intereview with Dr David M. Gershenson: Clinical Challenges of Low-Grade (serous) Ovarian Cancer (includes comment on BRAF mutations, borderline tumors, age...)

Editor's Note:

About 10% of all serous ovarian carcinomas are low grade. Recent research indicates that these tumors differ in major ways from high-grade serous ovarian carcinomas. David M. Gershenson, MD, who holds the J. Taylor Wharton, MD, Distinguished Chair in Gynecologic Oncology at The University of Texas MD Anderson Cancer Center in Houston, Texas, discussed with Medscape current approaches to low-grade serous carcinoma of the ovary and peritoneum.
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Medscape: What is the next step for LGSC clinical research?
Dr. Gershenson: The major finding in the GOG 0239 study was a higher response with the MEK inhibitor than with conventional chemotherapy or hormonal therapy, so these drugs need to be studied further. They should also be tested in conjunction with drugs that block the PI3-kinase/Akt pathway. Dual pathway blockade may be required to produce a more robust response.
In the GOG 0239 trial, we saw a response rate of slightly over 15%, which is about 3-fold higher than with conventional chemotherapy and about 50% higher than with hormonal therapies in the recurrent setting. Unlike the situation with melanoma, there was no correlation with mutational status. That was something of a surprise and suggests that we don't understand what the impact of having a mutation is. I was certainly disappointed that there was not a correlation. We are looking at other markers in that pathway using data from that trial, and that analysis has not yet been completed..........

....Finally, the principal advance over the past decade is the recognition of LGSC as a distinct entity^[9] -- very different from the typical high-grade ovarian cancers. Women with this subtype deserve separate clinical trials and treatment options.