Standard therapy for advanced ovarian cancer consists of primary debulking surgery followed by chemotherapy. But some patients present with clinical features (e.g., extensive comorbid conditions, poor performance status, radiologically determined unresectable disease) that can preclude surgical intervention. Neoadjuvant therapy before cytoreductive surgery has been studied; however, a meta-analysis involving 835 patients showed that neoadjuvant chemotherapy was associated with worse prognosis (Gynecol Oncol 2006; 103:1070).

Now, investigators randomized 670 patients with stage IIIC or IV epithelial ovarian, fallopian, or peritoneal cancer to primary debulking surgery followed by platinum-based chemotherapy or to 3 cycles of platinum-based neoadjuvant therapy followed by interval debulking surgery and subsequent continuation of chemotherapy. The primary endpoint was overall survival (OS). The ultimate goal was complete resection of all macroscopic disease, whether performed as primary treatment or after neoadjuvant chemotherapy.

The largest residual tumor was 1 cm in 41.6% of patients after primary debulking and in 80.6% of patients after interval debulking. In an intent-to-treat analysis, median OS (29 months in the primary surgery group vs. 30 months in the neoadjuvant group) and median progression-free survival (12 months each) were similar in the two groups. The hazard ratio for death in the neoadjuvant group compared with the primary surgery group was 0.98 (P=0.01 for noninferiority). Post hoc analysis did not reveal any subgroup in which one treatment was superior to the other. In descending order, the strongest independent predictors of prolonged survival were absence of residual tumors after surgery (P<0.001), stage IIIC disease (P=0.001), small tumor size before randomization (P=0.001), endometrioid histology (P=0.005), and younger age (P=0.005). The authors concluded that neoadjuvant chemotherapy followed by interval debulking was not inferior to primary debulking surgery.

Comment: This study confirms the role of neoadjuvant chemotherapy followed by interval debulking for the management of patients with advanced ovarian cancer, particularly those whose condition at diagnosis limits surgical intervention. The issue is whether this approach should supersede primary surgery as a treatment option. Given the noted advantage of intraperitoneal chemotherapy in patients whose disease has been optimally debulked, the standard of care should remain primary surgical cytoreduction. Nonetheless, neoadjuvant therapy has other advantages; moreover, the approach is useful for assessing novel cytotoxic and biological therapeutics and might prove particularly beneficial in a selected cohort of patients.

See full article here

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Submitted by Nibal Nina Lindeberg-Bowers

One evening in January, I woke up in the hospital bed with 2 diagnoses: infertility and cancer, whispered to me by my husband after I reassured him that I was strong enough to handle the news.

I was 35 years old when I was diagnosed with Stage 1b-c endometrioid adenocarcinoma or endometrial ovarian cancer, from which I had to have a total hysterectomy, debulking and staging, followed by chemotherapy.

In the succeeding days I found myself crying in the middle of the night, crying for the fear of mortality, crying because my husband stood by my side no longer as my romantic partner but as my sole caregiver.

We were trying to get pregnant, and after an imaging test, my doctor noticed a rapid increase in size of my ovarian cyst within 10 month’s time. If we were not trying, the doctor would not have caught it in time, and I would have been a walking time bomb. The only symptoms I experienced seemed GI-related. God had spared me.

The 2 weeks during my recovery from surgery was challenging. I had to learn to be vigilant about my diet and heal for chemotherapy. My husband and I had no immediate family around but I was so grateful for the family and friends who showed up and deeply cared. I have accepted those who were not at ease in addressing my illness, or those who did not visit me maybe because they were busy with their own lives or their own problems. But each member from my side of the family flew in to take turns and keep me company. I was given the rare chance of bonding with each one of them.

Thinking simply, I told myself that I have cancer and I need treatment. I chose not to be too informed about it but only focused on getting a second opinion on my pathology report and treatment options.

During my chemotherapy sessions, I met a wonderful and positive network of cancer patients and survivors. We actually got to have a conversation that made sense to us, despite our dose of Benadryl and our chemo-brain.

A busy-bee by nature, I filled up my schedule to my physical capacity with knitting lessons and walks in the park. After almost 20 years, I also found joy in dancing the ballet again, this time among housewives. When my count was down, I was forced to learn to slow down.

Then before you knew it, my chemo was over! This was my second chance in life and I decided to live in the present; taking pleasure in loving those who have given me comfort, support, and hope. With my doctor’s clearance, I hopped in a plane to go back to my roots. I caught up with my high school friends, personally thanked those who prayed for me, spent time with my family and visited my grandmother who has Alzheimer’s. My husband and I also celebrated our 8th wedding anniversary filled with unplanned activities (so unlike me) where I learned the sense of peace that you get from letting go.

My husband has been very supportive the entire time. When I saw my abdominal scar, he said it was okay. When I lost my eyebrows, he said I looked “mestiza”. When my skin broke out like a teenager, he told me my acne will go away. When I was cold, he told me to turn my heater on (with my hot flashes). When I lost my hair, he said I was as cute as a baby. His positive attitude helped me deal with accepting my new situation. And to my amusement, my 4 year old niece asked her mom if I had gotten a haircut, while my 3 year old nephew told me that I’m no longer a porcupine because my hair got thicker.

It was not easy going back to normal overnight. Slowly my eyebrows started growing back but my hair was still not long enough. I was able to do a pirouette in ballet class but I suffered from pain in my hands and feet. I felt re-energized to carry a conversation but I had cognitive difficulties at times.

I have always been content and happy. But my outlook on life has changed. I value experiencing life through activities, travels, and relationships more than buying that dream house.

Bonnie’s Wish

You need to be brave and strong when facing adversity.

