Personalized Ovarian Cancer Treatment
- Doctors can now individualize ovarian cancer treatment based on genetic testing
- Women with BRCA gene mutations can get a type of drug called PARP inhibitors to prolong the time before their cancer returns
- New drugs in the pipeline may turn ovarian cancer into a chronic, manageable condition
“The kind of targeted therapies that are coming out are related to genetic mutations within the tumors,” says Dr. Karen Zempolich, gynecologic oncologist at St. Mark’s Hospital in Salt Lake City, Utah. “Are there mutations that this particular patient has in their tumor that might make a subset of medication more useful for them?”
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When normal, the BRCA genes help cells repair their broken DNA. But when these genes are mutated, the DNA repair mechanism goes awry, allowing cells to turn cancerous. The same vulnerability that makes women more likely to get ovarian cancer can also make them more likely to respond to drugs called PARP inhibitors, which work by preventing cancer cells from repairing their damaged DNA. When cancer cells can’t fix their genetic material, they can no longer divide and spread.
Three PARP inhibitors are currently approved to treat ovarian cancer, and they are transforming treatment, especially for women with BRCA gene mutations. When given after initial treatment with surgery and intravenous chemotherapy, these drugs act as maintenance therapy, prolonging remission and preventing the cancer from returning or spreading.
“That has dramatically changed how we take care of many women’s ovarian cancer and prolonged not just life, but meaningful life with disease-free or progression-free time,” Dr. Zempolich says. “I think we really are at an exciting time in ovarian cancer care.”
Most recently, the American Society of Clinical Oncology (ASCO) released new guidelines recommending 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.
Be a Voice in Your Own Care
The consideration of which ovarian cancer treatments to have and when to have them should be a collaborative process. A woman’s hopes and concerns should carry just as much weight in this process as her doctor’s recommendations.
Dr. Zempolich says it’s important to have the type of relationship with your oncologist where you’re comfortable asking questions like, “What’s right for me?” Let your doctor know your treatment priorities, and your primary concerns. Ask about potential side effects from the treatment your doctor is suggesting, like nausea, vomiting, or fatigue, and what you can do to prevent or relieve them. And discuss which treatment makes sense for you to receive first. “That allows for individual care,” she adds.
The Future of Ovarian Cancer Treatment
Ovarian cancer research has progressed at a rapid pace, leading to therapies Dr. Zempolich says she couldn’t have envisioned when she started caring for patients about 20 years ago, or even five years ago. “I can’t imagine what we’re going to be at five years from now,” she says.
“We have so many drugs in the pipeline acting on very specific cell mechanisms that…we’re going to have more and more options two, three, five years from now,” she adds.
She foresees a day when ovarian cancer is going to become a chronic disease like diabetes, that women can manage long-term with medications, without it taking their life. “I couldn’t be more hopeful for the future,” she says.