Therapeutic implications for ovarian cancer emerging from the Tumor Cancer Genome Atlas

With increasing insights into the molecular landscape of ovarian cancer, subtypes are emerging that might require differential targeted therapies. While the combination of a platinum and a taxane remains the standard of care, newer therapies, specifically targeted to molecular anomalies, are rapidly being tested in various cancers. A major effort to better understand ovarian cancer occurred through the Cancer Atlas Project. The Catalogue of Somatic Mutations in Cancer (COSMIC) is a database that collates mutation data and associated information extracted from the primary literature. The information from the Cancer Genome Atlas (TCGA) and the International Cancer Genome Consortium (ICGC), which systematically analyzed hundreds of ovarian cancer, are included in COSMIC, sometimes with discordant results. In this manuscript, the published data (mainly from TCGA) on somatic high grade papillary serous ovarian cancer (HGSOC) mutations has been used as the basis to propose a more granular approach to ovarian cancer treatment, already a reality for tumors such as lung and breast cancers. TP53 mutations are the most common molecular anomaly in HGSOC, and lead to genomic instability, perhaps through the FOXM1 node. Normalizing P53 has been a therapeutic challenge, and is being extensively studied. BRCAness is found an about 50% of HGSOC and can be targeted with poly (ADP-ribose) polymerase (PARP) inhibitors, such as olaparib, recently approved for ovarian cancer treatment. Other less common mutations have been found (MECOM, MAP15, CCNE1). Common mutations in other cancer (PI3K pathway, ERK kinase pathway, and EGFR family) are uncommon in ovarian cancer.