What You Need To Know About Hard-To-Treat Ovarian Cancer
- Ovarian cancer that has a high level of a protein known as folate receptors may become resistant to traditional chemotherapy treatments.
- Folate receptors, acting like “doors” on cell surfaces, allow vitamin B9 (folate) to flood into the cancer cells which spurs growth and spread.
- Targeted therapies, like the new drug Elahere, can improve survival from this disease by 33% and stop its spread by 35% compared to chemotherapy.
- Specialized testing called immunohistochemistry (IHC), helps identify patients who will respond well to Elahere.
Called Elahere, it treats folate receptor-positive cancer by targeting folate receptors called FRα, which are proteins on the surface of cancer cells.
Read MoreHow do I know if my cancer is folate receptor positive?
To check for folate receptor in ovarian cancer, doctors usually need a piece of tumor tissue. They can get this during surgery or with a biopsy if the cancer comes back.Doctors use a special test called immunohistochemistry (IHC) to measure FRα protein levels. This test helps them see how many folate receptors are on the cancer cells.
But doctors don’t always check for folate receptors in ovarian cancer. Patients should talk to their doctor about this test and push for it if they think it may help give more information about their cancer.
Testing early gives important info for planning future treatment. It can lead to better outcomes down the road.
Related: When Ovarian Cancer Returns, Is the New Drug Elahere an Option & Will Insurance Cover It?
How can I get tested at no cost?
Some patients can have folate receptor expression tested at no cost in Cleveland and elsewhere in the United States.
- You have epithelial ovarian cancer
- You live in the United States or a US Territory
- You have not been tested before
- You don’t have a known FRα expression from a previous test
- Your doctor says you need it
NeoGenomics partners with ImmunoGen to offer the FR-ASSIST program.
Labcorp also participates in the FR-ASSIST™ FOLR1 Immunohistochemistry (IHC) Sponsored Testing Program.
How does Elahere work?
Elahare is now a fully approved medication by the US Food and Drug Administration (FDA) to treat ovarian cancer that doesn’t respond to platinum-based chemotherapy after 1-3 treatments.
“Results from the phase III trial (MIRASOL) are promising and show significant improvement in overall response rate, overall survival and progression-free survival compared to standard of care chemotherapy,” says Dr. Mariam Al Hilli, an obstetrician-gynecologist with the Cleveland Clinic’s Obstetrics & Gynecology Institute.
Al Hilli calls the final results from the MIRASOL study practice changing:
- It reduced the chances of death compared to chemotherapy by 33%. Patients taking Elahere lived for an average of 17 months compared to about 13 months for the patients on chemotherapy.
- It reduced the chance of the cancer progressing by 35%. Patients on Elahere went nearly 6 months without their cancer spreading compared to 4 months for the patients on chemotherapy.
- More than 40% of patients taking Elahere saw their tumors shrink — and for 5% they disappeared completely.
- Elahere was also better tolerated than chemotherapy. Very few patients in the study had to stop taking it because of side effects.
The US Food and Drug Administration granted full approval for Elahere on the basis of these findings.
Your doctor can now offer it as an effective treatment for folate receptor alpha positive tumors. Previously there was very little to fight this disease. Elahere changes that.
“I consider Elahare for patients with high grade serous recurrent platinum resistant ovarian cancer whose tumors are positive for folate receptor alpha (defined as >75%),” Dr. Al Hilli adds.
Compared to traditional chemotherapy, Elahare’s targeted approach may have fewer side effects on healthy tissues. But there are still safety considerations and side effects that can occur.
Safety Concerns
- Serious eye problems
- Lung inflammation (Pneumonitis)
- Nerve problems (Peripheral Neuropathy)
Common Side Effects
- Feeling tired
- Increased liver enzymes in the blood
- Nausea
- Stomach-area (abdominal) pain
- Decreased red or white blood cell counts
- Diarrhea
- Decreased albumin level in the blood
- Constipation
- Decreased magnesium level in the blood
“Common side effects were GI related and low grade ocular events. These side effects did not significantly impact patients or lead to discontinuation of treatment. Treatment discontinuation can be considered for severe ocular toxicity.” Dr. Al Hilli says.
Another important consideration: If you’re pregnant or planning to become pregnant, tell your doctor. You should use effective birth control during treatment and for 7 months after the last dose of Elahare.
Avoid breastfeeding during treatment and for 1 month after the last dose.
Remember to discuss Elahare with your healthcare provider to determine if it’s suitable for your specific situation. The earlier you have this discussion in treatment the sooner you can gather valuable information that could help treat your cancer more effectively.
Related: Considering The New Ovarian Cancer Treatment Elahere?
Questions for your doctor
- Am I a good candidate for an immunohistochemistry (IHC) test?
- How does folate receptor positivity affect my treatment options?
- Are there any targeted therapies or clinical trials available for folate receptor-positive cancer?
- What are the potential side effects of treatments for folate receptor-positive cancer?
- How often will I need follow-up testing or monitoring for folate receptor-positive cancer?
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