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7/16/14
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OVARIAN CANCER 101 Victoria L Chiou, MD
Women’s Malignancies Branch National Cancer Institute, National Institutes of Health
July 11, 2014
FAST FACTS • Approximately 22,000 women will be
diagnosed with ovarian cancer in 2014. • About 14,000 women will die of ovarian
cancer this year.
SEER Data: Surveillance, Epidemiology, and End Results Program
http://statecancerprofiles.cancer.gov
http://statecancerprofiles.cancer.gov
In 2011, there were an estimated 188,867 women living with ovarian cancer in the United States.
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FAST FACTS
• Average age at diagnosis is 61. • More than 70% of women with ovarian
cancer present with advanced disease (stage 3, 4).
• 70% diagnosed with high grade serous ovarian cancer. • Of these, 15-20% carry a deleterious
mutation. • Longterm survival for advanced disease
is less than 35%.
SYMPTOMS: Development of an ovarian cancer symptom index
Cancer Volume 109, Issue 2, pages 221-227, 11 DEC 2006 DOI: 10.1002/cncr.22371
http://onlinelibrary.wiley.com/doi/10.1002/cncr.22371/full#fig1
ü Abdominal or pelvic pain ü Bloating ü Increased abdominal size ü Difficulty eating, feeling full early ü Urinary symptoms
RISK FACTORS: INCREASED RISK
Reproductive ü Infertility, Nulliparity ü Duration of menses ü PCOS ü Endometriosis
Individual Health History
ü Prior breast cancer ü Age
Environment ü Obesity ü Talc exposure ü Cigarette smoking
Genetics
ü BRCA 1 or BRCA 2 mutations
ü Lynch Syndrome or Hereditary Non Polyposis Colorectal Cancer (HNPCC)
ü Family history of breast or ovarian cancer
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Reproductive ü Use of oral contraceptives ü Pregnancy ü Breastfeeding
Gynecologic Surgery
ü Tubal ligation ü Salpingo-oophorectomy:
removal of ovaries & fallopian tubes
PROTECTIVE FACTORS: DECREASED RISK
blood tests
CA-125, AFP
imaging
CT scan transvaginal ultrasound
physical exam
family history
breast, ovary colon, pancreas
prostate
DIAGNOSIS & WORKUP
surgery
pathology
staging chemo-therapy
NEXT STEPS
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GYNECOLOGIC SURGERY
ü Goal: to remove all visible disease ü Optimal debulking ü Abdominal fluid sampling ü Consider fertility conservation
• in early stage disease • salpingo-oophorectomy: removal of ovaries
& fallopian tubes
TREATMENT OPTIONS
Surgery
• DEBULKING: all stages • Stage IA, IB, can be treated with surgery alone
Chemo
• After surgery +/- before surgery • Intravenous (IV): taxanes, platinum, others • Intraperitoneal (IP): taxanes, platinum
Radiation
• Targeted, supportive treatment • Gamma knife, brain metastases • External beam radiation therapy
SIDE EFFECTS Carboplatin
• Low blood counts: ü increased risk of infection
and bleeding ü neutropenia ü anemia ü low platelets
• Peripheral neuropathy • Nausea and vomiting
Cisplatin • Low blood counts as above • More nausea, vomiting,
neuropathy than carbo • Hearing loss • Color vision changes • Kidney damage
Paclitaxel • Low blood counts with
associated increased risk of infection and bleeding
• Hair loss • Nerve damage • Irregular heartbeat • Muscle and bone pain • Severe allergic reaction
including changes in blood pressure, difficulty breathing
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NEW AGENTS: TARGETED THERAPY
BEVACIZUMAB
• Targets angiogenesis, formation of new blood vessels to feed the tumor and provide a conduit for spreading • Antibodies attach to substances found on cancer cells to prevent
cancer growth or to kill cells
NEW AGENTS: TARGETED THERAPY
PARP INHIBITORS
• Olaparib, rucaparib, neliparib, velaparib, BMN673
• Target DNA repair mechanisms
NEW AGENTS
IMMUNOTHERAPY
• Biologic therapy boosts, directs, or restores the body’s natural defenses
against cancer
• Using your immune system to fight cancer cells
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CLINICAL TRIALS
You
How can a clinical trial
help me?
Does the proposed treatment
apply to my cancer? What are
all of my treatment options?
Taking part in clinical trials may benefit you, and may add knowledge to help improve cancer care
TREATMENT AT NCI • Screening visit: eligibility • Informed consent • Enrollment • Travel provided after enrollment completed • Small allowance to assist with outpatient costs while on-site
• Drugs, medical tests, and hospital admissions at no cost to the patient
• Care at the Clinical Center in Bethesda, MD
AVAILABLE NCI CLINICAL TRIALS
• Bevacizumab with dasatinib: a few slots left for women with biopsiable disease (prior bev ok)
• Olaparib with cediranib: ongoing trials (Boston&NCI) with phase III studies (coming 4Q14)
• CHEK1/2 inhibitor: new agent! HGS/EOC or gBRCAm, biopsiable disease (3-4Q’14)
• BMN673, PARPi for immediate next therapy post progression on PARPi for gBRCAm, (prob 3-4Q’14)
• Other Phase I studies available through Medical Oncology Branch
Contact: Laura Otten, 301-451-1228 or 1-888-624-1937
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ADDITIONAL RESOURCES • clinicaltrials.gov
• Database of clinical trials • http://www.cancer.gov/cancertopics/types/ovarian/
• National Cancer Institute Ovarian Cancer Website • Clinical Trials • Prevention and Treatment • Genetics, Literature, Statistics • Coping
• http://ovariancancer.jhmi.edu/typesca.cfm • Johns Hopkins Ovarian Cancer Web • “Understanding your pathology report”