Embracing Life as a Two-Time Ovarian Cancer Survivor
- Tennis legend Chris Evert, 70, is back at the French Open after a devastating ovarian cancer recurrence disrupted her sports anchor gig with ESPN last year.
- Highly revered for winning 18 Grand Slam Singles titles over the course of her career, the Florida native is now back in the community that she loves, this time with a mic in her hand, embracing life as a two-time cancer survivor.
- Evert first disclosed her diagnosis for stage 1 ovarian cancer in 2022. After undergoing treatment, she reached remission as no evidence of the disease was present during scans at the time. With ovarian cancer, however, despite initial treatment, there is typically a high chance of recurrence. And unfortunately, Evert’s disease returned last year, but thankfully, she was once again given an all clear in February.
- One of the most common biomarker tests for ovarian cancer is called a CA-125, which is a measurement of a specific type of cancer antigen, a protein that is found in everyone’s blood. High levels of CA-125 in an ovarian cancer patient can often be a warning signal for your doctor that the cancer may have returned.
- 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.
Evert, who concludes her coverage on June 8 after kicking off on May 19 in the City of Light, discussed her positive health news earlier this year.
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“I think that has helped me tremendously in this fight. I think it’s definitely the competition and being a professional athlete that has helped me [through cancer].
Evert also discussed the importance of patience. “I have always taken blows pretty well, emotionally and mentally.”
Going on to share a more logical view on the disease as a whole, she noted that “half the world has cancer” or “will get cancer,” so her “reaction” is: “I’m just like everybody else.”
Chris Evert’s Cancer Journey
Chris Evert first disclosed her diagnosis for stage 1 ovarian cancer in 2022. After undergoing treatment, she reached remission as no evidence of the disease was present during scans at the time. With ovarian cancer, however, despite initial treatment, there is typically a high chance of recurrence.
“I wanted to give you all an update. My cancer is back,” Evert announced on X in a joint post with ESPN, explaining why she would not be a part of ESPN’s 2024 Australian Open coverage. “While this is a diagnosis I never wanted to hear, I once again feel fortunate that it was caught early.”
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
Most women, around 80 percent who are diagnosed with ovarian cancer, will respond positively to their first round of treatment and go into remission. However, of that 80 percent, a majority will likely experience a recurrence, meaning their cancer will come back.
“With ovarian cancer, the standard of care is a very, very effective chemotherapy,” gynecologic oncologist at Arizona Oncology Dr. Dana Chase told SurvivorNet in a prior interview.
“Meaning we give you chemotherapy when you first have your diagnosis of ovarian cancer – 80% chance that you go into remission. So, 80 percent, I consider pretty good for cancer therapy,” Dr. Chase added.
Coping with Recurrence
Some experts say the number is even a little higher, around 85 percent.
“Unfortunately, for about 85 percent 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,” Dr. Resnick continued. “And then there will be times when they’re in the valley when they’re in remission.”
A Biomarker Test for Ovarian Cancer Patients
One of the most common biomarker tests for ovarian cancer is called a CA-125, which is a measurement of a specific type of cancer antigen, a protein that is found in everyone’s blood. High levels of CA-125 in an ovarian cancer patient can often be a warning signal for your doctor that the cancer may have returned.
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.
In a previous chat with SurvivorNet, Dr. Noelle Cloven from Texas Oncology-Fort Worth Cancer Center explained: “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.”
Treatment Options for Recurrent Ovarian Cancer
Continued treatment after the patient finishes their initial treatment is called maintenance therapy.
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 (a type of targeted cancer drug used to treat ovarian cancer and other types of cancers) every day after chemotherapy and can keep cancer in remission longer.
Ovarian Cancer Treatment Options
Genetic testing helps doctors determine the best maintenance therapy.
“The biggest question is: How do you choose between bevacizumab (Avastin) or a PARP inhibitor for maintenance therapy?” Dr. Alpa Nick, a gynecological oncologist with Tennessee Oncology in Nashville, said in a prior interview with SurvivorNet.
The drugs have very different ways of combating 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 (FDA) approved bevacizumab (Avastin) to be used in conjunction with olaparib (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.
“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 explained.
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.
PARP Inhibitor Guidelines
The American Society of Clinical Oncology (ASCO) guidelines recommend PARP inhibitors be offered to women, with or without genetic mutations (Evert carries a BRCA gene mutation), 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,” known as HRD. If it does, that also suggests they would benefit from PARP inhibitor maintenance therapy,” says Dr. Nick.
Additionally, Elahere (mirvetuximab soravtansine-gynx) 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.
Ovarian Cancer Symptoms
Ovarian cancer has been called “the cancer that whispers,” due to its hard-to-detect symptoms, which may include:
- Feeling full earlier/decrease in appetite
- Feeling bloated
- Changes in bowel habits
- Pain in the pelvis
- Urinary symptoms, such as an urgent need to go
- Extreme fatigue
- Abdominal swelling
- Pain during sex
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