ASCO Knowledge Part III: Value Concepts in the Management of OC

This education session at ASCO covered a number of important topics early detection, personalized medicine, treatment choices and treatment costs. 

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)

For high risk women Dr Menon recommended CA-125 every 4 months. In the ROCA
(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:

• 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 1^st 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!

Breastfeeding & Ovarian Cancer

Earlier this week I read the online article "Breastfeeding reduces ovarian cancer risk by 91%". I had breastfeed my daughter so I was interested in more details about the study. So I searched for the actual breastfeeding study in the American Journal of Clinical Nutrition to learn more. Although I could not read the entire article I could read the abstract.

Just reading the title  Ovarian Cancer risk is reduced by prolonged lactation :a case controlled study in southern china hinted that the study might hold some surprises. I had wrongly assumed the study was done in Australia since the article I read reported the researchers were from Australia. There was no mention in the article that the study subjects were from  Guangzhou, Gunagdong Province in China.  Between August 2006 and July 2008  women were given a questionnaire and asked to recall how many months they breastfeed (lactated ) and how many children they breastfeed. The questionnaires were given to 493 women with ovarian cancer and 473 women in the control arm.  The mean age of the women was 59.

The Australian researchers found an  inverse relationship between breastfeeding and ovarian cancer risk and an inverse relationship between the number of children breastfeed and ovarian cancer risk. In other words the longer you breast feed the lower your ovarian cancer risk and the more children you breastfeed the lower your ovarian cancer risk. The researchers concluded "Prolonged lactation is associated with a lower risk of ovarian cancer in parous Chinese women."( Parous women are child bearing women.)  So the study's conclusion related to Chinese women, not Autralian, American or European women.

This study was a retrospective study. In these type of studies researchers ask participants to recall if they did or used something ( breastfeed, exercise, drink coffee, use a drug)  to determine if it was a factor in developing a disease or condition later in life. If you asked me today in 2013 how long I breastfeed my daughter back in 1982  I would not be able to give you an exact answer. Was it 6 months?  9 months? I don't think it was more than 12 months but I am not sure. So in this type of study patient recall can impact the results.

This study is interesting. But if we repeat the study in the US would we get the same results? The original article I read did not mention other studies to support the results of the Australian study but did note the benefit of  breastfeeding to lower their risk of ovarian cancer.

Well, I did some research and back in 2007 the study "Breastfeeding and risk of ovarian cancer in two prospective cohorts."was published.  The results are part of the Nurses Health Study  and was a prospective study. A prospective study starts out with a healthy population with certain characteristics ( like having breastfeed) and the subjects are followed over time to see if a particular disease develops. This study concluded that there was no significant reduction in risk of ovarian cancer  in women who ever breastfeed or  never breastfeed.  But women who breastfeed 18 months or longer did show a significant reduction in risk for epithelial ovarian cancer.The average length of breastfeeding in this study was 9 months.

The conclusion of both studies is about increased risk of developing the disease. This Women's Cancer Network page does a nice job of explaining ovarian cancer risk.  The average woman's risk of developing ovarian cancer is 1 in 70.

I enjoy reading articles about cancer research studies and the related journal abstracts but sometimes find it frustrating that crucial details about the studies are often missing from media accounts.

Dee
Every Day is a Blessing !