According to a recent article published in the Journal of Clinical Oncology, expression of genetic components from cancer cells in women with advanced ovarian cancer help predict outcomes to standard therapy and may ultimately guide treatment decisions for these patients.
Ovarian cancer is a malignancy that arises from various different cells within the ovaries. Ovarian cancer accounts for 4% of cancers among women and is the fifth leading cause of cancer related deaths. Unfortunately, most ovarian cancers are not detected until the disease has progressed to other sites in the abdomen or other organs in the body. Once ovarian cancer has spread from its site of origin to other sites in the body, long-term survival for these patients remains suboptimal with current treatment approaches, which typically consist of platinum-based chemotherapy, radiation and/or surgery. Researchers continue to evaluate ways in which to determine which patients may respond more or less favorably to specific types of therapy, in order to individualize treatment approaches and ultimately improve outcomes for patients with this disease.
With the advent of the field of genetics entering into the clinical management of cancer by revealing different prognoses among patients with various cancers, researchers are beginning to be able to further classify patients into specific subgroups according to the expression of their genes or genetic products (proteins). For example, through genetics, researchers now have an idea as to whether a patient with breast cancer may respond to specific chemotherapy agents or whether patients with different types of leukemia have a more or less aggressive type of leukemia. In the hopes of truly individualizing cancer treatment for patients, gene expression is being evaluated in several ongoing studies including multiple types of cancers.
Researchers from Beth Israel Deaconess Medical Center, Harvard University, and Memorial Sloan-Kettering Cancer Center recently conducted a clinical study to evaluate possible associations that may exist between gene expressions and outcomes in ovarian cancer. This study included tissue from cancer cells of 68 patients, 96% of whom were diagnosed with advanced (stage III/IV) ovarian cancer. All patients had been treated with standard chemotherapy including a platinum (cisplatin or carboplatin) regimen. Researchers identified expressions of 115 genes, referred to as the Ovarian Cancer Prognostic Profile (OCPP), that were associated with outcomes of these patients. According to the OCPP, patients could be grouped into “favorable” or “unfavorable” in terms of cancer-free and overall survival times. At a follow-up of 49 months, the average duration of survival had not yet been reached for the favorable group, while the average duration of survival for the unfavorable group was 30 months. In addition, disease-free survival was 33 months for the favorable group according to the OCCP, and only 10 months for the unfavorable group. Upon analysis of multiple clinical variables, OCCP independently predicted the prognosis of a patient.
The researchers concluded that gene expression may help to determine the prognosis of patients with advanced ovarian cancer who receive treatment with the standard platinum-based chemotherapy. They suggest that although further studies are necessary to validate these findings, it appears that gene profiles such as the OCPP can help guide patients to optimal treatment options. Patients with a favorable prognosis according to their gene expression may opt for standard therapies, while patients with an unfavorable prognosis may wish to consider participation in a clinical trial evaluating novel therapeutic approaches. Patients diagnosed with ovarian cancer may wish to speak with their physician regarding their risks and benefits participation in a clinical trial further evaluating gene expression or other novel screening or treatment measures. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.cancerconsultants.com. Personalized clinical trial searches are also performed on behalf of patients at cancerconsultants.com.
Reference: Spentzos D, Levine D, Ramoni M, et al. Gene expression signature with independent prognostic significance in epithelial ovarian cancer. Journal of Clinical Oncology. 2004;22:4648-4658.