Angeles Alvarez Secord, MD
Treatment for patients with ovarian cancer has evolved considerably over the last few years, in part due to the implementation of genetic testing.
According to Angeles Alvarez Secord, MD, once a patient is diagnosed with ovarian, fallopian tube, or peritoneal cancer, the conversation about genetic testing begins. She added that it is important to include a genetic counselor in these conversations if possible, as they can guide the patient on the importance of testing, as well as the different tests available and the implications of their results.
For example, if a test reveals that a patient has a BRCA1/2
mutation, PARP inhibitors have shown to be beneficial. Genetic testing can also reveal whether a patient has a predisposition for other cancers, such as those of the breast and pancreas, and steps can then be taken to address that risk.
“It is incredibly important to understand that it is not a one-size-fits-all paradigm anymore,” said Secord.
In an interview during the 2018 OncLive®
State of the Science Summit™ on Ovarian Cancer, Secord, a gynecologic cancers specialist at Duke Cancer Center, discussed recent updates in ovarian cancer, with an emphasis on the clinical significance of genetic testing.
OncLive: Reflecting on the different presentations tonight, what does this signify about the progress being made in this disease?
: We have made incredible progress in ovarian cancer. Some of this program provided basics in terms of the landscape and the treatment of women with newly diagnosed disease, as well as surgical management of ovarian cancer. The first half of the meeting dealt with how to treat someone with advanced, newly diagnosed ovarian, fallopian tube, and peritoneal cancer. We covered the chemotherapy options, as well as the surgical management. Importantly, we also discussed genetic testing. This part of the program provided a hint of what is to come. That is personalized medicine—individualized care for women who have these types of cancers.
Dr Wendel Naumann of Atrium Health discussed the surgical management of this disease. Surgery is certainly a cornerstone of management, but we need to decide in which patients primary debulking surgery should be done versus neoadjuvant chemotherapy followed by interval debulking surgery and more chemotherapy. Dr Jubilee Brown of Atrium Health highlighted the importance of genetic testing in identifying women with mutations such as BRCA1/2
or homologous recombination deficiency (HRD) who may benefit from PARP inhibitors.
Additionally, genetic testing can identify women who are at an increased risk for breast and ovarian cancer, so we can use this information to prevent other cancers. That is so striking to me—the fact that we can identify women who have a genetic predisposition to ovarian and breast cancer. Now, it is even beyond that; we are able to identify increased risk of pancreatic and other cancers. We can institute cancer screening, give treatments to try to prevent these cancers, or even surgery. We will be able to reduce ovarian, fallopian tube, and peritoneal cancer incidence by about 20%.
In regard to genetic testing, how do you choose when and how to test these patients?
As soon as someone has a diagnosis of ovarian, fallopian tube, or peritoneal cancer, I am talking to them about genetic testing. We have a fantastic program at Duke Cancer Institute, and we are very fortunate to have a genetic center that is available to us. The genetic counselors will [guide] patients regarding the different tests available, the importance of testing, and the different outcomes of the tests. For instance, they may have a test that indicates a pathologic mutation that puts [the patient] at an increased risk. Or, they could have a test that is negative. However, in the setting of significant family history, they are still at an increased risk.
We might not identify the gene of interest, or the patient could have a test that shows a variant of uncertain significance (VUS). A VUS means that we don't know if it deleterious, pathogenic, or neither. That can institute its own challenges in understanding for the patient. They could also have a negative test and family history that is not concerning, so they do not need to undergo unnecessary screening or procedures.