February 17 2020
By Douglas A. Levine, MD, NYU Langone Health Perlmutter Cancer Center
Reducing cancer risk and detecting cancer early has the greatest potential to decrease mortality from cancer and improve quality of life. February is National Cancer Prevention Month and NRG Oncology is poised to launch two major cancer prevention trials in the areas of ovarian and colon cancer prevention.
Ovarian cancer has traditionally been a difficult cancer to diagnose at an early stage due to the lack of any reliable screening methods and few specific symptoms of early stage disease. Women who carry genetic mutations certain DNA repair genes are at known high-risk for ovarian cancer and surgical risk reduction is recommended and highly effective. Carriers of germline mutations in BRCA1, in particular, have an early age of ovarian cancer diagnosis and risk reducing surgery to remove the ovaries and fallopian tubes is recommended by age 40. Many women do not undergo the recommended surgical procedure due to the consequence of surgically induced early menopause. For these women, there have been no successful alternatives for prevention or early detection of ovarian cancer.
Approximately one decade ago, the fallopian tube hypothesis was introduced and suggested that high-grade serous ovarian cancer (HGSC) may originate in the distal fallopian tube. Since that time, mouse models and human studies suggest that most HGSC do arise from the epithelium of the distal fallopian tube. The logical next step was to consider if removal of the fallopian tube alone could reduce the risk of ovarian cancer while avoiding surgical menopause. Several studies have confirmed that removal of the fallopian tubes (salpingectomy) is safe, quick, and avoids symptoms of surgical menopause. NRG-CC008, described below, is the first prospective clinical trial to test the hypothesis that bilateral salpingectomy can reduce the risk of ovarian cancer. The study has been approved by the NCI Division of Cancer Prevention and the NCI central IRB. It will be conducted through the NCI Community Oncology Research Program (NCORP) and all NRG Oncology member and affiliate sites.
Colon cancer screening with colonoscopy is a highly effective method for early detection and prevention of colon cancer. With the increasing uptake of screening colonoscopy many potential precancerous lesions are discovered and the appropriate follow-up is uncertain. Often a colonoscopy will identify one or two benign appearing adenomas and the proper interval until subsequent screening colonoscopy is unknown. There is obviously a balance between excessive surveillance colonoscopies which can lead to increased patient and economic burden and insufficient surveillance colonoscopies which would miss the opportunity for prevention and early detection. To address the unknown interval for surveillance colonoscopy after a diagnosis of one or two non-advanced adenoma, the FORTE study will test the hypothesis that colon cancer incidence will not be significantly increased with surveillance colonoscopy at 10 years compared to surveillance colonoscopy at 5 and 10 years. This study is tentatively approved by the NCI Division of Cancer Prevention and is under review at the NCI central IRB. For sites anticipating high accrual to this study, there will be a kick-off meeting in May at the University of Pittsburgh.