Most women diagnosed with ovarian cancer are told the same thing: it was caught late. Stage 3. Stage 4. And for a long time, that meant one path: chemotherapy, surgery, and hope.
Something has changed and if you’ve been researching ovarian cancer treatment lately, you may have already sensed it. At this year’s ASCO Annual Meeting, world’s largest cancer conference, gynecologic oncology specialists were talking less about managing the disease and more about outpacing it.
Read MoreMore options at diagnosis than ever before
When someone is newly diagnosed, the type they’re most likely dealing with is called high-grade serous carcinoma (fast-moving, usually already advanced). The standard treatment has been carboplatin and paclitaxel, two chemotherapy drugs given by IV, often alongside a targeted drug called bevacizumab (brand name Avastin). That hasn’t changed. What has changed is everything happening around it. “When somebody is newly diagnosed,” Dr. Matulonis explains, “it’s really important that we get the histology correct — what the cancer looks like under the microscope. Then we look at the molecular aspects of that cancer through sequencing. And thirdly, we’re looking at cell surface molecules, because now we’re using antibody drug conjugates.”Put simply: your tumor isn’t just “ovarian cancer.” It has a specific biology, and your doctors are now building your treatment around that.
What is molecular testing, and why does it matter for you?
What she’s talking about is a set of tests run on tumor tissue (usually whatever was taken during the initial biopsy). Some results tell doctors how the cancer is likely to behave. Others point toward specific drugs that have a better shot at working against it.
One of the most important tests for ovarian cancer patients is called HRD, or homologous recombination deficiency testing. It helps doctors determine whether a patient will benefit from a class of drugs called PARP inhibitors —which, for women who carry a BRCA gene mutation, have already proven to be genuinely life-changing.
“For patients who have underlying BRCA-mutated ovarian cancer — either an inherited BRCA mutation from a parent or a mutation found in the tumor itself — PARP inhibitor use in the upfront setting post-chemotherapy is absolutely standard of care,” Dr. Matulonis says. “And there are definitely patients who are cured when they’re using those drugs.”
That word — cured — is not something ovarian cancer patients have always heard. It matters.
A new wave of treatments: antibody drug conjugates
PARP inhibitors aren’t the only thing changing. A newer class of drugs, called antibody drug conjugates, or ADCs, has been drawing serious attention in gynecologic oncology, and Dr. Matulonis says it may be the most important shift she’s watching right now, across ovarian cancer, endometrial cancer, and cervical cancer alike.
The way they work: an antibody hunts down a specific protein on the cancer cell’s surface and delivers a toxic payload straight to it. It’s targeted in a way that standard chemotherapy isn’t.
One ADC already FDA-approved for ovarian cancer targets a protein called folate receptor alpha. If a woman’s tumor has high levels of it (present in 75% or more of the cancer cells) this drug moves to the front of the line.
“If her folate receptor alpha positivity is on the cancer cell at 75% or higher,” Dr. Matulonis explains, “I’m going to prioritize that type of drug.”
Most of the ADCs in trials right now don’t require a specific biomarker, which means they could work for more patients without needing special testing first. That may change. As more of these drugs become available, the question of which one to use, and for whom, will get harder to answer.
Why your doctors are collecting all this information upfront
One of the more practical things Dr. Matulonis shared is something easy to miss in the middle of a new diagnosis: your oncologist is gathering information now that may not be needed for months or may be needed urgently.
“I get all that information at new diagnosis,” she says, “because sometimes what happens is, God forbid, somebody has a recurrence and it’s a significant one, and we have to start treatment right away. I can’t wait a few weeks to get results back. I have to move on information I already have.”
The tests ordered in those first weeks (genetic sequencing, folate receptor alpha, HRD) aren’t just about deciding what to do right now. Months or years from now, if the cancer comes back, your doctor needs that information ready. Waiting on results when things are urgent isn’t an option.
More options means more conversations and that’s a good thing
More options doesn’t always feel like good news when you’re sitting in an oncologist’s office trying to understand what comes next. Dr. Matulonis doesn’t pretend otherwise.
“The conversations that I have with patients have become much more complex because there are many more options,” she says. “It is my responsibility to sit with that patient and review each option. Sometimes I enumerate them, sometimes I rank them, and we go through the pros and cons.”
Treatment decisions in ovarian cancer don’t always get sorted out in a single appointment anymore.
- Bring someone with you if you can.
- Write your questions down.
- And ask your oncologist directly what tests are being ordered and why. Not because you need to understand all of it, but because that information will matter later.
Yes, it’s a lot. But Dr. Matulonis has watched this disease long enough to remember when the options were few and the conversations were short. That’s not where things stand now.
“When somebody has a diagnosis of an advanced gynecologic cancer, they have a lot of treatment options,” she says. “That’s the very hopeful piece here.”
Questions to Ask Your Doctor
- What type of ovarian cancer do I have, exactly and does that change how we treat it?
- Has my cancer been tested for the FRα protein, BRCA mutation and HRD?
- Am I eligible for PARP inhibitor therapy or antibody drug conjugates?
- How will we know if treatment is working?
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