Genetic standard of care

Development and validation of the gene expression Predictor of high-grade-serous ovarian carcinoma molecular subtype

https://tinyurl.com/y9ybnbho

         High-grade serous ovarian cancer (HGSOC) is the commonest (about 70%), and often lethal. There had been little change in outcomes for 20 years or so but recently improved treatment is becoming available based on the genetic signature of the cancer.

         Currently the evaluation of genetic status is non-standard with various centres adopting different strategies. This review evaluated an algorithm derived from the gene-expression data from 1650 tumours and applied the new analysis to 3829 cases of HGSOC.

         This multi-centre study in Canada, Australia, and the USA proved the validity of the algorithm as a predictor for drug sensitivity. The authors suggest that standardised genetic testing should be used for HGSOC.

More BRCA Quicker

Feasibility of tumor testing for BRCA status in high grade serous ovarian cancer using fresh-frozen tissue based approach

https://tinyurl.com/ya55bka3

         The presence of a BRCA mutation has been an important predictor of increased risk of breast and ovarian cancer. Now, with the development of targeted therapy via PARP inhibitors, it is important to know the BRCA status for all women with ovarian cancer.

         This study looks at 456 women with stage III/IV ovarian cancer and the efficacy of frozen section diagnosis, at the time of initial surgery, to determine the presence of BRCA variants, which may respond to targeted therapy.

         The results show 32% of the women had BRCA variants and that the frozen section analysis was accurate for 86% of cases. This means that it is possible to commence appropriate therapy more quickly and for more patients.

An Honour for Jill

Jill Emberson OAM

         In the Queen’s Birthday Honours list this week, Jill Emberson posthumously received the award of Medal of the Order of Australia. The Australian people have a larrikin disregard for imperial honours. However, in this instance the award was completely appropriate and well deserved.

         Jill developed ovarian cancer in 2016. Like many others, her ovarian cancer was diagnosed late being stage 3 on presentation She knew the advanced stage meant that her outlook was grim, saying, “ Every day in Australia 4 women are diagnosed with ovarian cancer, 3 will die of it, 2 within 5 years or less”.

         Recognising that the prospects for women with ovarian cancer had not changed significantly in 20 years and realising that there is chronic underfunding, Jill set out to make change. As an ABC journalist, she was well placed to do so, starting a podcast; “Still Jill” and lobbying politicians for much needed funds. Though sadly missed by her family and friends, they have the consolation that she did, and will continue, to make a difference.

https://podcasts.apple.com/au/podcast/still-jill/id1437853975

More good news from the SOLO2 trial

Andres Poveda

Maintenance Olaparib Improves OS in Patients With BRCA-Mutated, Relapsed Ovarian Cancer

https://tinyurl.com/ycbvgzkk

         The SOLO2 clinical trial has now concluded, there is data available for the 5 years follow up of patients who received Olaparib therapy.  Patients were selected as being BRCA mutation positive and having had at least 2 previous platinum chemo courses.

         The primary end point, an improvement in progression free survival was reported in 2017 and has caused a significant change in the treatment of ovarian cancer, with Olaparib maintenance now being standard therapy for some patients.

         The secondary end point is improvement in overall survival; it is a feature of many oncology clinical trials that this is not achieved. However, analysis of the final data as of February 2020 shows significant improvement in overall survival with a median of 51.7 months compared to 38.8 months for the placebo group.

         This trial confirms the value of Olaparib therapy, which is now suitable for increasing numbers of ovarian cancer patients who fit in the homologous recombination deficiency group.