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Ovarian cancer

Ovarian cancer is an unlikely consideration for most general practitioners, as they typically see their patients only every few years. Many symptoms, such as bloating, pelvic or abdominal pain, or urinary issues, may not be immediately associated with cancer. 

As the symptoms aren’t as noticeable as other cancers, ovarian cancer is diagnosed at a late stage in the majority of women. Advanced diagnostic assays, such as folate receptor 1 protein (FOLR1 or FRɑ), facilitate the identification of patients for targeted therapy.

About 19,710 women will receive a new diagnosis of ovarian cancer.

Understanding ovarian cancer subtypes

Epithelial2

The most common subtype originates along the lining of the ovarian surface, fallopian tube or peritoneum. Clinical presentation can be classified as acute or subacute, depending on symptoms. Acute cases present with bowel obstruction or venous thromboembolism, while subacute cases may present with non-specific symptoms such as abdominal bloating or pain.

Germ cell1

Germ cell tumors of the ovary originate from germ cells. Although there are numerous subtypes of this cancer, most cases are benign, and around 2% transform into malignant germ cell tumors. The survival rates are encouraging, with nine out of 10 patients surviving for at least five years following the diagnosis.

Stromal3

Stromal ovarian cancer is the rarest of these subtypes and most frequently develops alongside signs of hormonal production, such as hirsutism and virilization, menstrual changes, or early puberty. Stromal cancers are often found in adolescents and young adults, although adult granulosa cell tumors commonly occur at older ages.

Advancement in ovarian cancer diagnostic 

Early detection of ovarian cancer is critical. Unfortunately, over 70% of cases are not diagnosed until the later stages,⁴ which makes reliable diagnostic tools essential. However, currently there are no guidelines for ovarian screening. 

Fortunately, new research has led to the development of diagnostic tools such as blood tests, which measure Carbohydrate Antigen 125 (CA 125) and Human Epididymis Protein 4 (HE4), and algorithms to help screen women.⁴ To make the screening process more timely, two algorithms, risk of ovarian malignancy algorithm (ROMA) and risk of malignancy index (RMI), have been developed that consider the levels of CA 125 and HE4, along with women's menopausal status.⁴

This approach helps to evaluate the risk of ovarian cancer in women with pelvic masses more accurately. The dual marker combination can classify women into low- and high-risk groups, which enables clinicians to provide more informed guidance and make better treatment decisions.⁴

Researchers are exploring new screening methods, like proteomics to analyze protein patterns in the blood and investigate genes for familial ovarian cancer.⁵ The familial ovarian cancer gene provides insights into new prevention and treatment strategies for high-risk women by examining BRCA1 and BRCA2 mutations.⁵

 

Treatments are evolving along with biomarker advances

With the advancement of companion diagnostics, the VENTANA FOLR1RxDx assay provides critical insights that enable more informed clinical decisions and improved patient outcomes.

This assay is the first FDA-approved immunohistochemistry (IHC) companion diagnostic test that helps detect FOLR1 biomarker in patients with epithelial ovarian cancer (EOC).⁶ By testing for FOLR1, 35% of patients with EOC may benefit from new targeted therapies like ELAHERE.6,7

References 

  1. American Cancer Society. Last accessed October 31, 2023.

  2. National Library of Medicine. Last accessed November 6, 2023

  3. Minnesota Ovarian Cancer Alliance. Last accessed November 6, 2023.

  4. National Library of Medicine. Last accessed November 6, 2023.

  5. American Cancer Society. Last accessed November 6, 2023. 

  6. FOLR1 Interpretation Guide. 

  7. SORAYA, the clinical study conducted by our pharma partners, Immunogen.

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