ESMO
Published: 21 September 2016. Authors: J.A. Ledermann
1, C. Sessa
2 & N. Colombo
3 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.