OVARIAN CANCER 101 7/16/14 FAST FACTS

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1 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 About 14,000 women will die of ovarian cancer this year. SEER Data: Surveillance, Epidemiology, and End Results Program In 2011, there were an estimated 188,867 women living with ovarian cancer in the United States. 1

2 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 ü Abdominal or pelvic pain ü Bloating ü Increased abdominal size ü Difficulty eating, feeling full early ü Urinary symptoms Cancer Volume 109, Issue 2, pages , 11 DEC 2006 DOI: /cncr RISK FACTORS: INCREASED RISK 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 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 2

3 PROTECTIVE FACTORS: DECREASED RISK Reproductive ü Use of oral contraceptives ü Pregnancy ü Breastfeeding Gynecologic Surgery ü Tubal ligation ü Salpingo-oophorectomy: removal of ovaries & fallopian tubes DIAGNOSIS & WORKUP family history breast, ovary colon, pancreas prostate physical exam blood tests CA-125, AFP imaging CT scan transvaginal ultrasound NEXT STEPS surgery pathology staging chemotherapy 3

4 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 4

5 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 5

6 How can a clinical trial help me? CLINICAL TRIALS Does the proposed treatment apply to my cancer? What are all of my treatment options? You 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, or

7 ADDITIONAL RESOURCES clinicaltrials.gov Database of clinical trials National Cancer Institute Ovarian Cancer Website Clinical Trials Prevention and Treatment Genetics, Literature, Statistics Coping Johns Hopkins Ovarian Cancer Web Understanding your pathology report 7

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