Staying Hopeful Through Recurrence
- Tennis legend Chris Evert, 69, was diagnosed with stage 1 ovarian cancer in 2021, then after going into remission, announced in December that her cancer recurred, or came back.
- Though a cancer recurrence is a highly stressful situation, especially after the elation of first “beating” the disease, there is more hope than ever before when it comes to ovarian cancer recurrence.
- After surgery, ovarian cancer survivors will have their tumors tested for a homologous recombination deficiency (HRD), which suggests they would benefit from PARP inhibitor maintenance therapy, which is only used if the person had a complete or partial response to recent treatment.
- Elahere (molecular name mirvetuximab) is an FDA-approved targeted therapy providing hope for patients with platinum-resistant ovarian cancer. This drug treatment is for women who test positive with high levels of a molecular factor called folate-receptor alpha (FRα).
Though this is a highly stressful situation, especially after the elation of first “beating” the disease, there is more hope than ever before when it comes to ovarian cancer recurrence, and Evert appears to be handling her health situation the only way she knows how, through her love of fitness — staying active during her treatment with Pelaton’s stationary bike workouts.
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“You’re both so great. And so fortunate to have each other. ❤,” journalist Laurie Cohen wrote.
A Difficult Announcement
Chris Evert announced her tragic news to fans back on Dec. 8.
“My cancer is back,” the ESPN announcer shared in a joint post on X (formerly Twitter) with the sports network. “While this is a diagnosis I never wanted to hear, I once again feel fortunate that it was caught early.”
Evert said that “all cells were removed” from her pelvic area and she had started chemotherapy.
“I encourage everyone to know your family history and advocate for yourself. Early detection saves lives.”
A message from @ChrissieEvert
Evert will not be part of ESPN's 2024 @AustralianOpen coverage pic.twitter.com/LKGmKDBNGU
— ESPN PR (@ESPNPR) December 8, 2023
Just a year before her own diagnosis, Evert’s sister Jeanne Evert Dubin died from the same disease. According to the American Cancer Society, your ovarian cancer risk is increased if your sister, mother or daughter has or has had ovarian cancer.
Evert’s High Risk for Ovarian Cancer
Chris Evert also carries the BRCA1 gene mutation, which increases your risk of developing breast and ovarian cancer. The ASC states that “the lifetime ovarian cancer risk for women with a BRCA1 mutation is estimated to be between 35% and 70%.” So, out of 100 women with a BRCA1 mutation, “between 35 and 70 of them would get ovarian cancer.”
RELATED: Tennis Star Chris Evert Urges Women Who May Have ‘The Breast Cancer Gene’ To Get Tested Early
Evert has also been keeping her humor up, posting a picture last month with ex-husband and best pal Andy Mill, 71, who was wearing one of her wigs in the photo underneath a black baseball cap with his arm around the fellow athlete.
“Andy Mill, give me my wig back….🤷♀️😡,” Evert joked to the two-time Olympian in the caption.
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Mill was an alpine ski racer on the U.S. Ski Team in the 1970s and ’80s, and graced the cover of PEOPLE magazine twice with his former wife and is still one of her biggest supporters through this latest challenge.
Learning More About Ovarian Cancer Recurrence
The standard of care for ovarian cancer patients is chemotherapy, which helps many patients reach remission.
“While the great majority of patients will be able to go into remission, unfortunately, for about 85% of patients, the disease will come back,” Dr. Kimberly Resnick, gynecologic oncologist at MetroHealth in Cleveland, previously told SurvivorNet.
“For the majority of ovarian cancer patients, their course with ovarian cancer is going to look like a wave, meaning there will be times when the disease rises and when it has to be treated. And then there will be times when they’re in the valley when they’re in remission.”
High levels of CA-125 in an ovarian cancer patient can often be a biomarker, a warning signal for your doctor that the cancer may have returned. A CA-125 test is a measurement of a specific type of cancer antigen, a protein that is found in everyone’s blood.
