@Francy @Elise54 @Barbara @Sandrina @jojo02 @Lulu22 @LuLuLu @Danie et les autres soeurs turquoises
Bonjour,
La "petite soeur" américaine de Cancer de l'ovaire Canada, la Ovarian Cancer Research Alliance(OCRA) a tenu sa conférence du 1er au 3 novembre 2023. Cela fait un bout de temps que je veux mettre le résumé qu'une amie, Helen Palmquist, m'a fait parvenir (avec sa permission biensûr). Prendre note que ce sont ses notes personnelles, il peut donc y avoir des erreurs. Je joins également les hyperliens à l'agenda et aux présentations des experts. Le tout est en anglais seulement.
Bonne lecture!
Christine
Résumé d'Helen Palmquist2022
OCRA CONFERENCE - My Notes - Please excuse any errors
What’s New in
Ovarian Cancer Research, Treatment and Survivorship
Stephanie Blank – Mt. Sinai
High grade serous = 70 to 75%
There have been more drug approvals
since 2014
PREVENTION – genetic testing, test family
members, risk reducing surgery – remove tubes, oral contraceptives
3000 counties in US without gyn/oncs.
Maintenance is not for everyone –
Avastin – PARPS
30% of ovarian is HRD Somatic – look
at tissue Genetic – look at blood = determines receive PARP
SOLO 1 Study - determine if use PARP
(2 years). 20% more likely disease not progress. Progression Free Survival – 2
years if BRCA positive, Progression Free Survival – 1 year if HRD
Recurrence- There is no one choice
treatment for recurrence. PARP may still help after recurrence.
Immunotherapy not as effective as
hoped for ovarian cancer
Trial- using Avastin + Cytoxan ADC-
Deliver chemo directly to tumor – toxic – Mirvetuximab
Managing Recurrence
– Sarah Adams – University of New Mexico
To determine if use neoadjuvant –
where disease is located, health and age of patient
Maintenance – use Avastin, PARP or
both
See gyn/onc once every 3 months
first 2 years, 3rd year – see gyn/onc every 4 months – see gyn/onc every 6
months up to 10 years.
Stage III – 68% recur if optimally
debulked 88% recur if not optimally debulked
Recurrence symptoms – bloating ,
pelvic pain, lymphodema, double CA125
61% of women diagnosed with
recurrence – based on elevated CA125, also do CT, MRI or PET scan
Options for treating recurrence – 1.
surgery, chemo targeted therapy. Surgery for bowel obstruction, limited sites
of recurrence, long treatment free intervals. 2. Chemo – second line treatment
if platinum resistant such as Gemzar, Doxil, Topotecan, Etoposide, Avastin
Targeted Agents – Avastin –
Bevacizumab – 6 months PFS – Progression Free Survival 20 – 40%
PARP – block DNA repair. Best
response – those with BRCA mutation, delay recurrence
Immune Therapy - only used in
trials, targets immune cells, cancer vaccines, Tcell therapy
Hormone Therapy – Tamoxifen,
response 17 to 20%
When treat Recurrence – 2010
European study – Does earlier treatment improve Survival? No
Small volume of disease – wait to
start treatment
TRIALS – Phase 1 – safety and
tolerable. Phase 2 – dose findings. Phase 3 – Compare one drug to another drug.
Standard drug vs new drug
Emerging Therapies: 1. Antibody drug
conjugate 2. Immunotherapeutic strategies 3. Combine regimens
Rare Cancers – Clear Cell – easier to treat
stage 1a. Need to be aggressive for stage III.
Low Grade – use Letrozole Granulosa
– surgery + radiation.
Ask The Experts – Dinl Khabele – Washington U, ST.
Louis, Mogre – U. of Oklahoma, Diane Yomato – U. of Chicago
Early Detection – Nothing changed. Working on liquid
biopsy – vaginal swab.
Staging & Recurrence – optimally debulked –
removing all visable tumor (no tumor left larger than a centimeter).
Muscinus – resistant and harder to
treat. Sometimes found early.
Clear cell also harder to treat.
Neoadjevant – Imaging and laproscopy determine
whether to do surgery first. If believe cannot remove all visible disease then
do neoadjevent. 7% of the time (somatic) mutation found in tumor.
Maintenance – Epithelial, If test positive for a
BRCA mutation then often respond well to platinum drugs and PARP Inhibitor.
