Early Ovarian Cancer :
Can we find it, Can we stop it, Cane we afford it?
Usha Menon
Dr Menon practices in London , England. She explained that ovarian cancer screening is a
process . She noted that:
- picking up low grade Ovarian Cancer (OC) is different that picking up high grade OC
- 50% of OC cancer arises in the fallopian tubes
- OC takes an average of 4 years to develop, stage 1&2 disease size is < 1cm
- Focus should be on finding low volume disease
Her suggestions for following low risk women include:
- CA-125 over time
- Autofluorescense high resolution imaging
- Ultrasound with microbubbles
- ctDNA (circulating tumor DNA)
(Risk of Ovarian Cancer Algorithm) study 53% of the women had a CA-125 < 35 yet had invasive ovarian cancer.
Personalized Treatment
in OC:Fancy Science or Expensive Hype
Douglas Levine
There is a broad applicability of personalized medicine.
We have developed treatments for BRCA mutations so we know
what to do with those but we are not too sure what to do when we learn about
these other mutations.
Some points Dr Levine made include:
Some points Dr Levine made include:
- Genomic scarring may occur. It is a mechanism of DNA repair which leaves a scar or signature . Those signatures can be used to classify tumors .
- Chemoresistant tumors contain an extensive number of alterations – including BRCA1& BRCA 2
- There are other mutations (6% of the women have a pTen mutation) but we few to date are clinically actionable. In other words we know about mutations but there are no treatments currently available for that mutation.
- Tumor tissue will change and evolve over time so it is important to profile the tumor in the time it needs to be treated.
- ctDNA ( circulating tumor DNA) can be found in blood plasma. It may be able to be used to monitor for recurrence and response .
Crossroads in Treatment :Primary Treatment Choices ,
Consolidation, and Postplatinum Endgame
David Spriggs
Value is patient centric. It drives care during primary
treatment. Treatment cost for patients is heavily loaded in 1st year
(hospital / treatment /diagnostic /drugs) . The actual amount the physician
charges is a very low percentage of that total cost.Primary surgery done by a gynecologic oncologist increases 5 year survival of women with OC. (gynecologic -oncologist
38% , non gynecologist 30% )
Dr Spriggs presented a few new terms that
I was unfamiliar with so I want to share them with you. The quality-adjusted life-year (QALY) measures the value
of health outcomes. QALY combines the value of the length of life and quality
of life in one number. Researchers are evaluating the cost of drugs using the
ICER(incremental cost-effectiveness ratio) . From the ASCO DAILY NEWS article
“Cost of Cancer Drugs Should be a part of Treatment Decisions” The estimated
ICER range for the US is between $50,000/QALY and $200,000/QALY. Dr Spriggs in
his presentation mentioned that the ICER for Olaparib a newly FDA Approved Parp
inhibitor was $193,000 .
Dr Spriggs noted that IP (
interperitoneal ) treatment continues to show an survival advantage and that consolidation
treatment for OC using paclitaxel is more cost effective than bevaciszumab (Avastin)(
Lesnock) .
Tomorrow’s post will report on ASCO’s CancerLINQ a health information technology platform.
Dee
Every Day is a Blessing!
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