ADC and platinum resistance

FDA Approves Elahere to Treat Platinum-Resistant Ovarian Cancer

https://tinyurl.com/4sv787ff

 

      One of the many difficulties in managing ovarian cancer is the treatment of platinum resistant cancer i.e. recurrence of cancer within 6 months after initial therapy. 

      The FDA has recently approved the use of Elahere an antibody-drug conjugate that targets the cancer by attaching to a commonly found cell surface protein (Folate Receptor Alpha; FR𝛂), thereby enabling cytotoxic access.

      FR𝛂 is found in 45% of all platinum resistant ovarian cancers. The approval followed the improved survival shown in the SORAYA trial with better response and duration of effect. The principal side effects include ocular toxicity, nausea and marrow suppression. This new treatment, the first approved by the FDA since 2014 helps in the management of a challenging condition.

Stem cells in OC

Therapeutic effect of haploidentical peripheral blood stem cell treatment on relapsed/refractory ovarian cancer

https://tinyurl.com/3s2xsckt

 

         Marrow stem cell transplant has been used in the treatment of leukemia for many years. Previously this has required a donation from a compatible donor. This has been problematic due to the few suitable donors. New technology has enabled the use of donations from family members, (parents or some siblings) who share 50% of the genetic signature of the recipient, (known as haploidentical).

         These readily available stem cells are being put to other purposes, notably in the treatment of renal cancer. This small study looks at the benefit or otherwise of stem cell treatment of recurrent or resistant ovarian cancer.

         13 patients received this treatment, it is known that recurrence and resistance is associated with immune incompetence. No suitable treatment currently is available. Initial results from the stem cell therapy are encouraging with improved quality of life and some increase in survival. The short duration of this study and small numbers means further evaluation is required before any conclusion can be reached.

BRCA Saliva screen

Genetic Technologies to Launch Ground-breaking Comprehensive Risk Test for Breast & Ovarian Cancer

https://tinyurl.com/y2f44mch

 

         As discussed during the recent education session, the excess capacity for genetic testing post Covid is a resource that will be used. 

         This article refers to a proposed new saliva test for BRCA positive mutations. A commercial company; (Genetic Technologies) has developed it, the testing aimed at the US market, will be done in Fitzroy, Melbourne.

         The expected positive rate is 0.5%, the company suggest a negative result will provide comfort. However, with the normal incidence of breast and ovarian cancer being much greater, this may be cold comfort. Apparently FDA approval is not required for Consumer Initiated Testing. Currently the legality in Australia is in doubt. 

HRD pitfalls

Implementing HRD Testing in Routine Clinical Practice on Patients with Primary High-Grade Advanced Ovarian Cancer

https://tinyurl.com/r8mj6cnt

         Personalised treatment of ovarian cancer is the preferred and seemingly most effective course of management. With the development of PARP inhibitors this becomes available for those women who have a genetic mutation (HRD), which limits DNA, repair.

         It is now possible to screen ovarian cancer patients for the presence of HRD either directly or indirectly via the BRCA status. This small review of 163 women showed 44% to be HRD, with only 12% being BRCA positive.

         There are however difficulties in direct HRD testing with 27 patients having insufficient tumor load for HRD testing and the median delay for results was 37 days. HRD testing will not replace germ line BRCA screen but does increase the numbers of women who will benefit from personalised care.