Ovarian Cancer

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2019 Ovarian Cancer

Approximately 22,240 women are diagnosed with ovarian cancer every year in the U.S. Seventy-five percent of these cases aren’t usually diagnosed until an advanced stage, which is more difficult to cure. Recent advances, however, are paving the way toward earlier detection and more effective treatment methods for this gynecologic cancer.

Genetic Testing

The majority of ovarian cancer cases have unknown origins. But some women have an inherited condition referred to as hereditary breast and ovarian cancer syndrome, which can predispose them to developing ovarian cancer.

If you and your doctor have discussed your risk for developing ovarian cancer and have determined that you should undergo genetic testing, know that testing methods have recently evolved. Genetic tests now screen not only for BRCA1 and BRAC2, the most common gene mutations, but for a complete panel of genes less frequently associated with the risk for developing breast or ovarian cancer.

Screening

Currently, there is not an effective test that screens for this disease. However, researchers are working to develop a test that can diagnose ovarian cancer in its earliest stages.

For example, an ongoing, multi-institutional study conducted by Dr. Robert Bast at MD Anderson Cancer Center is using an algorithm that includes CA 125 and ultrasound to try to screen for ovarian cancer in women at average risk of developing the disease. Preliminary results from this trial are promising, but additional research is needed. Find out more about the Ovarian Cancer Low Risk Study at MD Anderson Cancer Center.

Preserving Fertility

Researchers are always searching for possible ways to treat gynecologic cancers while preserving a woman’s fertility. When surgery is recommended to treat ovarian cancer, the method used is almost always bilateral salpingo-oophorectomy.

Bilateral salpingo-oophorectomy may also be recommended to reduce the risk of ovarian cancer for certain women, such as BRCA mutation carriers. But studies are being conducted to determine the safety and efficacy of bilateral salpingectomy with delayed oophorectomy for women who are BRCA mutation carriers. This is not only to avoid the negative effects of early-onset surgical menopause. It is to address the possibility that some forms of ovarian cancers may initiate in the fallopian tubes instead of the ovaries. Therefore, removal of the fallopian tubes may be a preferred alternative to bilateral salpingo-oophorectomy.

Discoveries in Diagnosis and Treatment

The Society of Gynecologic Oncology and the American Society of Clinical Oncology’s current guidelines recommend that women with suspected ovarian cancer should be evaluated and treated by a gynecologic oncologist. Data show that ovarian cancer patients who receive treatment from a gynecologic oncologist have improved survival over those who do not.

Patients who are treated by a gynecologic oncologist have improved survival over those who aren’t

These same guidelines also recommend that women with suspected ovarian cancer have a tissue diagnosis through either primary surgery or biopsy prior to any chemotherapy treatment. Tissue diagnosis is the most accurate way to confirm invasive epithelial ovarian, fallopian tube or peritoneal malignancy. This ensures that patients receive the appropriate treatment for their disease.

Tissue sampling, rather than simply studying cells, can also help gynecologic oncologists verify a patient’s genetic status. This will help determine the best course of therapy. Though it applies to all gynecologic cancers, a tissue diagnosis is particularly important in treating ovarian cancer.

PARP Inhibitors

The standard of care for treating ovarian cancer is a combination of surgery and platinum-based chemotherapy. This course of action results in remission for most patients. However, the majority of ovarian cancer cases will eventually recur, leading to the constant search for more effective treatments.

Studies have led to the promising, recent development of PARP inhibitors. PARP inhibitors are a group of pharmacological inhibitors of the enzyme poly ADP ribose polymerase (PARP). These are being developed for multiple indications, the most significant being the treatment of cancer.

Three PARP inhibitors were approved in 2017-2018 for maintenance in platinum-sensitive recurrent ovarian cancer: olaparib, niraparib and rucaparib. Studies conducted in 2018 have shown positive results using Lynparza (olaparib) as frontline maintenance therapy in patients with BRCA-positive tumors. Further trials are being conducted to determine the efficacy of Lynparza in combination with bevacizumab as frontline maintenance therapy for newly diagnosed ovarian cancer, regardless of BRCA status.

PARP inhibitors are considered one of the most promising new advancements in the treatment of ovarian cancer. Experts say this is changing the landscape for treatment of this disease.

Rare Types of Ovarian Cancer

The vast majority of ovarian cancer cases are epithelial. Rare types include ovarian germ cell tumors and ovarian low malignant potential tumors. It can be extremely difficult to study certain types of rare cancers because of their low incidence numbers. Despite these challenges, gynecologic oncologists are reporting progress on the treatment of certain types of rare gynecologic cancers.

New treatments for nonepithelial ovarian cancers are being studied in clinical trials. These trials are studying the efficacy of combination chemotherapy, or the use of more than one anticancer drug. Studies are also underway to determine the effectiveness of hormone therapy, which is less toxic than chemotherapy. If hormone therapy is found to be as effective as chemotherapy in treating low grade serous ovarian tumors, it could eventually become the standard treatment. In addition, clinical trials are evaluating whether active surveillance can provide better quality of life, less toxicity and equal outcomes than chemotherapy for these younger women who develop  early stage ovarian germ cell tumors.

Clinical Trials

The development of PARP inhibitors and hormone therapies demonstrates the vital role that clinical trials play. Clinical trials lead to new discoveries and treatments for all types of cancer. The more patients who participate in clinical studies, the better the chances of improved therapies and outcomes.

Clinical studies are the backbone of research and can offer opportunities for cancer patients to receive the best treatments available. Find out more about the importance of clinical trials and whether you or a loved one may be eligible to participate.

Experts say PARP inhibitors are changing the landscape for ovarian cancer treatment

2019 State of Gynecologic Cancers