Ovarian Cancer? Now What?

Ovarian cancer prognosis guidelines based on gene maps may guide treatments in the future

(RxWiki News) Upon ovarian cancer diagnosis, the big question is: now what? Classification systems based on the gene profiles of ovarian tumors are in the works to help guide doctors and patients.

A recent study evaluated the gene maps of high-grade serous ovarian carcinoma tumor samples. The study’s results helped to design a classification structure to guide treatment plans and patient understanding. Further analysis and testing will be necessary before this classification system is ready for clinical use.

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Roeland G. W. Verhaak, PhD, assistant professor in the Department of Bioinformatics and Computational Biology at MD Anderson Cancer Center in Houston, TX, led an investigation into the genes of serous ovarian carcinoma.

In the study background, the authors discussed high-grade serous ovarian cancer, which is found in approximately 60 to 80 percent of the 26,000 women in the US diagnosed with ovarian cancer every year. There is a high risk for high-grade serous ovarian cancer returning after treatment and surgery. Less than 40 percent of patients with high-grade serous ovarian cancer live for five years after diagnosis.

Following up on existing research and data from The Cancer Genome Atlas Research Network (TCGA) of 489 tumor samples, researchers further identified ovarian cancer classifications with 879 high-grade serous ovarian carcinoma gene profiles.

Researchers were able to group subtypes of genetic profiles in the high-grade serous ovarian carcinomas and assign the probable outcomes of those specific subtypes. The isolated subtypes found were: mesenchymal, differentiated, proliferative and immunoreactive.

Authors recommended the findings in this study undergo further evaluation before being used to predict high-grade serous ovarian carcinoma outcomes in a clinical setting.

The results of this study could provide the foundation for an oncologist to look at the gene profile of a patient’s tumor to discover which subtype exists and then factor in the patient's age, history, tumor grade, BRCA mutations and any residual disease after surgery. This combined knowledge could map out a relatively accurate prognosis for the patients and direct future treatments.

Authors said, “Concerns of prognosis are often among the first issues dealt with by ovarian cancer patients, and robust prognostic classification may aid in providing patients insight into this life-changing event.”

As this study highlights, not all high-grade serous ovarian carcinomas are the same genetically. Therefore, treatments could be most successful when tailored to the specific gene subtype of cancer.

The authors named this system the “Classification of Ovarian Cancer” (CLOVAR). Based on the 879 gene profiles they sampled, 23 percent were classified in the “worst outcome group” with a 23-month life expectancy and a likelihood of treatment resistance of 63 percent. The average life expectancy was 46 months with only a 23 percent treatment resistance rate.

A high-grade serous ovarian cancer classification system may help influence treatment plans and help patients understand what to expect from their treatment course.

This study was published in January in The Journal of Clinical Investigation.

The National Institutes of Health, the Chapman Foundation, the National Health and Medical Research Council of Australia supported funding for this study. Co-author Matthew Meyerson reported having a relationship with Foundation Medicine and Novartis, but no conflicts of interest were found.

Review Date: 
January 30, 2013