Gershenson_subbed_qxp 30/4/09 11:40 Page 64
Gynaecological Oncology
In addition, immunohistochemistry may be helpful in distinguishing progression-free survival or overall survival time. Currently, there is
mucinous ovarian carcinoma from mucinous cancer of the an international study in development combining the efforts of the
gastrointestinal tract. In primary ovarian carcinomas, CK7 is UK Medical Research Council with the GOG. This is a phase III
generally positive and CK20 is usually negative, although it may randomised trial of paclitaxel/carboplatin versus capecitabine/
occasionally be weakly or focally positive. Conversely, colorectal and oxaliplatin with a secondary randomisation to bevacizumab for
appendiceal cancers are usually CK7-negative and CK20-positive.
35
patients with newly diagnosed mucinous ovarian carcinoma. It is
anticipated that this trial will open to patient accrual sometime in
Molecular Studies early 2009.
K-ras mutation appears to be an early event in the pathogenesis of
mucinous ovarian carcinoma, whereas p53 mutation appears to be Summary
extremely infrequent.
36–38
As with clear-cell carcinomas, expression Within the classification of epithelial ovarian cancer, there are at
profiling of mucinous ovarian carcinomas has identified genes that are least three uncommon subtypes – low-grade serous carcinoma,
differentially overexpressed in mucinous carcinomas compared with clear-cell carcinoma and mucinous carcinoma – that appear to be
serous carcinomas.
39
Furthermore, these studies highlighted pathways relatively resistant to conventional chemotherapy and to have a
with genes involved in drug resistance and in cytoskeletal regulation. pathogenesis, molecular signature and clinical behaviour distinct
from typical high-grade serous carcinoma of the ovary. Emerging
Clinical Studies information strongly argues for separate clinical trials for women
Mucinous carcinomas account for approximately 10% of all ovarian with each of these histological types, with emphasis on targeted
cancers, but only fewer than 5% of advanced-stage tumours. therapeutics and translational research components. ■
Although patients with stage I mucinous carcinoma have an
excellent prognosis, with a 90% five-year disease-free survival,
David M Gershenson is Professor and J Taylor Wharton,
women with advanced-stage disease have a poor response to
MD, Distinguished Chair in Gynecologic Oncology in the
platinum-based chemotherapy and a worse prognosis compared Department of Gynecologic Oncology at the University
with serous carcinomas.
28 of Texas MD Anderson Cancer Center in Houston. He is
recognised as an international expert in the area of
ovarian cancer and has been listed in ‘The Best Doctors
Two case-control studies have been reported, both of which in America’ in American Health magazine, Good
suggest that advanced-stage mucinous ovarian carcinoma has a
Housekeeping’s ‘Best Doctors in America for Women’,
‘America’s Top Doctors’ in Castle Connolly’s Guide, in
worse prognosis than non-mucinous ovarian cancers.
40,41
Hess et al.
Woodward & White’s ‘Best Doctors in America’ and in the Guide to America’s Top
compared 27 patients with mucinous carcinoma and 54 controls.
40
Obstetricians and Gynecologists. Dr Gershenson has been the principal investigator of
The response rate to first-line platinum-based chemotherapy was
several clinical trials in ovarian cancer and was MD Anderson’s Principal Investigator
of the Gynecologic Oncology Group (GOG) (1990–2002). He was Principal Investigator
26% for patients with mucinous carcinomas compared with 65% for
on a US Department of Defense US$1.2 million grant to study ‘Chemoprevention of
those with non-mucinous carcinomas. In addition, both the Ovarian Cancer’ and has been Co-Principal Investigator on the National Cancer
progression-free survival and overall survival were significantly
Institute’s Specialized Program of Research Excellence (SPORE) in ovarian cancer grant
since 1999. In addition, he is conducting several clinical and translational research
worse for those patients with mucinous carcinomas. In a study from
studies of rare ovarian tumours: malignant germ-cell tumours, sex cord-stromal
the Hellenic Cooperative Oncology Group, 47 patients with tumours, borderline ovarian tumours and low-grade serous carcinomas. Dr
mucinous carcinoma and 94 with serous carcinoma were analysed.
Gershenson is Editor Emeritus of Gynecologic Oncology, having been Editor in Chief
from 1990 to 2008; in addition, he is Associate Editor of the Obstetrical and
The response rate in the former group was significantly worse: 38.5
Gynecological Survey.
versus 70%. However, there were no differences in either
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