Notes from 2010 Alliance Conference

NOTES FROM 2010 ALLIANCE CONFERENCE

DR. BARBARA GOFF - DIRECTOR , DIVISION OF GYN/ONC U. OF WASHINGTON,SCHOOL OF
MEDICINE
DR. MICHAEL SEIDEN, PRESIDENT AND CEO FOX CHASE CANCER CENTER,PHILADELPHIA, PA.
DR. DEBORAH ARMSTRONG, ASSOC. PROF. OF ONCOLOGY, GYNECOLOGY AND OBSTETRICS JOHNS
HOPKINS, BALTIMORE, MD

DR. GOFF
10% of those with epithelial type cells have the BRCA1 or BRCA2 mutation
40 in 100,000 are diagnosed with ovarian cancer.
They are now thinking that the disease may have started in a fallopian tube for
those with inherited mutations and therefore different screening strategies
may be needed for those with family history.
Ovasure was taken off the market. Screening has not changed since 1994.
**I really appreciate that Dr. Goff mentions Cindy Melancon, Conversations and the survivor community input when discussing her studies regarding symptoms. It is proof that together we can make a difference, especially when a alert professional pays attention!


DR. SEIDEN
There is a 29% decrease in recurrence when Avastin is used initially.
There are some new helpful web sites: 1. www.healthcare.gov 2. www.kff.org
These are national healthcare coverage updates. The second one is from the
Kaiser Family Foundation. It gives fact sheets and timelines.
The original epithelial cells are the size of poppy seeds. The CA125 is still
the best test for identifying ovarian cancer.
PARP Inhibitors are taken orally. They are without side effects. A person can
become resistant to them but they do help. If the PARP is turned off, the
cancer cells cannot repair and then the cells will die. Dr. Seiden, the
principle investigator for the NCI said PARPS will be approved in the next 12
months.
GOG 0218 uses Taxol + Carbo + Avastin as first line treatment followed by
Avastin for maintenance. In 2003, 2000 women got a 4 month longer remission
by adding Avastin to first line treatment.
Whole Genome Sequence Analysis is Becoming Affordable. It is costing less and
it is taking less time. Some day when genetics is applied to cancer, the
therapies can be applied to the individual.
Between the years 2005 to 2009 more progress has been made and things are
moving faster with the development of Avastin and PARP Inhibitors. Women who
have serous type cells but do not have the BRCA1 or BRCA2 mutations will benefit
from the PARP Inhibitors (DNA repair).
**PARP inhibitors: expected approval in 24-48 months.

**PARP inhibitors: appear to be active in non-BRCA high-grade serous. More trials to come for this population?

**Genome project: Dr. Seiden showed us a slide that had the "map" of errors for 3 different cancers. Apparently, in some cancers, the DNA errors are clustered in a certain specific areas, so that researchers can focus on developing agents to target just those trouble spots. In epithelial ovarian cancer, there appear to be more abnormal genes than in other cancers, and Dr. Seiden described it as "scrambled" and challenging. (Btw, lung cancer looked just as scrambled on the slide.)

**Cancer signaling: If one particular signaling pathway is cut off, it is possible that the cancer could work around it and signal growth using another pathway. (This slide was superimposed over a map of the Atlanta beltway.)


DR. ARMSTRONG
The later a person recurs, the more benefit from surgery. The longer the
treatment-free interval, the better the response to treatment. If the woman
has a 24 month platinum free interval, the response will then be better. If
a person recurs in less than 6 months, the platinum drugs should not be used.
Women are having a good response with Carboplatin + Doxil every 4 weeks.
Taxanes are effective for those who recur less than 6 months after last
recurrence. These are the platinum resistant agents listed: Docetaxel, weekly
paclitaxel, Pemetrexed and Nab-Paclitaxel.
Avastin does NOT work as well alone. There is better progression free survival
but not overall survival when using Avastin. Right now they are not sure if
it is best to use Avastin in initial treatment or for recurrence. Dr.
Armstrong also said that there are few side effects from Avastin. Dr.
Armstrong is excited about FARLETUZUMAB. It targets the Folate Receptor.
Nine drug companies are involved in PARP Inhibitors. Dr. Armstrong said they
will be in the clinic soon. PARPS do not increase toxicity of chemo. They have
little toxicity. Farletuzumab is low in toxicity.
*** Ovarian cancer is not one or two diseases – it is many diseases.
**Platinum sensitivity: generally based on image-able disease, not rising CA-125 alone.

**One last thing, Dr. Seiden was the Mello-Abrams Lecturer, named after Judy Mello who died of ovarian cancer and Judy Abrams, board member and past OCNA president. I really liked one of Judy Mello's quotes that was shared: Every day is a beautiful day. It is only the weather that changes.

The OCNA web site has educational materials for you to print and disseminate in your community. You can also find video clips and pictures from the Conference by visiting www.ovariancancer.org/conference/2010.