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Practice intentions: cervical cancer screening among HPV-vaccinated women
Abstracts / Gynecologic Oncology 133 (2014) 2–207
(34%) (p-value 0.008) and DM-non metformin (29%) (p-value 0.009). In Kaplan-Meier analyses, DM-Metformin group had a longer OS and PFS compared to DM non-metformin patients (p-values 0.0217 and 0.0252 respectively). In Cox proportional hazards analyses that included adjustment for demographic and clinical covariates there was a trend for a longer OS and PFS but it did not reach statistical significance. Conclusions: Metformin use is associated with earlier stage disease at diagnosis compared to DM non-metformin patients and nondiabetic ovarian cancer patients. Although metformin use is associated with longer OS and PFS compared to non-metformin DM and control in univariate analyses, it did not reach statistical significance in the multivariate analyses.
doi:10.1016/j.ygyno.2014.03.489
470 - Poster Session B Ovarian high grade serous cancer xenografts as pre-clinical models of response to chemotherapy P. Cybulska1,2, J.M. Stewart2, B.A. Clarke2, B.G. Neel3, M.Q. Bernardini4. 1 Institute of Medical Science, Toronto, ON, Canada, 2University of Toronto, Toronto, ON, Canada, 3Ontario Cancer Institute, Princess Margaret Hospital, Toronto, ON, Canada, 4University Health Network Princess Margaret Hospital, Toronto, ON, Canada. Objectives: Primary treatment for high-grade serous cancer (HGSC) patients consists of surgical debulking and platinum/taxol chemotherapy. This uniform approach to treating a highly heterogeneous disease is largely to blame for the virtually unchanged overall survival in the last 30 years. For successful new treatment strategies, pre-clinical in vivo models must be predictive of similar activity in humans. To date, no models of HGSC exist that recapitulate both inter- and intra-patient heterogeneity. HGSC patient-derived xenografts (PDX) could potentially resolve some of these issues, as these tumors have been shown to recapitulate the biological characteristics of the primary tumor. In this study, we tested the ability of a PDX model of HGSC to predict response to standard of care chemotherapeutics and thus examined its utility as a pre-clinical model. Methods: We have established conditions to generate PDX from fresh tumor and ascites samples. The mammary fat pads of NOD/SCID/Il2rg-/mice were injected with 106 cancer cells from platinum sensitive (n = 3), platinum resistant/refractory (n = 13) and prospectively identified (n = 2) patients. Once tumors were palpable (~200 mm3), mice were treated with carboplatin (75 mg/kg IP q week x 2 doses) or vehicle (saline IP q week x 2 doses). Tumor size was assessed every 72 hours. At the end of treatment, tumor histology was assessed. Results: PDX derived from sensitive patients showed a 77-90% reduction in tumor volume with platinum therapy. Platinum resistant PDX showed at most a 30% reduction in tumor volume or grew in spite of platinum therapy. Two samples obtained prospectively showed a 60-90% reduction in tumor volume and correspond to platinum sensitive patients. All PDX histology was confirmed to be HGSC. Conclusions: Our results suggest that PDX recapitulate patient response to chemotherapy. Specifically, the xenografts derived from chemosensitive patients show a nearly complete response to platinum therapy; conversely, xenografts derived from chemoresistant patients show a minimal response. Impressively, we were able to prospectively identify chemosensitive patients. These data suggest that the PDX model allows for accurate identification of platinum sensitivity and resistance and may allow for assessment of the efficacy of novel chemotherapies. doi:10.1016/j.ygyno.2014.03.490
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471 - Poster Session B Practice intentions: cervical cancer screening among HPV-vaccinated women N. Nair1, Z. Berkowitz2, M. Saraiya2. 1Emory University, Atlanta, GA, 2 Centers for Disease Control and Prevention, Atlanta, GA. Objectives: The Centers for Disease Control Advisory Committee on Immunization Practices recommends HPV vaccination of all females aged 9 to 26 years. Current recommendations for cervical cancer screening do not vary by HPV vaccination status. The objective of this study is to investigate whether physicians intend to change their screening practices and beliefs based on HPV vaccination status and whether they use criteria to vaccinate. Methods: A nationally representative sample of 2,101 U.S. physicians who perform cervical cancer screening from the 2007 to 2010 Cervical Cancer Screening Supplement to the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) was