Enough

The EOLO (End-of-Life Ovarian Cancer) Study: Approach to Ovarian Cancer Patients at the End of Life.

https://www.ncbi.nlm.nih.gov/pubmed/31437848

End-of-life chemotherapy is a thorny problem. This review of ovarian cancer patients, who died in the period between 2007 and 2017, recorded the frequency of chemo; the toxicity, mortality, and the most frequent palliative care measure adopted.

Of the 110 patients, 85 had undergone chemo in the last 3 months of life and 42 even had chemo during the last month.

The median overall patient survival was 52.8 months. The majority died at home, the quality of life decreased dramatically in the last 30 days.

Olaparib; not just BRCA?

Lynparza Phase III PAOLA-1 trial met primary endpoint as 1st-line maintenance treatment with bevacizumab for advanced ovarian cancer

https://tinyurl.com/y4z862f4

A recent press release showed positive results from the Phase III PAOLA-1 trial in women with advanced ovarian cancer. The trial, in the 1st-line maintenance setting, compared Lynparza (olaparib) added to standard-of-care Avastin (bevacizumab) vs. Avastin alone in women with or without BRCA gene mutations.

PAOLA-1 met its primary endpoint with a statistically significant and clinically meaningful improvement in progression-free survival.

Lynparza is currently approved as 1st-line maintenance treatment of platinum sensitive BRCA-mutated advanced ovarian cancer. Eric Pujade-Lauraine, Medical Director of ARCAGY Research, said, “By studying Lynparza in this broader patient population, we have learned more about how it may help even more patients with advanced ovarian cancer in the future.”

Genetic testing; buyer beware

Don’t Count on 23andMe to Detect Most Cancer Risks, Study Warns 

https://www.nytimes.com/2019/04/16/health/23andme-brca-gene-testing.html

23andMe, (a commercial non–referral genetic testing company), now has more than 10 million customers. 23andMe’s outmoded test focuses on BRCA1 and BRCA2 gene mutations involved in suppressing growth of abnormal cells. 

18 percent of ovarian cancer patients in a recent survey* carried genetic variants, 3/4 of which would not have been detected by 23andMe.

Mary-Claire King, a professor at the University of Washington says,  “The F.D.A. should not have permitted this out-of-date approach to be used for medical purposes”. “Misleading, falsely reassuring results from incomplete testing can cost women’s lives.”

*https://acmg.expoplanner.com/index.cfm?do=expomap.sess&event_id=13&session_id=10414

Infertility and ovarian cancer

Assisted reproductive technology and risk of ovarian cancer and borderline tumors in parous women: a population-based cohort study

https://link.springer.com/article/10.1007/s10654-019-00540-3

Assisted reproductive technology (ART) treatments involve systemic use of gonadotropins to stimulate ovarian follicles and subsequent aspiration of ova. ART is suspected to increase the risk of ovarian cancer.

The objective of the study was to investigate the incidence of invasive ovarian cancer and borderline tumours with infertility and ART.

   

The incidence of ovarian cancer was increased in women with infertility and following ART births; (The normal incidence of ovarian cancer is five per thousand women before age 65. This increases to seven for women diagnosed with infertility and eleven following ART). It is statistically significant but the number is small.

High risk: What next?

Ovarian Cancer Previvors: How to manage these patients?

https://tinyurl.com/y5rce2ys

Ovarian cancer is lethal, screening programs do not significantly decrease mortality from this disease. However, Previvors can be identified. Previvors have a much greater predisposition to cancer than the general population but have not yet developed the disease.

Prophylactic salpingo-oophorectomy is currently recommended for women with deleterious BRCA1 mutation. Most women do not have this surgery at the recommended age. The side effect of premature menopause is cited as the main reason women delay. The alternative of salpingectomy with delayed ovarian resection has been proposed but remains controversial.

Pre-implantation genetic diagnosis via IVF after early surgery would prevent the transmission of deleterious genetic conditions to the next generation. This too is controversial.

A management plan, “ Maximum effort to prevent ovarian cancer while preserving ovaries,” might be better accepted