Positron Emission Tomography PET Scans in Ovarian Cancer

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Positron Emission Tomography (PET) Scans in
Ovarian Cancer
Ovarian Cancer National Alliance
www.ovariancancer.org

• Effectiveness of PET Scans and
• Recommendations for CMS
• August 20, 2008

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Contents
Ovarian Cancer National Alliance
www.ovariancancer.org

• Ovarian Cancer Background
• Ovarian Cancer National Alliance (OCNA)
• Coverage with Evidence Decision
• PET Scans in Ovarian Cancer Initial Diagnosis
• PET Scans in Ovarian Cancer Recurrence
• PET Scans in Ovarian Cancer Monitoring Treatment
• Recommendations

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Ovarian Cancer Background
Ovarian Cancer National Alliance
www.ovariancancer.org

• This year, 21,650 American women will be
  diagnosed with ovarian cancer, and 15,520 will
  die from the disease (American Cancer Society,
  2008)
• Deadliest gynecologic cancer and the 5th leading
  cause of cancer death among women
• Less than half of the women diagnosed will die
  within five years

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Ovarian Cancer Background (cont)
Ovarian Cancer National Alliance
www.ovariancancer.org

• Initial Detection
• lt 20 women diagnosed in early (most treatable)
  cancer stages
• No reliable early detection test
• Combination of pelvic/rectal exam, transvaginal
  ultrasound and CA-125 serum blood test used for
  detection
• Recurrence
• gt 70 ovarian cancer patients
• CA-125 may be early route to detect recurrence
• CA-125 inaccurate picture of extent of disease or
  falsely elevated
• Radiologic devices (i.e. PET scans)
• Cancer extent and location

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Ovarian Cancer National Alliance (OCNA)
Ovarian Cancer National Alliance
www.ovariancancer.org

• National umbrella organization with state and
  local groups
• Represents grassroots activists, womens health
  advocates and health care professionals
• Patient advocacy group dedicated to conquering
  ovarian cancer

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Coverage with Evidence Decision
Ovarian Cancer National Alliance
www.ovariancancer.org

• Centers for Medicare and Medicaid Services
  (CMS) Coverage with Evidence Decision (CED)
• PET or PET/CT scans
• Covers Medicare patients
• Part of a clinical trial
• Clinical Trial Results (administered by National
  Oncologic PET Registry (NOPR)
• providers changed treatment decisions for 1/3 of
  cases
• gt 9 patients enrolled had ovarian cancer
• High enrollment for rare cancer
• CMS mission is to ensure effective, up-to-date
  health care coverage and to promote quality care
  for beneficiaries

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PET Scans in Ovarian Cancer Initial Diagnosis
Ovarian Cancer National Alliance
www.ovariancancer.org

• Pre-operative PET or PET/CT scans
• Detect tumors otherwise unnoticed
• Appropriate debulking
• High sensitivity and specificity
• Illuminate full extent of tumor proliferation
• Determine original course of treatment

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PET Scans in Ovarian Cancer Recurrence
Ovarian Cancer National Alliance
www.ovariancancer.org

• Sensitive to small volumes of disease
• Assist in determining CA-125 accuracy for
  individual patient
• Some patients do not emit CA-125 antigen, PET
  scans monitor patients for recurrence

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PET Scans in Ovarian Cancer Monitoring Treatment
Ovarian Cancer National Alliance
www.ovariancancer.org

• Monitoring chemotherapy response
• Resistance to platinum-based chemotherapies
  (after multiple recurrences)
• Patients may respond better to other treatments
• Stop ineffective toxic therapy from being
  administered
• Reduce costs of care
• Currently unable to predict treatment response
  before chemotherapy

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Recommendations
Ovarian Cancer National Alliance
www.ovariancancer.org

• OCNA urges CMS
• To provide coverage for PET and PET/CT scans for
  women with ovarian cancer for
• Diagnosis and staging
• Post-surgery evaluations
• Monitoring treatment results and recurrence
• Proper evaluation and treatments to provide
  appropriate care at appropriate time consistent
  with CMSs mission
• Provide most cost-effective and humane treatment
  of patients
• OCNA thanks CMS in advance for providing access
  under the Coverage with Evidence Decision while
  CMS makes its National Coverage Analysis