDaily (June 5, 2011) — A test that shows how many eggs a woman has in her ovaries may help young women with breast cancer know what their reproductive function will be after chemotherapy, a new study finds.

See Also:Health & MedicineWomen's HealthBreast CancerLung CancerMenopauseOvarian CancerColon CancerReferenceMenopauseHysterectomyOvarian cancerInfertility

The results are being presented at The Endocrine Society's 93rd Annual Meeting in Boston.

Called the anti-Mullerian hormone (AMH) test, this blood test measures levels of an ovarian hormone that reflects the size of the ovarian reserve, or remaining egg supply. Currently, doctors use it to quantify a woman's ovarian reserve before in vitro fertilization treatments. Now researchers from Scotland have found that measurement of AMH indicates how likely it will be for a woman to still have eggs in her ovaries after chemotherapy, which can often damage a woman's eggs and cause infertility.

"Future reproductive function is a concern for many young women with cancer," said lead investigator Richard Anderson, MD, PhD, professor of clinical reproductive science at the University of Edinburgh. "This test will be of benefit to women with newly diagnosed cancer to help decide whether they need to take steps to preserve their fertility."

In the U.S. alone, breast cancer is diagnosed in more than 25,000 women younger than 45 each year, according to the American Cancer Society.

For this study, Anderson and his colleagues recruited 50 premenopausal women, ages 29 to 51, who had just received a diagnosis of early breast cancer. All women had normal menstrual cycles and were asked to keep a daily record of their menstrual cycle, as an index of ovarian activity, during the two years of the study. Before the women started chemotherapy, they gave blood samples for AMH testing. They again had AMH tests one and two years after starting treatment.

Before chemotherapy the median AMH level was 0.4 nanograms per milliliter (ng/mL). After cancer treatment the AMH level fell rapidly, becoming undetectable (below 0.16 ng/mL) in 68 percent of the women after one cycle of chemotherapy, the authors reported. By one-year follow-up, 11 women withdrew from the study, mostly because of cancer recurrence, Anderson said. Menstrual records were available for 39 women at one year and for 29 women at two years.

A low AMH measurement before treatment correlated well with amenorrhea, or absence of menstruation, after treatment. Women whose AMH before treatment was low (below 0.4 ng/mL) were 16 times likelier to have stopped menstruating after chemotherapy than women with a high pretreatment AMH value, Anderson said. The odds of losing ovarian function remained higher even after statistical analysis controlled for increasing age, which tends to lower AMH levels. Women whose AMH before chemotherapy exceeded 0.92 ng/mL were reportedly almost five times more likely to continue menstruating after treatment.

"Our data suggest that the AMH test, taken before cancer treatment, can help individualize a woman's infertility risk after chemotherapy for breast cancer," Anderson said.

He added that results of this study, which was funded by the U.K. Medical Research Council, are likely to apply to other types of cancer as well.

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PET imaging determines malignancy in potential ovarian cancer cases

ScienceDaily (June 6, 2011) — A study presented at SNM's 58th Annual Meeting may provide a new tool for detection of malignant-stage ovarian cancer. Researchers found that positron emission tomography and computed tomography (PET/CT), which images both functional and anatomical changes in the body, was useful for preoperative cancer imaging of ovarian masses when used with a radiotracer that is actively metabolized by cells as fuel. Physicians imaging patients suspected of having malignant tumors can see where cancerous cells are hyper-metabolizing the tracer and accurately predict whether a mass is malignant, cancerous but stable, or benign.

See Also:Health & MedicineMedical ImagingOvarian CancerBrain TumorSkin CancerCancerColon CancerReferencePositron emission tomographyMetastasisOvarian cancerRenal cell carcinoma

"We found that PET/CT imaging with the radiotracer 18F-FDG gave us beneficial information about the ovarian cancer stage that helped gynecologists in their treatment planning," says Majbritt Frost, research technologist and lead author of the study at Aalborg Hospital Danmark in Aalborg, Denmark. "This research is important because it gives gynecologists and oncologists the opportunity to provide these women the best possible course of treatment. We were also able to find additional tumors, resulting in patient referral to the appropriate medical specialist."

The American Cancer Society estimates that more than 21,800 American women were diagnosed with ovarian cancer and approximately 13,850 women died from the disease in 2010.

This study was conducted to explore PET imaging with a radiotracer that combines a fluorine-based medical isotope with fluorodeoxyglucose (18F-FDG), which mimics glucose as a source of energy, to determine the malignancy of adnexal masses. These are lumps in the tissue of the adnexa, or connected structures of the uterus. Most commonly these masses affect the ovaries and fallopian tubes, but they can also develop within supporting tissues. PET imaging with 18F-FDG was able to ascertain whether lumps were malignant, because cancerous tissues are far more metabolically active than normal cells and this hyperactivity shows up as "hot spots" on PET scans.

For the purposes of this research, 104 patients with a mean age of 62 years presenting adnexal masses with the potential for ovarian cancer were imaged using PET/CT with the radiotracer 18F-FDG prior to surgery. Results of the scans were classified as either benign or malignant and were then compared to surgical findings. Preliminary research shows that 18F-FDG PET/CT was able to successfully detect 84 percent of benign and malignant tumors for these patients.

The ability to detect ovarian cancer expands hybrid molecular imaging in the field of gynecology. Already molecular imaging is useful for the staging of cervical cancer, and continuing research may one day open the door for the staging of endometrial and other cancers for women.

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Targeted testing offers treatment hope for ovarian cancer patients

ScienceDaily (May 31, 2011) — Women with ovarian cancer could be helped by a new test that identifies the specific type of tumour they have, a conference will hear this week.

See Also:Health & MedicineOvarian CancerDiseases and ConditionsPersonalized MedicineBreast CancerLung CancerLeukemiaReferenceHysterectomyMetastasisOvarian cancerMenopause

Researchers at the University of Edinburgh hope this improved diagnosis will help doctors to personalise treatment programmes so that patients receive the most effective drugs.

The Edinburgh team worked with scientists from Ireland to identify six subgroups of the disease, each of which had a different genetic signature.

To do this, they analysed tissue samples from more than 350 ovarian cancer patients and compared this information with the patients' medical records.

The results show how genetic profiling of ovarian cancers might predict a person's response to drug treatments.

Researchers say the development may be particularly helpful for women with an aggressive form of ovarian cancer, which is typically caught late by current diagnostic tests.

This type of aggressive -- or 'high grade' -- cancer can respond well to a recently-developed drug that targets the blood supply of the cancer cells.

The team hopes that by identifying the women with this type of cancer at the earliest opportunity, they could use the drug more effectively and help to improve survival rates.

The findings will be presented at the American Society of Clinical Oncology (ASCO) conference, being held in Chicago this week.

Dr Charlie Gourley of the University of Edinburgh, who led the study, said: "This research shows that by conducting a detailed analysis of the genes of ovarian cancers we may be able to identify those patients who will respond well to new drug treatments. This could bring valuable improvements in survival rates for the disease and would help us to personalise a patient's care to ensure the greatest possible success."

Ovarian cancer is the fifth most common cancer in women, with around 6,800 women being diagnosed every year in the UK.

Of these, nearly two-thirds will not live beyond five years of their diagnosis.

Chemotherapy and surgery can be effective treatments, but women could have a greater chance of surviving the disease if it is identified earlier on.

The findings will be presented at ASCO on the 4th of June.

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