eUpdate Sept 21st, 2016: Ovarian Cancer Treatment Recommendations | ESMO

ESMO

Published: 21 September 2016. Authors: J.A. Ledermann¹, C. Sessa² & N. Colombo³ on behalf of the ESMO Guidelines Committee
¹UCL Cancer Institute, University College London, London; ²Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland; ³European Institute of Oncology, University of Milan Bicocca, Milan, Italy.

Clinical Practice Guidelines

This update refers to the  Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up, Ledermann JA, Raja FA, Fotopoulou C et al, Ann Oncol 2013; 24 (Suppl 6): vi24-vi32; and Non-epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up, Colombo N, Peiretti M, Garbi A et al, Ann Oncol 2012; 23 (Suppl 7): vii20-vii26.

Section

Personalised medicine

Text update

Maintenance therapy with the oral PARP inhibitor, olaparib has been approved by the European Medicines Agengy in women with high grade serous ovarian cancer and a BRCA mutation who have responded to platinum-based chemotherapy. In the randomised placebo-controlled maintenance trial, study 19, the median progression-free survival was extended from 4.3 to 11.6 months, post randomisation hazard ratio [HR] 0.18; p<0.0001) [1]. An updated survival analysis in patients with either a germline or somatic BRCA mutation showed an improvement in median survival from 30.2 to 34.9 months (HR 0·62 [95% CI 0·41–0·94]). Because of the effect of previous analyses, this difference was not statistically significant. Among the patients with a BRCA mutation, 15% remained on olaparib for at least five years without evidence of any tumour progression [2]. A BRCA mutation is the first genetically defined predictive marker for treatment of ovarian cancer.

Recommendation

• Patients with recurrent high-grade serous ovarian cancer and a germline or tumour BRCA mutation should be offered maintenance olaparib after a response to platinum-based chemotherapy.

Text update

Testing for a BRCA mutation

BRCA mutations are found in 5%-15% of ovarian cancer population studies [3]. Cohort studies have shown that the absence of a family history of breast/ovarian cancer is a poor negative predictor for a BRCA mutation [4, 5]. It is now recommended that patients with high-grade tumours are tested for germline BRCA mutation. Somatic mutations of BRCA are found in 5%-7% of ovarian cancer cases [6].

Recommendation

• Patients with high-grade tumours should be tested for a germline BRCA mutation. Consideration should be given to testing tumours for a somatic BRCA mutation.