Review Article

The Emerging Role of Molecular Testing in Ovarian Cancer

Patrick J. Kiel,(1) PharmD, BCPS, BCOP, Courtney B. Cortez,(2) NP, Cynthia L. Hunter,(3) MS, LCGC, and Jeanne M. Schilder,(1) MD

(1)Indiana University School of Medicine and Indiana University Simon Cancer Center—IU Health, Indianapolis, Indiana; (2)Indiana University Simon Cancer Center—IU Health, Indianapolis, Indiana; (3)Indiana University Health, Indianapolis, Indiana

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Patrick J. Kiel, PharmD, BCPS, BCOP, Indiana University Simon Cancer Center—IU Health, 535 Barnhill Drive, Indianapolis, IN 46202. E-mail: pkiel@iuhealth.org


J Adv Pract Oncol 2017;8:7–25 | https://doi.org/10.6004/jadpro.2017.8.6.14 | © 2017 Harborside Press®


  

ABSTRACT

The post-genomic era has opened the door for personalized cancer treatments, and the trend of discovery is moving forward to identify more stratified biomarkers to accurately predict the progression of disease, as well as efficacy biomarkers to precisely determine drug response. Identification of accurate biomarkers for early detection and diagnosis of cancers such as ovarian cancer will prevent misdiagnosis and provide better patient outcomes. The recognition that ovarian cancer is not one cancer and instead is composed of several subtypes that are histologically and molecularly unique has begun to affect diagnostic and treatment strategies. Unfortunately, a large majority of patients have advanced-stage ovarian cancer at initial presentation. Thus, to provide more effective cancer care, advanced practitioners in oncology need to promote molecular testing among all their patients to develop the best treatment plan, especially since the majority of patients will become refractory to therapy. Regarding patients who are resistant to previous therapies, poly (ADP-ribose) polymerase (PARP) inhibitors are a unique class of agent that interferes with the repair of DNA single-stranded breaks. These orally administered agents have shown single-agent activity in recurrent ovarian cancer, with the highest anticancer activity demonstrated in BRCA1/2 ovarian cancer and in platinum-sensitive disease. Undoubtedly, patients with ovarian cancer care may have a brighter future, as the combination of advanced imaging technologies and the identification of more ovarian cancer–specific biomarkers continues. Advanced practitioners in oncology are in a unique position to help identify BRCA1/2-mutation carriers and assist them and their families with the complex issues involving genetic testing and management options. It is vital that advanced practitioners in oncology possess knowledge underlying the issues and concerns of patients and their families at risk for BRCA1/2-associated ovarian cancer. 




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