Monitoring CA-125 is considered one of the best ways to track cancer recurrence, so it’s important for women who are in remission to stay on top of their follow-up appointments so their doctor can spot a recurrence as early as possible.
Ovarian cancer is sub-categorized into two groups.
- Platinum-Sensitive Ovarian Cancer: Your cancer does not return for more than six months after treatment with platinum-based chemotherapies, like carboplatin and cisplatin.
- Platinum-Resistant Ovarian Cancer: Your cancer returns within six months of treatment with platinum-based chemotherapies, like carboplatin and cisplatin.
“The mechanism that causes platinum resistance will cause someone to be resistant to other chemotherapies, as well. That’s why we’re looking for what we call targeted therapies – precision medicine,” Dr. Noelle Cloven from Texas Oncology-Fort Worth Cancer Center explained.
Treatment Options for Ovarian Cancer Recurrence
Maintenance therapy is continued treatment after the patient finishes their initial treatment. After an ovarian cancer patient completes a round of treatments — such as surgery and chemotherapy — her doctor may recommend some form of maintenance therapy to try and delay possible recurrence. Maintenance therapy can involve taking an oral pill called a PARP inhibitor every day after chemotherapy and can keep cancer in remission longer.
Genetic testing helps doctors determine the best maintenance therapy.
RELATED: Making the Move to Maintenance Therapy for Ovarian Cancer
“The biggest question is: How do you choose between bevacizumab (brand name, Avastin) or a PARP inhibitor for maintenance therapy?” Dr. Alpa Nick, a gynecological oncologist with Tennessee Oncology in Nashville, told SurvivorNet in an earlier interview.
The drugs have very different ways of combatting cancer cells. PARP inhibitors prevent cancer cells from repairing their DNA, while Avastin blocks the formation of new blood vessels, starving tumors of nutrients.
The Food and Drug Administration approved bevacizumab (Avastin) to be used in conjunction with olaparib (brand name LYNPARZA) in HRD (Homologous Recombination Deficiency) positive women who show a response to platinum-based chemotherapy. During clinical trials, the drug combination increased progression-free survival from an average of 17 months to 37 months.
Managing an Ovarian Cancer Recurrence
“A patient really has to make a decision upfront, or near the beginning of their treatment, that they want bevacizumab maintenance treatment because they’ll have it with their primary chemotherapy,” Dr. Nick explains.
The drug is administered intravenously and can be given in combination with other chemotherapy drugs. Avastin affects the growth of blood vessels, starving tumors of the blood they need as nourishment.
The American Society of Clinical Oncology (ASCO) guidelines recommend PARP inhibitors be offered to women, with or without genetic mutations, who are newly diagnosed with stage III or IV ovarian cancer and have improved with chemotherapy.
Surgery offers another important decision point. “When patients have their surgery, we can test their tumor to decide if their tumor has a homologous recombination deficiency.” If it does, that also suggests they would benefit from PARP inhibitor maintenance therapy,” says Dr. Nick.
Learning About HRD: What Is It and How Might it Affect Your Treatment?
Elahere (molecular name mirvetuximab) is an FDA-approved targeted therapy providing much-needed hope for patients with platinum-resistant ovarian cancer. This drug treatment is for women who test positive for a molecular factor called folate-receptor alpha (FRα). While many ovarian cancers test positive for the folate receptor, to be eligible for Elahere, you must have very high levels (>75%) of the folate receptor-alpha (FRα).
It is an antibody-drug conjugate. This kind of new anti-cancer drugs, known as “biological missiles,” is leading a new era of targeted cancer therapy.
Dr. Lyons explains, “What that means is that the antibody part of the drug conjugate binds to the folate receptor on the tumor cells, and then that gets taken up into the tumor cell. And then the drug that is conjugated with is the part that actually kills the tumor cells, by affecting the tumor cells ability to divide.”
Contributing by SurvivorNet staff.
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