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Q. Can my sister-in-law undergo NGS after surgery for ovarian cancer?

Answered by
Dr. Vikas T. Talreja
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Jul 17, 2021

Hi doctor,

I am attaching the discharge summary and histopathological reports of my sister-in-law, diagnosed with ovarian cancer. She had abdomen pain, a CT scan was done, and her tumor marker was high. There is no previous history of cancer. We got the final histopathological reports and IHC report. Now I want to know whether she require any chemotherapy? If yes, then it can be injectable or can be oral therapy? Does radiation have any role on her?

Can we go for NGS to get the targeted chemotherapy? If yes, which processor company should we approach for NGS? Which one is better by blood or analyses through tissue? Kindly give your opinion.

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#

Hi,

Welcome to icliniq.com.

Ongoing through the report (attachments removed to protect the patient's identity), the probable diagnosis is Stage III cancer (involving left parametrium, left adnexa, and left pelvic lymph nodes).

For women requiring first-line chemotherapy for EOC (epithelial ovarian cancer), the standard IV (intravenous) regimen utilizes Platinum and Taxane agents. We prefer Carboplatin rather than Cisplatin because multiple trials have consistently demonstrated that Carboplatin produces equivalent response rates and survival outcomes to Cisplatin but is associated with less toxicity.

Although both Paclitaxel and Docetaxel (the most commonly used taxanes for EOC) can be administered along with Carboplatin in this setting, we prefer Paclitaxel because it is less myelosuppressive than Docetaxel.

Dose-dense intravenous (IV) therapy refers to administering chemotherapy with less time between treatments, typically in ovarian cancer, which refers to a weekly schedule. It typically refers to one of two regimens:

1) Carboplatin is administered every three weeks, with Paclitaxel administered weekly.

2) Both Carboplatin and Paclitaxel are administered weekly.

Evaluation of women after adjuvant chemotherapy varies depending upon clinician preference. At the completion of treatment, we perform a history and physical (including pelvic) examination and cancer antigen (CA) 125. Imaging such as computed tomography (CT) of the chest, abdomen, and pelvis may be utilized as well, especially in those who do not have an informative biomarker (example: CA 125)

Homologous recombination deficiency (HRD) is being evaluated as a biomarker for the selection of patients for poly (ADP-ribose) polymerase (PARP) inhibitor maintenance after initial therapy,

Trials evaluating PARP inhibitor maintenance therapy have found greater benefits for those with HRD (homologous recombination deficient) tumors relative to nongenetically altered ovarian cancers and similar to those with BRCA (breast cancer gene) associated tumors. Olaparib plus Bevacizumab has regulatory approval by FDA (Food and drug administration) for the maintenance treatment of adult patients with deleterious or suspected deleterious germline or somatic BRCA-mutated advanced EOC who are in complete or partial response to first-line Platinum-based chemotherapy and whose cancer is associated with HRD-positive status defined by either a deleterious or suspected deleterious BRCA mutation and/or genomic instability.

I hope this was helpful.


Hi doctor,

Thank you.

1) What is the role of the new generation sequence test (NGS) to have the idea of targeted chemo for my sister-in-law? If you recommend the NGS test, then how should it be done with blood or tissue? And also, from where it has to be done to get the best and reliable reports?

2) Can any oral chemo help the patient?

3) Does she require any radiation therapy in the future?

4) Any role of immunotherapy, which can help the patient?

Kindly give your opinion.

#

Hi,

Welcome back to icliniq.com.

1) Guidelines favor testing women for germline and somatic mutations to optimize the identification of germline mutations (which would open access to cascade testing of family members). Additionally, this strategy would expand the identification of women who may benefit from PARP (poly adenosine diphosphate-ribose polymerase) inhibitors. Relying only on somatic testing to identify women for "reflex" genetic testing may miss up to 5% of germline mutations due to differences in test coverage, variant classification, and the inability to detect large rearrangements by available commercial next-generation sequencing. Relying only on germline testing will miss approximately 7% of women who have somatic mutations only. Improvement of testing sequencing and strategy remains an urgent area of investigation.

Multiple standard labs (NABL accredited) offer the same like core, metagenome, etc. While only modest benefits have been demonstrated in randomized, first-line trials for Bevacizumab, it is approved by the Food and Drug Administration in front-line treatment. We suggest its use, in addition to conventionally dosed IV chemotherapy and as maintenance, in selected patients without a known mutation in BRCA1 or BRCA2 who have a high risk of recurrence (example, those with pleural effusions or ascites).

2) Trials evaluating PARP inhibitor maintenance therapy have found greater benefits for those with HRD tumors relative to nongenetically altered ovarian cancers. And similar to those with BRCA associated tumors. Olaparib plus Bevacizumab has regulatory approval in the United States by the FDA for the maintenance treatment of adult patients with deleterious or suspected deleterious germline or somatic BRCA-mutated advanced EOC who are in complete or partial response to first-line platinum-based chemotherapy and whose cancer is associated with HRD positive status defined by either a deleterious or suspected deleterious BRCA mutation or genomic instability

3) She does not require radiation therapy.

4) There is no role of immunotherapy.

I hope this was helpful.


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