Ovarian Cancer: One Disease or Many?
Monday December 1, 2008
It has been known for a while that research and treatment of breast cancer has advanced at least partly because the disease is sub-classified by a number of factors from histology to hormonal and molecular marker status. Is this the case in ovarian cancer?
While ovarian cancer is broadly sub-classified, mostly on histologic basis (i.e. what it looks like under the microscope), treatment for everything but low malignant potential tumors (LMP or borderline) has been largely stuck in the Taxol/Platinum paradigm. So, most women who develop ovarian cancer will be offered these two drugs at first, assuming they do not enroll in a clinical trial. This may be suboptimal because there is increasing reason to believe that ovarian cancer is a group of diseases, not just one.
As an example, one publication hot off the presses from Canada suggests that subclassification of ovarian cancer can be better used to guide treatment and determine prognosis BMC Cancer. 2008; 8: 17. Specifically, they are talking not only about histology (i.e. serous or clear cell etc.) but also about molecular events such as the mechanisms behind BRCA1 and 2 alterations as well as p53 and other pathways. This is a developing theme in research circles, since it is becoming clear that cancer is even more complex than initially thought with literally thousands if not millions of molecular pathways intertwined. However, it is not readily appreciated by clinicians and clinical researchers that we have to sub-classify ovarian cancer patients better and enroll far more in well-designed clinical trials to find "the answer"....which will undoubtedly be a complex solution as it is.
As it stands, even when patients are enrolled in chemotherapy clinical trials, most trials will accept a fairly broad range of ovarian cancer types, which means the results of the trial may not be as pure as they could be. Especially as we move towards molecular therapy, this will have to change.
While ovarian cancer is broadly sub-classified, mostly on histologic basis (i.e. what it looks like under the microscope), treatment for everything but low malignant potential tumors (LMP or borderline) has been largely stuck in the Taxol/Platinum paradigm. So, most women who develop ovarian cancer will be offered these two drugs at first, assuming they do not enroll in a clinical trial. This may be suboptimal because there is increasing reason to believe that ovarian cancer is a group of diseases, not just one.
As an example, one publication hot off the presses from Canada suggests that subclassification of ovarian cancer can be better used to guide treatment and determine prognosis BMC Cancer. 2008; 8: 17. Specifically, they are talking not only about histology (i.e. serous or clear cell etc.) but also about molecular events such as the mechanisms behind BRCA1 and 2 alterations as well as p53 and other pathways. This is a developing theme in research circles, since it is becoming clear that cancer is even more complex than initially thought with literally thousands if not millions of molecular pathways intertwined. However, it is not readily appreciated by clinicians and clinical researchers that we have to sub-classify ovarian cancer patients better and enroll far more in well-designed clinical trials to find "the answer"....which will undoubtedly be a complex solution as it is.
As it stands, even when patients are enrolled in chemotherapy clinical trials, most trials will accept a fairly broad range of ovarian cancer types, which means the results of the trial may not be as pure as they could be. Especially as we move towards molecular therapy, this will have to change.