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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”