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      Spectrum and Prevalence of Pathogenic Variants in Ovarian Cancer Susceptibility Genes in a Group of 333 Patients

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          Abstract

          Constitutional loss-of-function pathogenic variants in the tumor suppressor genes BRCA1 and BRCA2 are widely associated with an elevated risk of ovarian cancer (OC). As only ~15% of OC individuals carry the BRCA1/2 pathogenic variants, the identification of other potential OC-susceptibility genes is of great clinical importance. Here, we established the prevalence and spectrum of the germline pathogenic variants in the BRCA1/2 and 23 other cancer-related genes in a large Polish population of 333 unselected OC cases. Approximately 21% of cases (71/333) carried the BRCA1/2 pathogenic or likely pathogenic variants, with c.5266dup (p.Gln1756Profs*74) and c.3700_3704del (p.Val1234Glnfs*8) being the most prevalent. Additionally, ~6% of women (20/333) were carriers of the pathogenic or likely pathogenic variants in other cancer-related genes, with NBN and CHEK2 reported as the most frequently mutated, accounting for 1.8% (6/333) and 1.2% (4/333) of cases, respectively. We also found ten pathogenic or likely pathogenic variants in other genes: 1/333 in APC, 1/333 in ATM, 2/333 in BLM, 1/333 in BRIP1, 1/333 in MRE11A, 2/333 in PALB2, 1/333 in RAD50, and 1/333 in RAD51C, accounting for 50% of all detected variants in moderate- and low-penetrant genes. Our findings confirmed the presence of the additional OC-associated genes in the Polish population that may improve the personalized risk assessment of these individuals.

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          Ovarian cancer

          Epithelial ovarian cancer is the commonest cause of gynaecological cancer-associated death. The disease typically presents in postmenopausal women, with a few months of abdominal pain and distension. Most women have advanced disease (International Federation of Gynecology and Obstetrics [FIGO] stage III), for which the standard of care remains surgery and platinum-based cytotoxic chemotherapy. Although this treatment can be curative for most patients with early stage disease, most women with advanced disease will develop many episodes of recurrent disease with progressively shorter disease-free intervals. These episodes culminate in chemoresistance and ultimately bowel obstruction, the most frequent cause of death. For women whose disease continues to respond to platinum-based drugs, the disease can often be controlled for 5 years or more. Targeted treatments such as antiangiogenic drugs or poly (ADP-ribose) polymerase inhibitors offer potential for improved survival. The efficacy of screening, designed to detect the disease at an earlier and curable stage remains unproven, with key results expected in 2015. Copyright © 2014 Elsevier Ltd. All rights reserved.
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            Oral poly(ADP-ribose) polymerase inhibitor olaparib in patients with BRCA1 or BRCA2 mutations and recurrent ovarian cancer: a proof-of-concept trial.

            Olaparib is a novel, orally active poly(ADP-ribose) polymerase (PARP) inhibitor that induces synthetic lethality in homozygous BRCA-deficient cells. We aimed to assess the efficacy and safety of olaparib for treatment of advanced ovarian cancer in patients with BRCA1 or BRCA2 mutations. In this international, multicentre, phase 2 study, we enrolled two sequential cohorts of women (aged >or=18 years) with confirmed genetic BRCA1 or BRCA2 mutations, and recurrent, measurable disease. The study was undertaken in 12 centres in Australia, Germany, Spain, Sweden, and the USA. The first cohort (n=33) was given continuous oral olaparib at the maximum tolerated dose of 400 mg twice daily, and the second cohort (n=24) was given continuous oral olaparib at 100 mg twice daily. The primary efficacy endpoint was objective response rate (ORR). This study is registered with ClinicalTrials.gov, number NCT00494442. Patients had been given a median of three (range 1-16) previous chemotherapy regimens. ORR was 11 (33%) of 33 patients (95% CI 20-51) in the cohort assigned to olaparib 400 mg twice daily, and three (13%) of 24 (4-31) in the cohort assigned to 100 mg twice daily. In patients given olaparib 400 mg twice daily, the most frequent causally related adverse events were nausea (grade 1 or 2, 14 [42%]; grade 3 or 4, two [6%]), fatigue (grade 1 or 2, ten [30%]; grade 3 or 4, one [3%]), and anaemia (grade 1 or two, five [15%]; grade 3 or 4, one [3%]). The most frequent causally related adverse events in the cohort given 100 mg twice daily were nausea (grade 1 or 2, seven [29%]; grade 3 or 4, two [8%]) and fatigue (grade 1 or 2, nine [38%]; none grade 3 or 4). Findings from this phase 2 study provide positive proof of concept of the efficacy and tolerability of genetically targeted treatment with olaparib in BRCA-mutated advanced ovarian cancer. AstraZeneca. Copyright 2010 Elsevier Ltd. All rights reserved.
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              Inherited Mutations in Women With Ovarian Carcinoma.