These few words are so true – my late wife, Bonnie, and I were to find out. She had a pelvic pain start one day, a simple ovarian cyst. Surgery was needed. A minor problem turned into cancer, which would claim her life. September, October, November, December…all a blur. She fought hard and then some. The new year showed promise, as it always does. Early in February 2010, the prognosis was deemed terminal. Our worst fears were realized. She would die soon.

We were married 21 years. We thought our health was good. We were very wrong. Through her treatments and surgeries she said, “I wouldn’t wish this on anyone. Not even my worst enemy.” Bonnie’s wish was born.

I am vowing to let people know, mainly the female population, that ovarian cancer is deadly. Some of you may beat it … but many will not. I plead to you, please see your gynecologist and doctors. Keep your appointments. My Bonnie wouldn’t go for check-ups. “Too embarrassing,” she said. She never had children, so she didn’t have exams as in the case with pregnancy. Didn’t see the need and had no problems. Unfortunately for her and I, “problem” took her life.

“Now you showed me how I’m suppose to live. And now you showed me how to die.”

November 23, 1960-March 1, 2010

I Love You Honey,

Rest In Peace.

Karl Bates

In March of 2010, my doctor called me in to tell me that my CA125 was elevated and I needed a CT scan. My cancer has recurred and I am presently under going a clinical trial and I have faith that God will get me through this. I am blessed in so many ways!

The day she died I was at school. I was going to try to wake her up before I left to school but I didn’t want to disturb her. I just wanted to hear her voice one last time. I just left to school and while I was at school I was already crying because I kind of felt like she was gone. During lunch I was called to the office. My aunt was there to pick me up. When I saw her she told me and that was it…I cried and cried.

And now I want to support ovarian cancer because I know how it felt seeing someone I love go through it and I wouldn’t want anyone else to go through it either.

Submitted by Alana Ballor

TEAL is the ovarian cancer community’s color and serves as a reminder that ovarian cancer is the deadliest of all the cancers of the reproductive system and a leading cause of cancer death among women.

To find out what you can do this September to get involved, visit our September guide.

The United States of Teal campaign
United States of Teal is the Ovarian Cancer National Alliance’s campaign to raise awareness about ovarian cancer by gaining the support of state legislative leadership.

With our United States of Teal campaign we’re targeting all 50 state houses and asking legislators to pledge their allegiance to the fight against ovarian cancer. By signing a pledge card, they are letting their constituents know that they are committed to promoting ovarian cancer research, improving the lives of women suffering from ovarian cancer, and helping us raise awareness about ovarian cancer symptoms. Once a legislator pledges, we’ll turn his/her state teal on the United States of Teal web site (www.unitedstatesofteal.org). See the map below to see if your state has turned TEAL yet!

To learn more about the campaign, visit www.unitedstatesofteal.org.

What’s New?
Our Shop+Give Program
Some of our favortite retailers have teamed up with the Ovarian Cancer National Alliance this September. A portion of the proceeds of selected TEAL items from the following retailers will benefit the work of OCNA: Macy’s, Chico’s, Ann Taylor Loft, PaperSource, RedEnvelope, DHC, Sketchers and Tom Shoes.

Click here to shop TEAL items from your favorite retailer! And Don’t forget to download the App for future online purchases.

Ovarian Health 101: National Teleconference

Be on the look-out …
Lifetime Television
Set your DVR’s! The Ovarian Cancer National Alliance educates the viewers of Lifetime Television about ovarian cancer. On Monday, September 13th at 7:00am EDT OCNA Board President, Annette Leal Mattern, will be featured on Lifetime’s morning show, The Balancing Act. Check your local listings for show times.

To watch a preview of the segment, click here.

Costco Helps Raise Awareness
The Ovarian Cancer National Alliance would like to thank Costco for educating their shoppers about ovarian cancer this September. All 400+ Costco store locations will be running two of our Public Service Announcements (PSA’s) throughout the month of September on their high definition televisions. Be sure to check it out at your local Costco and thank the managers for their support!

To view all the inspirational stories and PSA’s, click here.

Upcoming Events

Wear TEAL Day!
Friday, September 3, 2010
Show your support by wearing TEAL the first Friday in September.

Lifetime Television’s The Balancing Act to feature OCNA Board President and ovarian cancer survivor, Annette Leal Mattern
Monday, September 13, 2010 at 7:00am EDT (Check your local listings)

Ovarian Health 101: National Teleconference
Monday, September 20, 2010 from 8:00pm-9:30pm EDT
RSVP to sarah@BeBrightPink.org

Teal Time in DC – three exciting opportunities!
1. Upstairs on 7th: Trunk Show with Ray Harris & Sissy Yates Designs  September 24-25, 2010
2. Gallery 555: Exhibit featuring Alan Binstock & Mila Kagan
Mid-September through Mid-October
3. Celadon Spa: Discounted services for those who donate to OCNA
Mid-September through Mid-October

14th Annual Ovarian Cancer National Alliance Conference
July 9-12, 2011
Hyatt Regency on Capitol Hill, Washington, DC

Click here for a full national calendar of events.

Help Make a Difference
To help the Ovarian Cancer National Alliance continue its programs and services, please make a donation this September. Every dollar counts in the fight against ovarian cancer. Visit www.ovariancancer.org/donate for more information.

Orders can be shipped nationally throughout the month of September. To place an order call (202)333-3309 or email shipping@georgetowncupcake.com. Please reference the Teal Velvet when ordering.

For those in the DC area, you can purchase Teal Velvet cupcakes from the two Georgetown Cupcake locations exclusively on Sundays and Mondays during September. Store locations can be found at georgetowncupcake.com.

Please make note of this because their cupcakes are wonderful … and the proceeds are going to a great cause!