Your oncologist has many options for the course of your ovarian cancer treatment. So how do they end up choosing which treatment plan to recommend? Doctors glean key information from indicators called biomarkers. Think of biomarkers as certain characteristics that each woman has that can help oncologists predict how they’ll respond to future treatment. Ultimately, the biomarkers for ovarian cancer are one of many factors doctors use to guide treatment decisions. We spoke to Dr. Douglas Levine, director of gynecologic oncology at the NYU Perlmutter Cancer Center, to help us understand the role of biomarkers in making treatment decisions and predicting outcomes.
Success of First Surgery
Dr. Levine says that the most important biomarker for treatment success and decisions is how the first surgical tumor removal went. He says, “For advanced ovarian cancer, which is how most women present with the disease, some people forget or overlook [that] the most important biomarker is your initial treatment…[including] surgical resection.”
“The goal of surgery is to remove all cancer that you can see with a naked eye, and this remains a very strong bio marker of overall survival,” he explains. This is because women who have a successful first surgery live significantly longer than those who have some cancer left after their surgery.
According to Dr. Levine, other than the outcome of initial treatment, the other biomarkers are:
- Age – Levine says this “is actually a tricky biomarker,” in large part because it usually packs two positive, or favorable, biomarkers in one. For one, younger women typically do better with treatment because they can tolerate treatment better. As Levine puts it, “They can tolerate all of the treatments without treatment breaks, and with minimal toxicity.” Secondly, younger women are also more likely to carry BRCA mutations, allowing them to respond better to treatments like PARP inhibitors. In this sense, age is a two-fold biomarker.
- Performance Status
- Where you receive treatment – The most important thing to note about the hospital where you receive treatment is how many ovarian cancer patients they treat. High volume cancer centers and surgeons who perform a high volume of surgeries have been shown to have better outcomes than those with fewer surgeries or patients. As Dr. Levine explains, “A number of studies have shown that if you go to a high volume center, a center that treats a lot of ovarian cancer, that your outcomes are dramatically better. So it’s both the center, and the surgeon, because surgeons who do this frequently and centers that treat ovarian cancer frequently, have processes in place … to incorporate all of the latest treatments, and give the best outcomes in the safest possible manner.”
- Tumor Genetics – In particular, the BRCA mutations are the most important genetic biomarker for ovarian cancer. It contributes to the development of early ovarian cancer in younger women, but if you do have the disease, then that mutation allows you to respond much better to certain treatments including the traditional carboplatin/paclitaxel chemotherapy as well as the more novel/new agents such as PARP inhibitors.
- CA-125 – This is a protein that can be present in the blood and is “one of the best biomarkers for monitoring ovarian cancer treatments,” Levine says. By tracking levels of CA-125 in the blood, oncologists can determine whether your cancer has returned following initial treatment.
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