Webinar: What Women Need to Know about Ovarian Cancer

You are indeed correct that some patients have tumors with BRCA mutations while the non-tumor cells (such as white blood cells) can have a normal BRCA gene. Currently there is not a tumor test for “BRCAness” that is used clinically to make decisions for treatment. There are tumor tests that are being used from a research standpoint to better understand tumors that have a BRCA mutation or behave like they have a BRCA mutation. Examples include the Myriad HRD test and FoundationOne Next Generation Sequencing. However, performing genetic profiling of the tumor will not help guide current therapies. For instance, Olaparib is an FDA approved drug for patients with BRCA mutations but it is not approved for use in the situation you describe. As such, testing the tumor would not guarantee insurance coverage for treatment and it would be considered off-label. However, it might be reasonable to test the tumor for mutations if you were interested in participating in a PARP inhibitor trial that does not mandate germ-line (or inherited) BRCA mutations. The Mayo Clinic Center for Individualized Medicine has expertise in this area and a consultation could be scheduled. The pros and cons of tumor gene profiling should be discussed with your local oncologist.

Age 18

Yes, recommend risk reducing bilateral salpingo-oophorectomy

The symptoms of ovarian cancer are vague and can include GI symptoms. In order to fully work up symptoms, imaging (CT scan) and GI assessment (often a colonoscopy and sometimes an EGD) are often recommended. Occasionally a diagnostic laparoscopy is considered if symptoms such as pelvic/abdominal pain persist.

Will depend on insurance. Many of the commercials labs have prior authorization process. The lab will contact you with out of pocket cost after testing is ordered. If out of pocket cost is prohibitive, testing can be cancelled.

At Mayo there is currently a vaccine trial open (MC1361; clinicaltrials.gov identifier: NCT02111941) for women who have completed radical surgery, chemotherapy and have no evidence of active cancer. For more details, please visit: http://www.mayo.edu/research/clinical-trials/cls-20110798.

We are also in the process of opening a phase III clinical trial (GOG 3005) that would randomize women to receive a PARP inhibitor during their initial chemotherapy. One-third of the women on that study will continue the PARP inhibitor as maintenance after they have completed chemotherapy. This trial will be open for women with newly-diagnosed ovarian cancer.

This trial is open at Mayo Clinic in Rochester, MN. It is open at other institutions as well. Details on this clinical trial can be found at: http://www.mayo.edu/research/clinical-trials/cls-20111785 and at: https://clinicaltrials.gov/ct2/show/NCT02122861?term=ID-LV305-2013-001&rank=1.

Males can undergo genetic testing. Consultation with a genetic counselor will help guide whether he should be tested and what tests to do.

This is a very good question. The short answer is “maybe”. However, the first step for any patient is to sign consent for the Mayo Clinic ovarian cancer tissue repository PRIOR to surgery. This is key. With this, the answer is “maybe”. Without this, the answer is “no”. For this reason, and countless others, I would encourage any willing patient to participate in the repository if approached by the team. There is one caveat. The challenge with trying to make an Ovatar from a tumor that has already been exposed to chemotherapy is that it can be more difficult to grow in the lab. It is essentially ‘crippled’ from the chemo, which is good for the patient, but bad for the Ovatar. That said, if you signed consent, we will make the attempt.