In the United States, an estimated 19,880 new cases of ovarian cancer (OC) were diagnosed in 2022, with an estimated 12,810 deaths. Globally, the estimated new cases of OC was 313,959, with 207,252 deaths in 2020.
OC ranked fifth in cancer deaths among women in the US in 2019, and epithelial OC is the leading cause of death from gynecologic cancer.
The risk of developing ovarian cancer (OC) gets higher with age, with most cases appearing after menopause. Half of all OCs are found in women 63 years and older.
Women taking hormone therapy after menopause also have an increased risk of developing OC compared with women who have never used hormones.
Ovarian cancer (OC) incidence exhibits wide geographic variation. The highest age-adjusted incidence rates are observed in North America and Central and Eastern Europe, with rates generally exceeding 8 per 100,000. Rates are intermediate in South America (5.8 per 100,000), and lowest in Asia and Africa (≤3 per 100,000).
Ovarian cancer (OC) is a histologically heterogenous disease that can be divided into epithelial and nonepithelial cancers.
Epithelial ovarian cancers (EOCs) account for >85% of OCs and are classified into histotypes as serous, endometrioid, mucinous, clear cell, carcinosarcoma, or undifferentiated carcinoma.
High-grade serous ovarian carcinoma (HGSOCs) is the most common histotype, accounting for 80% of EOCs. HGSOCs are highly invasive, grow quickly, and are typically diagnosed at an advanced stage.
The majority of ovarian cancers (OCs) present at an advanced stage due to factors such as lack of effective screening tools and nonspecific signs and symptoms. These can include pelvic or abdominal pain, early satiety, urinary frequency, constipation, and abdominal distension.
Approximately how many new cases of ovarian cancer (OC) are estimated to be diagnosed in the US in 2022? How many deaths are estimated?
[Slide ruler mark to the correct number.]
What regions have the highest age-adjusted incidence rates of ovarian cancer (OC)?
Risk factors are present across histologic subtypes of ovarian cancer (OC) and can be categorized into genetic and hormonal.
Risk factors include positive family history, higher number of lifetime ovulations (early age at menarche and late age at menopause), hereditary nonpolyposis colorectal cancer syndrome, and BRCA1/2 status.
Patients with BRCA1/2 mutations account for approximately 15% of all women who have OC. Approximately 39% to 44% of women with a BRCA1 variant and 11% to 17% with a BRCA2 variant will develop OC, compared with approximately 1.2% of women in the general population.
National Comprehensive Cancer Network (NCCN) guidelines include testing for the circulating biomarker cancer antigen 125 (CA-125) as a possible element of preoperative workup, if clinically indicated. This recommendation is based on data showing a correlation with extent of disease and clinical course.
European Society for Medical Oncology and European Society of Gynaecological Oncology (ESMO-ESGO) consensus guidelines suggest the serum marker CA-125 has utility in routine practice but recommended its use in combination with radiological and clinical assessment.
NCCN guidelines suggest testing for BRCA1/2 mutations as well as loss of heterozygosity (LOH) or homologous recombination (HR) status up front along with other markers (microsatellite instability [MSI], mismatch repair [MMR], tumor mutational burden [TMB], BRAF, and NTRK) in the recurrent setting.
ESMO-ESGO recommends that all patients with high-grade OC be tested for BRCA1/2 mutations at diagnosis, with additional recommendation for HR deficiency (HRD) status as well.
The use of next generation sequencing (NGS) in OC is still emerging.
Ovarian cancer (OC) is an immunogenic cancer with about half of patients demonstrating T-cell infiltration and 28% to 40% expressing PD-L1.
Which of the following are risk factors for ovarian cancer (OC)? [Please select all that apply.]
Approximately what percentage of women with a BRCA1 variant will develop OC in their lifetime?
Which potentially prognostic circulating biomarker do the NCCN guidelines and ESMO-ESGO recommend measuring?
Patients with early-stage ovarian cancer (OC) have 5-year survival rates of 90% and 70% for Stage I and Stage II, respectively.
However, over 80% of OCs are diagnosed in advanced stage (Stage III–IV) disease with a lower 5-year survival rate of ≤35%.
Platinum-based regimens are the standard treatments for ovarian cancer (OC).
While up to 25% of patients will have initial platinum resistance, 75% of patients are sensitive to front-line platinum therapy.
Unfortunately, those who are sensitive to front-line platinum therapy will likely relapse and develop secondary platinum resistance over time when exposed to platinum-based chemotherapy again.
These categories are based on the amount of time from the end of platinum treatment to relapse, which is referred to as the platinum-free interval.
Definitions
Platinum-sensitive can be defined as disease that relapses ≥6 months after initial chemotherapy.
Platinum-refractory can be defined as disease progressing during therapy or ≤4 weeks after the last dose.
Platinum-resistant can be defined as disease progressing ≤6 months after platinum-based therapy.
Definitions of platinum-sensitive and platinum-resistant disease are imprecise; clinical judgment and flexibility should be utilized in determining treatment options.
In platinum-sensitive individuals, the median survival time is about 2 years, but can range from a few months to >10 years.
Once platinum resistance develops after first-line chemotherapy, the median overall survival (OS) drops significantly with an expected timeframe of ≤1 year and progression-free survival (PFS) interval of 3 to 4 months.
Around what percentage of patients are diagnosed with ovarian cancer (OC) at an advanced stage?
[Slide ruler mark to the correct number.]
Select the word that would make the following statements true:
What is the expected median overall survival (mOS) and progression-free survival (PFS) interval for platinum-resistant OC?
The preferred regimens for recurrent platinum-sensitive ovarian cancer (OC) include re-challenge with:
The preferred regimens for platinum-resistant ovarian cancer (PROC) include:
Single agent immunotherapies have failed to show improvement over chemotherapy in platinum-resistant OC.
Combination therapies such as immune checkpoint inhibitors (ICI) + PARP inhibitors, ICI + cytokine therapy, or ICI + antiangiogenics are under investigation.
Tumor-infiltrating lymphocytes, in particular, high levels of intraepithelial CD3+ or CD8+ T cells, have been associated with improvements to progression-free survival (PFS) and overall survival (OS), suggesting that targeting the microenvironment could have an impact on prognosis and/or response to treatment.
Which is the preferred treatment for platinum-resistant ovarian cancer (OC)?
Which therapeutic combinations are being investigated in platinum-resistant OC? [Select all that apply.]
Which of the following cell types in the OC microenvironment have been associated with improved progression-free (PFS) and overall survival (OS)? [Select all that apply.]