              Germline mutations in BRCA1 and BRCA2 are relatively common in women with ovarian, fallopian tube, and peritoneal carcinoma (OC) causing a greatly increased lifetime risk of these cancers, but the frequency and relevance of inherited mutations in other genes is less well characterized.
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                Author and article information

                Journal
                Cancers (Basel)
                Cancers (Basel)
                cancers
                Cancers
                MDPI
                2072-6694
                14 November 2018
                November 2018
                : 10
                : 11
                : 442
                Affiliations
                [1 ]Department of Biology and Medical Genetics, Medical University of Gdansk, Debinki 1 St., 80-210 Gdansk, Poland; magda.koczkowska@ 123456gumed.edu.pl (M.K.); natalia.krawczynska@ 123456gumed.edu.pl (N.K.); alina.kuzniacka@ 123456gumed.edu.pl (A.K.); izabela.brozek@ 123456gumed.edu.pl (I.B.); bartosz.wasag@ 123456gumed.edu.pl (B.W.)
                [2 ]Laboratory of Clinical Genetics, University Clinical Centre, Smoluchowskiego 17 St., 80-952 Gdansk, Poland
                [3 ]Department of Gynecologic Oncology, Gdynia Oncology Center, Powstania Styczniowego 1 St., 81-519 Gdynia, Poland; stukan@ 123456wp.pl
                [4 ]Department of Gynaecology, Gynaecological Oncology and Gynaecological Endocrinology, Medical University of Gdansk, Kliniczna 1A St., 80-219 Gdansk, Poland; marcin.sniadecki@ 123456gumed.edu.pl (M.S.); jdebniak@ 123456wp.pl (J.D.); dariusz.wydra@ 123456gumed.edu.pl (D.W.)
                [5 ]Department of Pathology, Medical University of Gdansk, Smoluchowskiego 17 St., 80-952 Gdansk, Poland; wojciech.biernat@ 123456gumed.edu.pl
                [6 ]Institute of Bioorganic Chemistry, Polish Academy of Sciences, Noskowskiego 12/14 St., 61-704 Poznan, Poland; kozlowp@ 123456yahoo.com
                [7 ]The Gdansk section of the Polish Academy of Sciences, Jaskowa Dolina 31 St., 80-286 Gdansk, Poland; jlimon@ 123456gumed.edu.pl
                Author notes
                [* ]Correspondence: magdalena.ratajska@ 123456gumed.edu.pl ; Tel.: +48-58-349-1531
                Author information
                https://orcid.org/0000-0002-1882-6009
                https://orcid.org/0000-0001-8462-2189
                https://orcid.org/0000-0002-3634-7562
                Article
                cancers-10-00442
                10.3390/cancers10110442
                6266089
                30441849
                48e49543-8031-4730-b0d1-07e9d8d1718e
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 06 October 2018
                : 10 November 2018
                Categories
                Article

                ovarian cancer,low-penetrance gene,brca1/2,parp1 inhibitor,next-generation sequencing,chek2,nbn,bard1,mismatch repair genes

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