Endocrine therapy in epithelial ovarian cancer

INTRODUCTION: The estrogen receptor (ER) is expressed at high levels in many epithelial ovarian cancers (EOC) and represents a potential target for endocrine therapy. Both anti-estrogens and aromatase inhibitors have been evaluated in phase II clinical trials. Areas covered: We present an overview of the phase II and phase III trials of anti-estrogens (tamoxifen and fulvestrant) and aromatase inhibitors (letrozole, anastrazole and exemestane) undertaken in epithelial ovarian cancer identified through a Pubmed search. We describe predictive biomarkers that are being investigated to identify responsive cancers. Expert commentary: The efficacy of endocrine therapy in epithelial ovarian cancer is likely to be confined to histological subtypes with the highest ER expression while low grade serous ovarian cancer appears to be one subgroup with good sensitivity to these agents. The low toxicity profile of these agents is favourable although their use is unlicensed and the optimal setting undefined. Prospective clinical trials of endocrine agents in the early relapse and maintenance settings are urgently required to establish their definitive role in the management of epithelial ovarian cancer

Adolescent suicidal ideation: a comparison of incarcerated and school-based samples

and risk-taking behavior. RESULTS: Suicidal ideations during the past year were reported by 21.5% of detained males, compared to 6.7% in the general population. In females, 58.1% of detained individuals reported suicidal thoughts during the past year, compared to 14.4% of the general population. In girls and boys from the general population, both internalizing and externalizing problems were higher in suicidal ideators than in non-suicidal youth, while in the detention group mainly internalizing problems were higher in suicidal ideators. When comparing detention suicidal ideators with those from the general population, male suicidal ideators scored higher on delinquency, while detained female suicidal ideators also scored higher on posttraumatic stress, but lower on prosocial beliefs. LIMITATIONS: Information used in this study was solely based on self-report measures only and limited to Flemish adolescents. CONCLUSION: Since suicidal ideation is a frequent problem in detained youth, adequate recognition and treatment seems clinically relevant. While both internalizing and externalizing psychopathology may be an indicator of suicidal ideation in the general population, internalizing problems may be the main clinical predictor in detained yout

Pharmacoepidemiological approaches for population-based hypothesis testing

Pharmacoepidemiology aims to study the use and both the adverse and beneficial effects of drugs and vaccines in the population after market authorization. The efficacy of drugs is assessed in experimental studies before a drug is allowed on the market in a limited and usually selected group of patients. Therefore, after market authorization the focus is on serious and adverse effects in large groups of patients in daily clinical practice. Observational drug research is needed to establish and measure these effects. Observational research faces several challenges to minimize the chance of bias, including confounding by indication, which is caused by selective prescribing of drugs to certain patient groups. A comparison between treated and untreated subjects or between different drug regimens may be biased due to uneven distribution of risk factors for the outcome of interest. Important progress has been made during the past decade in controlling confounding by design and analysis in observational studies. The increasing accessibility of large electronic health record databases has fuelled various international initiatives to analyze multiple databases across countries using common protocols and common data models. Extensive sensitivity analysis across multiple designs, databases, and analytical techniques has provided more insight into causes of variation in results across studies and increases the confidence in findings of observational studies. Transparency of observational drug research through public registration of protocols and detailed reporting of methods should improve reproducibility and thereby reliability of pharmacoepidemiological studies