Eighty percent of women with ovarian cancer enter into remission. However, during the next five years, 70 to 80 percent of those women may have a “recurrence,” when the cancer comes back, according to Dr. Beth Karlan, a gynecologic oncologist at the UCLA Medical Center whose skill as a clinician is noted among her colleagues. The probability of recurrence is, without question, daunting, but there are exciting new options for treatment.
Standard of Care for RecurrenceRead More
Women dealing with reccurrence will likely need to go through chemotherapy or surgery again. And there may well be a decision to add a drug that cuts off the blood supply to tumors (Bevacizumab) or a class of drugs called PARP Inhibitors which help prevent cancer cells from repairing themselves at the genetic level.
According to Dr. Karlan, the type of treatment recommended for recurrence can depend on a number of factors:
- The time period within which the cancer recurred
- The kind of chemotherapy the woman underwent in the past
- Side effects that came as a result of past treatments
- The length of time between the last treatment the woman underwent and the recurrence.
If a woman’s time in between remission and recurrence is more than six months then the ovarian cancer is categorized as “platinum-sensitive” (that is, responsive to a platinum-based chemotherapy treatment) and that patient will be treated with chemotherapy and another platinum-based drug. However, if the recurrence time happens less than six months into remission, the ovarian cancer is classified as “platinum-resistant.” At that point, women are usually treated with another type of chemotherapy and encouraged to enter into a clinical trial. Alternatively, women might be platinum refractory, which refers to disease that grows while the patient is on chemotherapy and has a particularly poor prognosis.
Options for Recurrence- PARP Inhibitors
As many leading experts have told SurvivorNet, some of these treatment protocols for recurrence are changing quickly as there is growing data to support the idea that PARP Inhibitors, the class of drug which inhibits cancer cells from repairing their DNA can benefit a wide swath of women. PARP inhibitors are especially beneficial for women who have genetic testing to discover that they have a mutation called BRCA.
Other Tools to Fight Ovarian Cancer Recurrence
Oncologists can also use a tactic to determine if there is something called “microsatellite instability” in the tumor, which can indicate whether immunotherapy is an option, according to Karlan. Trying to activate the immune system to fight cancer through one of the approved immunotherapy drugs is not yet proving very effective for ovarian cancer, but there are interesting clinical trials going on which combine immunotherapy with other agents.
In the rounds of treatment after a recurrence, Karlan says that experienced doctors look at clinical trials to see if a woman’s disease has some of the features which might make her a potential candidate for novel agents or combinations.
Participating in a clinical trial can provide benefits while also providing vital information to the entire scientific community about potential future treatments.
Repeated Treatment is Possible
Dr. Karlan explains that oncologists may well treat women whose cancer comes back “three, four five, six, seven or eight times” and often it’s during treatment for their fifth or six recurrence that they might go back into remission.
This repeated treatment is possible as a result of a doctor’s careful analysis of a woman’s prior treatments, the time between treatments, and analysis of their tumors.
Probability of Recurrence
Determining the probability that a woman’s cancer will recur depends on the stage at which they were originally diagnosed. According to most data, when diagnosed, women with stage one ovarian cancer have a 10 percent chance of recurrence, women in stage two have a 30 percent chance of recurrence and women in stage three have a 70 to 90 percent chance of recurrence. When your disease is given a stage four designation, unfortunately there is a 90 to 95 percent chance of recurrence.
A recurrence may well evoke emotions including fear, anger or sadness–and those are normal responses.
Like many women, Annie Ellis, an ovarian cancer survivor, told SurvivorNet the overwhelming emotion she felt with recurrence was anxiety. She says joining a survivor community helped her deal with that anxiety.