Ovarian and breast cancer

Investigators in the Breast and Ovarian Cancer Moon Shot have developed a new surgical protocol that’s dramatically increasing the rate of complete tumor removal in ovarian cancer patients, an accomplishment that improves survival.

Under the new protocol, all patients receive a laparoscopic evaluation during which two surgeons independently rank the distribution and spread of the disease to other organs. If the resultant score is less than 8, patients proceed to surgery. If it’s greater, they receive chemo before going to surgery.

“Our new surgical algorithm allows us to be much smarter about whom we operate on upfront,” says moon shot co-leader Anil Sood, M.D., professor in Gynecologic Oncology & Reproductive Medicine.

In the first 78 cases involving the protocol, complete tumor removal was achieved 88% of the time. The protocol is now standard practice at MD Anderson.

Previously, virtually all new patients had surgery to explore the extent of disease and to remove as much of it as possible. Worldwide, this practice results in 20 to 30% of these patients achieving “complete gross resection,” or removal, of all of their visible tumor, Sood says. At MD Anderson, the rate was about 25%.

“One focus of moon shots is achieving the greatest clinical impact with current knowledge,” Sood says. “A great deal of effort went into this algorithm, but it was all based on existing knowledge.”

Reaching out to families

The moon shot focuses on high-grade serous ovarian cancer (the most malignant form of the disease) and triple-negative breast cancer (a particularly aggressive form more likely to spread and recur than other forms of breast cancer). All such patients now are offered genetic screening for mutations in the BRCA 1 and 2 genes, which elevate a person’s risk for either cancer. If the patient has these inherited mutations, that raises the possibility that sisters, daughters and other relatives might have the same risk-increasing mutations.

“We encourage patients to communicate their results with other family members, offer our help in facilitating that communication and also offer them genetic screening,” says moon shot flagship project leader Banu Arun, M.D., professor in Breast Medical Oncology.

When BRCA mutations are found, and other risk factors are considered, the moon shot offers preventive options, including mastectomy, removal of the ovaries, or both.

Eighty of the first 1,346 breast cancer patients and 34 of 298 ovarian patients tested positive for BRCA mutations. Of those 114 patients, 45 have enrolled in the outreach program, which was launched in April. As a result, women with elevated cancer risk have been identified.