Objective: We have previously reported the safety, efficient gene transfer, and favorable CA125 responses of individuals with recurrent ovarian cancer treated by p53 gene replacement with the adenoviral vector SCH 58500. The purpose of the present investigation was to evaluate the long -term follow -up of these heavily pretreated patients subsequent to SCH 58500 dosing. Methods: Patients ( n = 36 ) were treated with either single -dose SCH 58500 in the phase I study or with multiple doses ( MD ) of SCH 58500 over multiple cycles in combination of platinum -based chemotherapy in the phase I / II portion of the study. Five patients were initially treated in the single -dose group and re -enrolled in the MD group. The MD group was evaluated both without the reenrolled patients as MD1 ( n = 19 ), and as MD2 ( n = 24 ), which included them. Patients who were only treated on the single -dose arm were designated as SD ( n = 12 ). Most patients received additional chemotherapy at the discretion of their physicians on completion of the trial. The current analysis is a retrospective sequential cohort survival analysis. Results: The first patient was treated in March 1997 and the last patient completed SCH 58500 in September 1998. There was no difference in age at diagnosis, Karnofsky performance status, interval between diagnosis to SCH 58500, prior cycles or regimen of chemotherapy, platinum -free interval, percent platinum refractory patients, pretreatment CA125, or largest tumor volume between groups. Both MD groups had a slightly longer chemotherapy -free interval before SCH 58500 than the SD group. Median survival of individuals who received MD SCH 58500 with chemotherapy was 12 -13.0 months, compared to only 5 months for those treated with SD SCH 58500. There are 10 long -term survivors more than 20 months after MD treatment for recurrent disease compared to only 2 long -term survivors after SD SCH 58500. Conclusion: The 12 -to 13.0 -month median survival in a heavily pretreated population with recurrent ovarian cancer compares favorably to the 16 -month median survival for individuals treated with paclitaxel at the time of initial recurrence of this disease and is more than double the 5 -month survival seen with palliative radiotherapy or paclitaxel failure. These data suggest that further study of SCH58500 is clearly indicated.

The advantages and disadvantages of hormone replacement therapy (HRT) have been debated nearly as long as the treatment has been in use, especially the relationship between HRT and risk of cancer development. It is hoped that recently published studies will shed more light on this complex issue. Several large population studies suggest that there may be a small but increased risk of developing breast cancer in HRT users, especially in estrogen and progesterone users. This risk appears most pronounced after 5 years of HRT use. Endometrial cancer, which has long been associated with unopposed estrogen use, can be successfully prevented with the addition of progestins to the HRT regimen, provided it is given for at least 10 days each month. Estrogen replacement therapy has also been shown to significantly reduce the risk for colon cancer but not rectal cancers. Finally, a large prospective study has linked HRT with an increase in ovarian cancer mortality.

A cohort study was designed to evaluate the efficiency of gene transfer and whether biological activity from the expressed therapeutic gene resulted after administration of a recombinant adenovirus containing the human wild-type p53 (p53 wt ) gene (rAdp53 SCH 58500). The cohort study was conducted in five trial subjects with recurrent ovarian cancer. Each trial subject received multiple cycles of rAd-p53 SCH 58500, each cycle comprised of doses of 7.5 Â 10 13 particles on each of five consecutive days. Subjects were treated with rAd-p53 SCH 58500 alone during Cycle 1 and in combination with gemcitabine during the subsequent cycles. Both tumor biopsies and peritoneal aspirates were collected and evaluated for gene transfer and evidence of the biological activities of the expressed p53 wt gene. Using quantitative PCR and RT-PCR, and in situ PCR, gene transfer and expression were documented in tumor biopsies (four of five patients) collected from Cycle 1. Furthermore, upregulation of p21/WAF1, bax and mdm-2, and downregulation of survivin were observed in these same tumor biopsy samples, suggesting that intraperitoneal administration of rAd-p53 SCH 58500 leads to detectable p53 biological activity in target tumor tissue. In addition, gene transfer and its expression were observed in cells obtained from peritoneal aspirates. These fluids were mainly comprised of polymorphonuclear neutrophils, indicating that successful gene transfer can be achieved by multiple cycle intraperitoneal administration of recombinant adenovirus.

It has been postulated that androgens, through their interaction with androgen receptors (AR), may play an important role in the development of ovarian cancer. Exon 1 of the AR gene contains three highly polymorphic trinucleotide repeats. The length of the (CAG)n repeat segment 1 is inversely correlated with the transactivation function of the AR. Recent studies have shown that BRCA1 may function as an AR coregulator or coactivator and play positive roles in androgen-induced cell death in cancer cells as well as other androgen/AR target organs. We hypothesize that the AR gene, involved in endocrine signaling, may modify BRCA1-associated ovarian cancer risk. To test this hypothesis, potential associations between the (CAG)n repeat length, germ line BRCA1 mutation status, and age of diagnosis for ovarian cancer were investigated. One hundred and eleven ovarian cancer patients (27 hereditary and 84 sporadic) were included. All the cases were allelotyped for CAG repeat length and genotyped for mutations in the BRCA1 gene by direct sequencing. No association between CAG repeat length and BRCA1 mutation status was identified. Furthermore, there were no differences between hereditary and sporadic ovarian cancer in the number of (CAG)n repeats of the short allele (P= 0.336), long allele (P= 0.875), or average allele length (P= 0.550). However, ovarian cancer patients from both groups (hereditary and sporadic) who carried any AR allele of (CAG)n < or = 22 repeats were diagnosed on average 8.17 years (95% confidence interval [1.3, 15.0]) earlier than the patients whose shortest AR allele (CAG)n was >22 (P= 0.020). In conclusion, it is suggested that the CAG repeat length in AR exon 1 may affect the age of diagnosis of ovarian cancer but does so independent of germ line BRCA1 carrier status.

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