New Discoveries in Ovarian Cancer

in photo: Rebecca C. Arend, MD
(a GYN oncologist and ovarian cancer researcher at UAB)

The Laura Crandall Brown Foundation (LCBF), a local gynecologic (GYN) cancer foundation, encourages patients to be educated about their treatment options. LCBF’s CanSurvive Support Group meets monthly to help GYN cancer patients and their caregivers have a place to be around others on the same journey. At a recent meeting, Dr. Rebecca Arend, a GYN oncologist and ovarian cancer researcher at UAB, recently spoke with the group to share some of the results and information from her research on utilizing targeted agents to treat GYN cancers. Below is an excerpt from Dr. Arend’s presentation:

Since 2014, the FDA has approved 3 “targeted drugs” for ovarian cancer: Bevacizumab (an anti-angiogenesis agent) and 2 PARP inhibitors specifically for patients with BRCA germline mutations and tumors with somatic BRCA mutations.

“Additional research is being done and we are continuing to make new discoveries about the genes and pathways that suppress and promote cancer cell growth,” said Dr. Arend. Researchers are trying to identify therapies that can disrupt specific pathways and develop more targeted agents.

Improved and expanded genetic sequencing of tumors is enabling researchers to understand what is driving cancer metastasis and recurrence. In ovarian cancer, frequently the tumor suppressor gene TP53 is mutated and therefore, does not function as it should. In addition, about 15% of patients with ovarian cancer have a germline BRCA (or inherited) mutation. As tumors themselves have been genetically profiled, researchers have found that there are additional patients that have developed acquired BRCA mutations in the cancer cells specifically, even though the person does not have a germline mutation. Studies have shown that up to 50% of ovarian tumors have mutations in the same pathway as BRCA, called the Homologous Recombination Pathway and are thus considered to have Homologous Recombination Deficiency. Currently, PARP inhibitors are only approved for patients with germline and somatic BRCA mutations, but they could also be effective against other tumors with Homologous Recombination Deficiency. Trials are ongoing to investigate this.

UAB has started a Personalized Medicine Initiative (PMI) in the Gynecologic Oncology Division. Patients with recurrent ovarian cancer can consent to have their archival tumors undergo genetic sequencing and provide a blood sample to further investigate if tumor mutations can be detected in the blood. Since March of 2016, the Next Generation Sequencing Platform that has been used on the tumor is a 315 gene panel. The results are provided to the treating physician and are also added to the Ovarian Cancer PMI database. The patient’s physician then makes the clinical decision as to either recommend a targeted drug if one is available, a clinical trial, or a currently approved drug. The outcomes of the patients are being prospectively collected in order to provide additional information for current and future patients.