Bio

Clinical Focus


  • Cancer > Gynecologic Cancer
  • Gynecologic Oncology

Academic Appointments


Professional Education


  • Fellowship:Memorial Sloan-Kettering Cancer Center (2008) NY
  • Board Certification: Gynecologic Oncology, American Board of Obstetrics and Gynecology (2012)
  • Board Certification: Hospice and Palliative Medicine, American Board of Obstetrics and Gynecology (2010)
  • Board Certification: Obstetrics and Gynecology, American Board of Obstetrics and Gynecology (2009)
  • Fellowship:David Geffen School of Medicine at UCLA (2007) CA
  • Residency:Johns Hopkins School of Medicine (2004) MD
  • Medical Education:American University of Beirut (2000) Lebanon

Research & Scholarship

Clinical Trials


  • Trametinib in Treating Patients With Recurrent or Progressive Low-Grade Ovarian Cancer or Peritoneal Cavity Cancer Recruiting

    This randomized phase II/III trial studies how well trametinib works and compares it to standard treatment with either letrozole, tamoxifen citrate, paclitaxel, pegylated liposomal doxorubicin hydrochloride, or topotecan hydrochloride in treating patients with low-grade ovarian cancer or peritoneal cavity cancer that has come back, become worse, or spread to other parts of the body. Trametinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It is not yet known whether trametinib is more effective than standard therapy in treating patients with ovarian or peritoneal cavity cancer.

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  • Olaparib Maintenance Monotherapy in Patients With BRCA Mutated Ovarian Cancer Following First Line Platinum Based Chemotherapy. Not Recruiting

    Olaparib Monotherapy in Patients with BRCA Mutated Ovarian Cancer following First Line Platinum Based Chemotherapy.

    Stanford is currently not accepting patients for this trial. For more information, please contact Suzanne Friedrich, 650-725-0426.

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Publications

All Publications


  • Video-based Peer Feedback Through Social Networking for Robotic Surgery Simulation A Multicenter Randomized Controlled Trial ANNALS OF SURGERY Carter, S. C., Chiang, A., Shah, G., Kwan, L., Montgomery, J. S., Karam, A., Tarnay, C., Guru, K. A., Hu, J. C. 2015; 261 (5): 870-875

    Abstract

    To examine the feasibility and outcomes of video-based peer feedback through social networking to facilitate robotic surgical skill acquisition.The acquisition of surgical skills may be challenging for novel techniques and/or those with prolonged learning curves.Randomized controlled trial involving 41 resident physicians performing the Tubes (Da Vinci Intuitive Surgical, Sunnyvale, CA) simulator exercise with versus without peer feedback of video-recorded performance through a social networking Web page. Data collected included simulator exercise score, time to completion, and comfort and satisfaction with robotic surgery simulation.There were no baseline differences between the intervention group (n = 20) and controls (n = 21). The intervention group showed improvement in mean scores from session 1 to sessions 2 and 3 (60.7 vs 75.5, P < 0.001, and 60.7 vs 80.1, P < 0.001, respectively). The intervention group scored significantly higher than controls at sessions 2 and 3 (75.5 vs 59.6, P = 0.009, and 80.1 vs 65.9, P = 0.019, respectively). The mean time (seconds) to complete the task was shorter for the intervention group than for controls during sessions 2 and 3 (217.4 vs 279.0, P = 0.004, and 201.4 vs 261.9, P = 0.006, respectively). At the study conclusion, feedback subjects were more comfortable with robotic surgery than controls (90% vs 62%, P = 0.021) and expressed greater satisfaction with the learning experience (100% vs 67%, P = 0.014). Of the intervention subjects, 85% found that peer feedback was useful and 100% found it effective.Video-based peer feedback through social networking appears to be an effective paradigm for surgical education and accelerates the robotic surgery learning curve during simulation.

    View details for DOI 10.1097/SLA.0000000000000756

    View details for Web of Science ID 000352326900033

    View details for PubMedID 24887970

  • Does Omentectomy in Epithelial Ovarian Cancer Affect Survival? An Analysis of the Surveillance, Epidemiology, and End Results Database INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER McNally, L., Teng, N. N., Kapp, D. S., Karam, A. 2015; 25 (4): 607-615