used. Data represented approximately 100,000 providers and were stratified by specialty: obstetrician/gynecologist (ob/gyn) vs other specialties (internal medicine, family/general medicine and midlevel providers) and by survey type. Results: Over 92% of providers did not intend to change their cervical cancer screening practices and management for HPV vaccinated women. The majority believed that HPV vaccination will result in fewer abnormal Papanicolaou (Pap) tests and fewer referrals to colposcopy, with percentages ranging from 58.6% to 66.8% for the different physician and surveys types. NAMCS office-based ob/gyn’s were more likely than other specialties to rarely or never use number of sexual partners to determine who gets the HPV vaccine (66.7% vs 55.1%, P b 0.05), more likely to recommend the vaccine to females with history of abnormal Pap result (77.3% vs 62%, P b 0.05) and to females with a history of HPV positive test result (73.9% vs 56.1, P b 0.05). Conclusions: Although the majority of providers believe that HPV vaccination will result in fewer abnormal Pap tests and colposcopies, they do not intend to change cervical cancer screening practices based on vaccination status. Ob/gyn’s are more likely to recommend vaccination to females with abnormal test results who may benefit less from it than those with normal results while other specialties are more likely to use number of sexual partners to determine who should receive the vaccine, which is not recommended. Improving physician understanding of the HPV vaccine and appropriate vaccine targeting may lead to more efficient cervical cancer screening and prevention.
doi:10.1016/j.ygyno.2014.03.491
472 - Poster Session B Treatment of low-risk GTN with biweekly actinomycin-D C.J.M. Reade1, U. Habiba1, L.R. Eiriksson2, M. Cesari1, R.J. Osborne1. 1 University of Toronto, Toronto, ON, Canada, 2Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada. Objectives: Biweekly “pulsed” actinomycin-D (act-D) for the treatment of low-risk gestational trophoblastic neoplasia (GTN) has been shown to be superior to weekly methotrexate in terms of achieving a complete response in a randomized controlled trial (RCT). However, results from RCTs do not always translate into the ‘real-world’ setting. We endeavored to evaluate the performance of act-D in our institution, and to document the rate of complete response in patients with WHO scores of 5-6 and in those with high pretreatment bHCG levels.
(34%) (p-value 0.008) and DM-non metformin (29%) (p-value 0.009). In Kaplan-Meier analyses, DM-Metformin group had a longer OS and PFS compared to DM non-metformin patients (p-values 0.0217 and 0.0252 respectively). In Cox proportional hazards analyses that included adjustment for demographic and clinical covariates there was a trend for a longer OS and PFS but it did not reach statistical significance. Conclusions: Metformin use is associated with earlier stage disease at diagnosis compared to DM non-metformin patients and nondiabetic ovarian cancer patients. Although metformin use is associated with longer OS and PFS compared to non-metformin DM and control in univariate analyses, it did not reach statistical significance in the multivariate analyses.
doi:10.1016/j.ygyno.2014.03.489
470 - Poster Session B Ovarian high grade serous cancer xenografts as pre-clinical models of response to chemotherapy P. Cybulska1,2, J.M. Stewart2, B.A. Clarke2, B.G. Neel3, M.Q. Bernardini4. 1 Institute of Medical Science, Toronto, ON, Canada, 2University of Toronto, Toronto, ON, Canada, 3Ontario Cancer Institute, Princess Margaret Hospital, Toronto, ON, Canada, 4University Health Network Princess Margaret Hospital, Toronto, ON, Canada. Objectives: Primary treatment for high-grade serous cancer (HGSC) patients consists of surgical debulking and platinum/taxol chemotherapy. This uniform approach to treating a highly heterogeneous disease is largely to blame for the virtually unchanged overall survival in the last 30 years. For successful new treatment strategies, pre-clinical in vivo models must be predictive of similar activity in humans. To date, no models of HGSC exist that recapitulate both inter- and intra-patient heterogeneity. HGSC patient-derived xenografts (PDX) could potentially resolve some of these issues, as these tumors have been shown to recapitulate the biological characteristics of the primary tumor. In this study, we tested the ability of a PDX model of HGSC to predict response to standard of care chemotherapeutics and thus examined its utility as a pre-clinical model. Methods: We have established conditions to generate PDX from fresh tumor and ascites samples. The mammary fat pads of NOD/SCID/Il2rg-/mice were injected