Solo Trial – 7 year follow up – 50%
alive after using PARP
Avastin + Olaparib – 5 year data.
Large number not recur. Patients who want to continue PARP and or Avastin –
more is not always better. Avastin can cause perforation of bowel with
prolonged use. PARPS can cause bone marrow damage. PARPS work best on BRCA +
and HRD +.
If negative for BRCA and HRD then
use Avastin.
80% respond to platinum drugs. For
those who are platinum resistant – other drugs are being
studied to use with Taxol such as antibody congegants – potent
Immenotherapy has been disappointing
for ovarian cancer – T cells to fight protein. Enzymes from proteins to fight
cancer.
Access to Clinical Trials – 1. OCRA
2. Foundation For Womens Cancer
Low Grade - only 10% have low grade. Use
Letrozole instead of chemo or use Letrozole after chemo.
MANAGING RECURRENCE – DR. Sarah Adams –
New Mexico
Avastin – used as maintenance or for
recurrence
HIPEC – for muscinus under
investigation. Not for recurrence.
All people with ovarian cancer
should have genetic testing.
Repeating a PARP is being studied.
Progression Free Survival – CA125 + scans. If have progression
then go off trial.
Toxsisity to chemo – Can become hypersensitive to
Taxol. Can become hypersensitive to Carbo after dose 6, 7 or 8. Taxol can cause
neuropathy.
Use scans and CA125 instead of 2nd
look surgery.
Low Grade Maintenance – use hormone
treatment – Tamoxifen
Biochemical Recurrence – CA125 goes up but nothing shows on
scan. Sometimes CA125 high with no disease and sometimes CA125 is low with lots
of disease.
Hormonal Therapy – to stabilize disease. Maintenance -
use PARP or Avastin after recurrence.
Granulosa – good outcomes – slow growing
Stromal – do 2nd surgery. Use hormone
therapy
How long on PARPS – 2 years. Maybe safe to stay
on longer.
PARPS used more for maintenance than for
recurrence
Avastin – can cause perforation if
tumor invading bowel wall.
If CA125 is not a good marker then
use internal exam, symptoms, and scan
Trial – liquid biopsy – show
changes in tumor.
When disease is in lymph nodes treat
same as when not in lymph nodes.
Use a PET scan if a person had
radiation.
If have long progression Free
Survival then platinum sensitive and can use PARP. Not use radiation if disease
is widespread.
CART cells – modify T cells – not
work for ovarian yet.
MANAGING SYMPTOMS - Lori Spoozak – Palliative Care –
living with serious illness
Quality of life – Goals – short and
long term
Palliative – for those with 1.
Disease spread 2. Recurrence 3. When stop treatment 4. any time
How much time left – depends on how
respond to treatment
Slowing down, sleeping more, lack of
energy, no desire to eat
When dying – chemo can shorten life
Hospice – when have 6 months or
less, most often at home, nurses manage care 1 to 3 times a week, social worker
EARLY DETECTION – Dr. Deborah Armstrong – Johns
Hopkins Dr. Castle – NCI
The risk of ovarian in US general
public – 1 to 2% Family history – 3 to 5%
Easily get a sample for PAP and HPV
– cervical – preventable
Ovarian can be shed from normal cells
CA125 – not a screening tool, too
many false positivies
1. Ultra sound screening – not
reduce mortality
2. CA125 + ultrasound not reduce
mortality = only find benign disease
Need different strategy – just like
pancreatic, ovarian is hard to image
In UK – studying liquid biopsy tests
for cancer, biomarkers in blood, looking at DNA in fallopian tube, falopascope.
It took 25 years to find HPV vaccine
If BRCA positive then have
preventative surgery. Remove fallopian tubes to reduce risk& remove ovaries
later. This may reduce the number of women getting ovarian cancer.
STS – SURVIVORS
TEACHING STUDENTS
947 VOLUNTEERS, 91 in Australia, in
40 US states
Going into nursing schools
Update program language – new power
point
Knowing symptoms does NOT save lives. Now emphasize RISK
ASSESMENT – if high risk – remove tubes and ovaries later.
Looking more at prevention than
symptom
Agenda
https://ocrahope.org/patients/support-education/national-conference/2023-agenda/Présentations des experts
https://ocrahope.org/patients/support-education/national-conference/2023-ovarian-cancer-national-conference-videos/