Ovarian Cancers Evolving Paradigms in Research and Care (2016) / Chapter Skim
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6 Recommendations
6 Recommendations
Pages 255-278
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From page 255... ...
The committee identified four overarching concepts that should be applied to each recommendation in this report: • Because high-grade serous carcinoma (HGSC) is the most common and lethal subtype ovarian cancer, its study needs to be prioritized; • Even with a focus on HGSC, more subtype-specific research is also needed to further define the differences among the various subtypes; • Given the relative rarity and heterogeneity of ovarian cancers, col laborative research (including the pooling and sharing of data and biospecimen resources, such as through consortia)
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From page 256... ...
Ovarian cancers can arise from many cell types, and even among ovarian carcinomas there are a number of distinct subtypes. For example, recent evidence suggests that many ovarian carcinomas do not arise in the ovary per se.
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From page 257... ...
is essential and will serve as the necessary foundation for all future research in ovarian cancer, including treatment course determination. Therefore, the committee recommends the following: RECOMMENDATION 2: Pathology organizations, oncology profes sional groups, and ovarian cancer researchers should reach consensus on diagnostic criteria, nomenclature, and classification schemes that reflect the morphological and molecular heterogeneity of ovarian cancers, and they should promote the universal adoption of a standardized taxonomy.
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From page 258... ...
For example, in 2003 a workshop was co-convened by the National Institutes of Health Office of Rare Diseases, the National Cancer Institute's (NCI's) Office of Women's Health, and the NCI Cancer Diagnosis Program to resolve conflicts regarding the characterization of borderline ovarian tumors (BOTs)
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From page 259... ...
RISK ASSESSMENT, SCREENING, AND EARLY DETECTION Better methods for identifying high-risk women could facilitate the prevention or early detection of ovarian cancers. A family history of ovarian cancer and specific germline (inherited)
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Therefore, the committee recommends the following: RECOMMENDATION 4: Researchers and funding organizations should identify and evaluate the underlying mechanisms of both new and established risk factors for ovarian cancers in order to develop and validate a dynamic risk assessment tool accounting for the vari ous ovarian cancer subtypes. Furthermore, a spectrum of risk factors should be considered, including genetics, hormonal and other biological markers, behavioral and social factors, and environmental exposures.
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From page 261... ...
, often in combination with imaging technologies. While the use of these strategies in large screening trials has resulted in more ovarian cancers being detected at earlier stages, to date these methods have not had a substantial impact on overall mortality (Buys et al., 2011; Jacobs et al., 2015; Kobayashi et al., 2008; Menon et al., 2015; van Nagell et al., 2007)
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From page 262... ...
DIAGNOSIS AND TREATMENT Compared to the situation over the past few decades, newly diagnosed ovarian cancers are now being more accurately and consistently staged. Thanks both to better characterization of tumor biology and to a precision medicine approach in the development of therapeutics, a wider variety of treatment options now exist.
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From page 263... ...
. Standard of Care Several organizations have developed standards of care for the assessment and treatment of women with both newly diagnosed and recurrent ovarian cancers.
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From page 264... ...
The committee concludes that the current patterns of care for women with newly diagnosed and recurrent ovarian cancers reveal inconsistencies in therapeutic approaches and disparities in care and subsequent outcomes. Therefore, the committee recommends the following: RECOMMENDATION 7: To reduce disparities in health care delivery and outcomes, clinicians and researchers should investigate methods to ensure the consistent implementation of current standards of care (e.g., access to specialist care, surgical management, chemotherapy regimen and route of administration, and universal genetic germline testing for newly diagnosed women)
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From page 265... ...
. Therefore, the committee recommends the following: RECOMMENDATION 8: Clinicians and researchers should focus on improving current treatment strategies, including • The development and validation of comprehensive clinical, his topathologic, and molecular characterizations that better inform precision medicine approaches for women with newly diagnosed and recurrent disease; • Advancement in the understanding of the mechanisms of recurrent and drug-resistant (e.g., platinum-resistant)
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From page 266... ...
A better understanding of the histologic subtypes and molecular features of the range of ovarian cancers has led to a more targeted approach for the use and development of new therapeutic treatments. To address the growing number of new therapeutics, innovative early phase clinical trials that
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From page 267... ...
Therefore, the committee recommends the following: RECOMMENDATION 9: Researchers should develop more effective pharmacologic and nonpharmacologic therapies and combinations of therapies that take into account the unique biology and clinical course of ovarian cancer. These approaches should include • Developing immunologic and molecularly driven treatment ap proaches specific to the different ovarian cancer subtypes; • Identifying markers of therapeutic resistance and exceptional re sponse; and • Using interdisciplinary teams to design and conduct statistically efficient and information-rich clinical studies.
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From page 268... ...
A 2013 IOM report stated, "A high-quality cancer care delivery system depends upon clinical research that gathers evidence of the benefits and harms of various treatment options so that patients, in consultation with their clinicians, can make treatment decisions that are consistent with their needs, values, and preferences" (IOM, 2013, p.
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From page 269... ...
The committee concludes that a majority of women with ovarian cancer require long-term active disease management, necessitating more effective approaches for supportive care and selfmanagement across the survivorship trajectory. Therefore, the committee recommends the following: RECOMMENDATION 10: Researchers and funding organizations should study the supportive care needs of patients with ovarian cancer throughout the disease trajectory, including • Identifying the array of factors that put women at high risk for poor physical and psychosocial outcomes; • Identifying and overcoming barriers to the systematic assessment of the physical and psychosocial effects of disease and treatment; • Developing and implementing more effective supportive care and self-management interventions; and • Defining the parameters that indicate when patients and their fami lies would benefit from transitioning to end-of-life care.
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The cancer care team should place a pri mary emphasis on providing cancer patients with palliative care, psychosocial support, and timely referral to hospice care for end of-life care (IOM, 2013)
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2013. A meta-analysis: Neoadjuvant chemotherapy versus primary surgery in ovarian carcinoma FIGO stage III and IV.
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From page 272... ...
2009. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: A combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: By the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR)
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2013. State of the art of surgery in advanced epithelial ovarian cancer.
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2013. Racial disparities in the treatment of advanced epithelial ovarian cancer.
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2015. Tubal ligation and salpin gectomy and the risk of epithelial ovarian cancer and borderline ovarian tumors: A na tionwide case-control study.
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2015. Long-term survival advantage and prognostic factors associated with intraperitoneal chemotherapy treatment in advanced ovarian cancer: A Gynecologic Oncology Group study.
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2015. Society of Gynecologic Oncology recommendations for the pre vention of ovarian cancer.
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