with 106 cancer cells from platinum sensitive (n = 3), platinum resistant/refractory (n = 13) and prospectively identified (n = 2) patients. Once tumors were palpable (~200 mm3), mice were treated with carboplatin (75 mg/kg IP q week x 2 doses) or vehicle (saline IP q week x 2 doses). Tumor size was assessed every 72 hours. At the end of treatment, tumor histology was assessed. Results: PDX derived from sensitive patients showed a 77-90% reduction in tumor volume with platinum therapy. Platinum resistant PDX showed at most a 30% reduction in tumor volume or grew in spite of platinum therapy. Two samples obtained prospectively showed a 60-90% reduction in tumor volume and correspond to platinum sensitive patients. All PDX histology was confirmed to be HGSC. Conclusions: Our results suggest that PDX recapitulate patient response to chemotherapy. Specifically, the xenografts derived from chemosensitive patients show a nearly complete response to platinum therapy; conversely, xenografts derived from chemoresistant patients show a minimal response. Impressively, we were able to prospectively identify chemosensitive patients. These data suggest that the PDX model allows for accurate identification of platinum sensitivity and resistance and may allow for assessment of the efficacy of novel chemotherapies. doi:10.1016/j.ygyno.2014.03.490
185
471 - Poster Session B Practice intentions: cervical cancer screening among HPV-vaccinated women N. Nair1, Z. Berkowitz2, M. Saraiya2. 1Emory University, Atlanta, GA, 2 Centers for Disease Control and Prevention, Atlanta, GA. Objectives: The Centers for Disease Control Advisory Committee on Immunization Practices recommends HPV vaccination of all females aged 9 to 26 years. Current recommendations for cervical cancer screening do not vary by HPV vaccination status. The objective of this study is to investigate whether physicians intend to change their screening practices and beliefs based on HPV vaccination status and whether they use criteria to vaccinate. Methods: A nationally representative sample of 2,101 U.S. physicians who perform cervical cancer screening from the 2007 to 2010 Cervical Cancer Screening Supplement to the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) was used. Data represented approximately 100,000 providers and were stratified by specialty: obstetrician/gynecologist (ob/gyn) vs other specialties (internal medicine, family/general medicine and midlevel providers) and by survey type. Results: Over 92% of providers did not intend to change their cervical cancer screening practices and management for HPV vaccinated women. The majority believed that HPV vaccination will result in fewer abnormal Papanicolaou (Pap) tests and fewer referrals to colposcopy, with percentages ranging from 58.6% to 66.8% for the different physician and surveys types. NAMCS office-based ob/gyn’s were more likely than other specialties to rarely or never use number of sexual partners to determine who gets the HPV vaccine (66.7% vs 55.1%, P b 0.05), more likely to recommend the vaccine to females with history of abnormal Pap result (77.3% vs 62%, P b 0.05) and to females with a history of HPV positive test result (73.9% vs 56.1, P b 0.05). Conclusions: Although the majority of providers believe that HPV vaccination will result in fewer abnormal Pap tests and colposcopies, they do not intend to change cervical cancer screening practices based on vaccination status. Ob/gyn’s are more likely to recommend vaccination to females with abnormal test results who may benefit less from it than those with normal results while other specialties are more likely to use number of sexual partners to determine who should receive the vaccine, which is not recommended. Improving physician understanding of the HPV vaccine and appropriate vaccine targeting may lead to more efficient cervical cancer screening and prevention.
doi:10.1016/j.ygyno.2014.03.491
472 - Poster Session B Treatment of low-risk GTN with biweekly actinomycin-D C.J.M. Reade1, U. Habiba1, L.R. Eiriksson2, M. Cesari1, R.J. Osborne1. 1 University of Toronto, Toronto, ON, Canada, 2Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada. Objectives: Biweekly “pulsed” actinomycin-D (act-D) for the treatment of low-risk gestational trophoblastic neoplasia (GTN) has been shown to be superior to weekly methotrexate in terms of achieving a complete response in a randomized controlled trial (RCT). However, results from RCTs do not always translate into the ‘real-world’ setting. We endeavored to evaluate the performance of act-D in our institution, and to document the rate of complete response in patients with WHO scores of 5-6 and in those with high pretreatment bHCG levels.