Understanding Ovarian Cancer Maintenance Therapy
- Christiane Amanpour was diagnosed with stage 2 ovarian cancer in 2021. Since then, she’s undergone surgery and chemotherapy to reach remission. However, the chance for recurrence of ovarian cancer is relatively high for women impacted.
- Ovarian cancer recurrence happens in “almost 25 percent of cases with early-stage diseases and in more than 80 percent with more advanced stages,” according to research published in Gland Surgery medical journal.
- After ovarian cancer patients complete initial treatment, maintenance therapy may be recommended to try and delay possible recurrence.
- Bevacizumab (Avastin) or a PARP inhibitor are maintenance therapy options. PARP inhibitors prevent cancer cells from repairing their DNA, while Avastin blocks the formation of new blood vessels, starving tumors of nutrients.
- Genetic testing helps doctors determine the most effective maintenance therapy.
Christiane Amanpour, 65, is an international affairs and war correspondent who’s demonstrated her bravery beyond doubt, but she says her battle with ovarian cancer was “very different.” Her heroic efforts are partly why she’s the recipient of an award advocating for women. While the resilient journalist has since completed treatment for her cancer, the chance of a recurrence is high. Fortunately, for women impacted by this cancer, treatment options exist to not only deal with recurrence but potentially slow the time it takes for recurrence.
View this post on InstagramRead MoreAt the awards ceremony, Clinton honored the recipients for their role in peace and security and advocacy for women.
Amanpour’s work as a journalist has impacted the lives of many people. However, she said her cancer journey changed her life when she was diagnosed in May 2021.
“I’ve spent my career covering genocides in Bosnia and Rwanda, wars in Afghanistan, Iraq – all really dangerous stuff…And I’ve survived all that. But this is very different,” Amanpour told People.
She learned she had cancer after undergoing routine screening. Her doctor discovered a “grapefruit-sized cyst” on her right ovary. Her ovarian cancer was stage 2. Ovarian cancer is considered the cancer “that whispers” because of its unsuspecting symptoms. According to the National Cancer Institute, most women diagnosed with this cancer experience recurrence.
“I was shocked,” Amanpour said.
To treat her cancer, she underwent surgery followed by 18 weeks of chemotherapy. While the type of chemo she received is unclear, her treatment helped her reach remission. The experience moved her in ways many cancer warriors who journeyed through their diagnosis can also relate to. She has since used her platform to promote awareness about ovarian cancer, which Amanpour calls an “invisible killer.”
“Get all the scans that you can. We women know better what’s going on with our own bodies than anybody. We can trust ourselves. If there’s something wrong, pursue it,” Amanpour said.
Helping Patients Understand Treatment Options for Ovarian Cancer
Why Ovarian Cancer Can Be Tricky
“Ovarian cancer does not have any specific symptoms,” Dr. Beth Karlan, a gynecologic oncologist at UCLA Medical Center, told SurvivorNet.
“It’s often referred to as the ‘cancer that whispers’ in that it has symptoms that are really very vague and nothing that may bring your attention directly to the ovaries.
WATCH: Signs of ovarian cancer.
“The symptoms include things like feeling full earlier than you usually would when your appetite is strong and feeling bloated. Some changes in your bowel habits. Some pain in the pelvis. These are symptoms women may have every month. These are not very specific. But what we’ve found from multiple studies, it’s this constellation of symptoms,” Dr. Karlan added.
How Ovarian Cancer Is Treated
The standard of care for ovarian cancer patients is chemotherapy, which helps many patients reach remission.
Ovarian cancer recurrence happens in “almost 25 percent of cases with early-stage diseases and in more than 80 percent with more advanced stages,” according to research published in Gland Surgery medical journal. With recurrence a strong possibility for this disease, especially in the later stages of ovarian cancer, certain drug treatments to deal with it are giving many women hope.
WATCH: Treating ovarian cancer.
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.
Targeted therapies or precision medicine specifically target the proteins controlling cancer cells’ growth, division, and spread.
Maintenance Therapy for Ovarian Cancer
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.
“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, tells SurvivorNet.
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 showed an increase in 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 explains.
The drug is administered intravenously and can be given in combination with other chemotherapy drugs. Avastin works by affecting 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,” known as HRD. If it does, that also suggests they would benefit from PARP inhibitor maintenance therapy,” says Dr. Nick.
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.”
Questions for Your Doctor
If you have been diagnosed with ovarian cancer and need guidance to further educate yourself on the disease and treatment, consider these questions for your doctor.
- What type of ovarian cancer do I have?
- What stage is my cancer in?
- Do you recommend I get genetic testing for any gene mutations, such as the BRCA gene mutation?
- What initial treatment options do you recommend?
- What are the possible side effects of the recommended treatment, and how to cope with them?
- Will insurance help cover my recommended treatment?