Treatment
Recommendation 2.2
➤ Women diagnosed with recurrent epithelial ovarian cancer with
identified dMMR should be offered FDA-approved treatment under their
labeled indication based on these results. dMMR qualifies for FDA-
approved treatment. (Moderate recommendation; EB-B-I)
Recommendation 2.3
➤ No recommendations can be made supporting routine tumor testing
using currently available homologous recombination deficiency (HRD)
assays. Current assays evaluating HRD have been applied to stratify
women with ovarian cancer for treatment. (No recommendation; L)
Recommendation 2.4
➤ Clinical decisions should not be based on a variant of uncertain
significance (VUS). Care providers and patients and family members
tested should be aware that reclassification of VUS is an ongoing
process, and it may eventually become possible to definitively determine
if a variant is deleterious or benign. Until that time, the patient's clinical
features and family history should inform clinical decision-making.
(Strong recommendation; EB-B-H)
Recommendation 3.1
➤ Women with epithelial ovarian cancer should be offered testing, as
outlined in 1.1, at the time of diagnosis. This has implications for
therapeutic decision making. (Strong recommendation; EB-B-H)
Recommendation 3.2
➤ Women with epithelial ovarian cancer who have not had germline testing
at the time of diagnosis should be offered germline genetic testing as
soon as feasibly possible, as outlined in 1.1. In women who do not carry
a germline pathogenic or likely pathogenic BRCA1/2 variant, somatic
tumor testing for BRCA1 and BRCA2 pathogenic or likely pathogenic
variants should be offered. Somatic tumor testing for BRCA1 and BRCA2
pathogenic or likely pathogenic variants may be reserved for time of
recurrence for women who have completed upfront therapy and are
currently in observation, as presence of these mutations qualify the
patient for FDA-approved treatments. (Moderate recommendation; EB-
B-I)