    Abstract

    Although omentectomy is part of the staging and treatment of epithelial ovarian cancer (EOC), its performance in a patient with a grossly normal omentum—acknowledging its role in debulking gross tumor deposits—has never been definitively shown to improve survival.Using Surveillance, Epidemiology, and End Results data from 1998 to 2010, we identified patients with EOC and assessed their age, race, year of diagnosis, tumor grade, histologic subtype, International Federation of Gynecology and Obstetrics stage, lymph node dissection, nodal findings, and performance of omentectomy. We compared disease-specific survival (DSS) based on the presence or absence of omentectomy using log-rank univariate analysis, Cox multivariate analysis, and Kaplan-Meier survival curves.A total of 20,975 patients with invasive EOC underwent surgical treatment. Initial univariate analysis indicated a lower mean DSS with performance of omentectomy. However, multivariate analysis demonstrated no significant association between DSS and performance of omentectomy (hazard ratio, 0.978; P = 0.506). The DSS was improved if lymphadenectomy was performed (hazard ratio, 0.60; P < 0.001). In recent years, there was a trend toward decreased performance of omentectomy.To look specifically at patients without bulky omental disease, a subset analysis was done looking at patients with stage I-IIIA disease who had had lymphadenectomy performed. There were 5454 patients in the group who underwent an omentectomy and 2404 patients in the group who did not. No difference in DSS was seen between the groups based on performance of omentectomy (P = 0.89). However, the analysis was limited by the lack of Surveillance, Epidemiology, and End Results data on the extent of omentectomy, amount of residual disease, and adjuvant chemotherapy.In this analysis, performance of omentectomy in patients with EOC without bulky disease (≤stage IIIA) did not seem to confer improvement in survival. A randomized control trial would be needed to fully address this question.

    View details for DOI 10.1097/IGC.0000000000000412

    View details for Web of Science ID 000354103000011

    View details for PubMedID 25756404

  • Increased risk and pattern of secondary malignancies in patients with invasive extramammary Paget disease BRITISH JOURNAL OF DERMATOLOGY Karam, A., Dorigo, O. 2014; 170 (3): 661-671

    Abstract

    Extramammary Paget disease (EMPD) is often associated with underlying or distant synchronous malignancies. The prognosis for affected patients is generally favourable; however, the risk of secondary malignancies is unknown.The goal of the study was to analyse the incidence, prognosis and pattern of secondary malignancies for patients with invasive EMPD using data from the Surveillance, Epidemiology and End Results (SEER) Program.We searched the SEER Program database for patients diagnosed with invasive EMPD between 1973 and 2008. Demographic data, outcome and secondary malignancies more than 1 year after the initial diagnosis of invasive EMPD were included in the analysis. We calculated the standardized incidence ratio (SIR) and estimated the excess absolute risk (EAR) per 10 000 person-years (PY).There were 1439 patients who were diagnosed with invasive EMPD. Most patients (80·4%) had localized disease, while 17·1% had locoregional spread and 2·5% presented with distant disease. The SIR for secondary malignancies in patients with invasive EMPD was significantly elevated with an EAR of 97·4 additional malignancies per 10 000 PY. The excess risk was mostly due to a significantly increased incidence of colorectal and anal malignancies. The initial site of disease predicted the site of the secondary malignancies, with patients with colorectal, anal, vulvar and scrotal disease showing an increased risk of colorectal, anal, vulvar and scrotal malignancies, respectively.Our study identified a long-term increased risk of developing secondary malignancies in patients with invasive EMPD that are mainly related to the site of origin of this disease. Patients with invasive EMPD require prolonged follow-up and screening for these malignancies.

    View details for Web of Science ID 000332586100019

  • HER-2/neu targeting for recurrent vulvar Paget's disease A case report and literature review GYNECOLOGIC ONCOLOGY Karam, A., Berek, J. S., Stenson, A., Rao, J., Dorigo, O. 2008; 111 (3): 568-571

    Abstract

    The treatment of Paget's disease of the vulva particularly for recurrences can be challenging. Overexpression of the HER-2/neu protein has been found in about 30% of vulvar Paget's cases therefore presenting a potential therapeutic target.We report the case of a 52-year-old patient with persistent Paget's disease of the vulva despite eight surgical excisions over a 15-year period. Immunohistochemistry demonstrated overexpression of the HER-2/neu protein in the vulva resection specimen. Treatment with Trastuzumab resulted in a significant regression of her disease and resolution of symptoms.Based on our case report, therapeutic targeting of HER-2/neu for patients with Paget's disease of the vulva using for example Trastuzumab is a potentially effective, alternative approach, and warrants further investigation.

    View details for DOI 10.1016/j.ygyno.2007.12.014

    View details for Web of Science ID 000261758000037

    View details for PubMedID 18252264

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