Clinical Review

2017 Update on ovarian cancer

Ovarian cancer remains the most deadly gynecologic malignancy in the United States. What are the practice implications of recent research results on screening, neoadjuvant chemotherapy, and an investigational agent that targets recurrent ovarian cancer?

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In 2017, an estimated 22,240 women will be diagnosed with ovarian cancer, and 14,080 women will die of the disease.1 The high mortality associated with ovarian cancer is due largely to the inability to detect the disease early and the lack of effective therapeutics for women with recurrent disease. In this Update, we review important advances in the diagnosis and treatment of ovarian cancer.

Development of an effective screening tool for women at average risk has been an elusive challenge. The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) examined the efficacy of transvaginal ultrasound and cancer antigen 125 (CA 125) monitoring for ovarian cancer in a large cohort of women.

For women diagnosed with ovarian cancer, treatment paradigms for the initial management of the disease have shifted dramatically. Based on data from multiple randomized controlled trials, neoadjuvant chemotherapy (NACT) is being used more frequently. The American Society of Clinical Oncology and the Society of Gynecologic Oncology developed consensus recommendations for the appropriate use of NACT and primary cytoreductive surgery for women with ovarian cancer.

Finally, all of oncology has moved toward incorporating molecularly targeted therapeutics directed toward individual genetic abnormalities in tumors, so-called precision medicine. In ovarian cancer, poly(adenosine diphosphate [ADP]–ribose) polymerase (PARP) has emerged as an important target, particularly for women with BRCA gene pathway mutations. We describe a recently published randomized controlled trial of the PARP inhibitor niraparib.

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