Symposium

NCI in partnership with the GOG recently successfully completed clinical trial GOG-0199, a non-randomized trial comparing RRSO and screening among 2,605 women at 151 institutions. This trial, along with accumulating literature, demonstrates that many HSCs in BRCA1/2 mutations carriers arise in the fallopian tube fimbria, rather than the ovary, as previously supposed. This discovery has stimulated the development of a GOG protocol (CPC-1206) to assess whether initial bilateral salpingectomy followed by delayed oophorectomy might enable high-risk premenopausal women to reduce their HSC risk (and risk of other types of “ovarian cancer”) while mitigating harms of early hormonal deprivation. 

At this time, there is an important opportunity to: 1) critically discuss recent advances in the understanding of the pathogenesis of HSC and to define unanswered questions that limit progress in prevention and 2) foster multi-disciplinary interactions that can improve clinical study designs and speed translation. CPC-1206 provides a critical opportunity to collect new specimens and data aimed at informing our understanding of the role of the fallopian tube in “ovarian” carcinogenesis. There is a narrow window of opportunity to add innovative, hypothesis-driven research questions to that protocol that may accelerate progress.

Accordingly, we propose a multi-disciplinary symposium to address: the pathogenesis of HSC, with emphasis on the pathophysiology of the fallopian tube, collection and analysis of biospecimens, means to define high-risk populations and hormonal effects of gynecological surgery. The program will include sessions related to lessons learned from GOG-0199 and other trials and will end with a panel discussion with active audience participation. The symposium will be held at the NRG Oncology Semi-annual Meeting, July 10, 2014, with the goals of educating NRG practitioners about the state-of-the-science and major gaps in our knowledge and fostering engagement with NRG members who would participate in future prevention studies, such as CPC-1206. Speakers will include non-NRG members with experience that complements that of NRG members and talks will focus on addressing critical questions, including some formulated in advance via teleconferences.

LEARNING OBJECTIVES:

At the end of this activity, participants will be able to:

1. Identify the data supporting the origin of high-grade serous carcinoma from the fallopian tube and the uncertainties about these findings with regard to other possible sites of origin.
2. Recognize the frequency of incidental carcinomas at risk-reducing oophorectomy and factors that influence the likelihood of discovering same.
3. Apply best practices for performing risk-reducing surgery and interaction with pathologists about clinical history, histological processing and diagnosis.
4. Apply enhanced knowledge of risks and benefits of risk-reducing surgery to better guide patients in making informed choices about these procedures, given state-of-the-science knowledge and gaps.

Program Agenda