1. Fuerst, Mark L.

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SAN DIEGO-Ovarian cancer is not just one disease, but rather a constellation of distinct types of cancer involving the ovary. That's one of the main messages from the recently released report by the National Academy of Medicine (NAM), entitled "Ovarian Cancers: Evolving Paradigms in Research and Care."

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A panel of ovarian cancer experts discussed the report, released in March 2016, during the Society of Gynecologic Oncology's 47th Annual Meeting on Women's Cancer.


"This report is a comprehensive summary of our current understanding of, and recent progress in the challenges posed to women and gynecologic oncologists by ovarian cancer," said SGO President Robert L. Coleman, MD, Professor, Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. "The document provides a strong argument that ovarian cancer research is on a steep trajectory of success, and now is the time to invest research dollars and effort into maintaining or increasing this momentum."


Outcomes data in the report are a good historical reference, but "do not reflect the potential impact from recent advances in the science. New approaches in early detection, prevention, and treatment make patient access to and participation in clinical trials more important than ever," said Coleman.


The report addresses the challenge of designing clinical trials with endpoints that are both reflective of the treatment intervention and contextually meaningful. "For example, it is difficult to determine the impact of a single therapeutic strategy on overall survival because women typically will undergo several subsequent therapies," said Coleman.


While overall survival is the most accepted tangible endpoint for clinical trials, SGO now advocates for the use of progression-free survival as an alternative when appropriate, and has been working with regulatory agencies to clarify acceptable endpoints.


The NAM report calls attention to the near unanimous recommendation "that all women diagnosed with ovarian carcinoma receive referral for genetic counseling and testing regardless of their family history," but noted that rates of referral are low.


The report identified four overarching concepts to be applied to its recommendations:


1. The study of high-grade serous carcinomas needs to be given priority because it is the most common and lethal subtype of ovarian cancer.


2. More subtype-specific research is also needed to further define the differences among the subtypes.


3. Collaborative research, including the pooling and sharing of data and biospecimen resources, is essential, given the relative rarity and heterogeneity of ovarian cancers.


4. Dissemination of new knowledge and the implementation of evidence-based interventions and practices are the final steps in the knowledge translation process.



The NAM report equally emphasized the importance of educating and informing clinicians and patients.


"SGO will continue to play a leadership role by gathering experts within the gynecologic oncology community to assess the current state of knowledge, to recommend strategies to advance our knowledge, and to improve methods of early detection and treatment," Coleman said.


Mark L. Fuerst is a contributing editor.