A Number of Promising Treatments Are Helping Women Live Longer
- Eighty percent of women who are diagnosed with ovarian cancer will go into remission following their initial treatment.
- Of that 80 percent, most will likely experience a recurrence, meaning their cancer will come back.
- There are a number of promising treatment options that are helping women to live longer.
- Many cancer treatment centers offer support services for patients and their families, who may be dealing with an array of emotions.
“After recovering from an [often] elaborate surgery and then completing their chemotherapy, it will appear that [a patient] has no evidence of disease,” says Dr. Michael McHale, gynecologic oncologist at the University of California, San Diego. “And then 12 months later, something’s popping in an exam, and they’ve recurred. We see, on average, the time to recurrence vary anywhere from 13 to 18 months or so for this particular cancer. And that’s one of the biggest frustrations, and challenges.”Read More
What Causes RecurrenceRecurrence often occurs because some cancer cells are left behind after treatment, and, over time, they grow. Or the cancer may have specific features that are resistant to a specific treatment.
Probability of Recurrence
Determining the probability of recurrence depends on the stage at which the cancer was originally diagnosed. According to most data, Stage 1 ovarian cancers have a 10 percent chance of recurring, Stage 2 has a 30 percent chance of recurrence, and women with Stage 3 have a 70 to 90 percent chance of recurrence. If you are diagnosed with a Stage 4 cancer, there’s a 90 to 95 percent chance that your cancer will recur.
Treatment Options for Cancer Recurrence
Women dealing with recurrence will likely undergo chemotherapy, or possibly surgery, though recent studies show that secondary surgery does not improve survival. There may be a decision to add a drug that cuts off the blood supply to tumors (bevacizumab/Avastin) or the use of a new class of drugs called PARP Inhibitors, which help prevent cancer cells from repairing themselves at the genetic level.
The type of treatment you receive for a recurrence can depend on a number of factors:
- The time period within which the cancer recurred
- The type of chemotherapy you had in the past
- The length of time between your last treatment and the recurrence
If the time between remission and recurrence is more than six months, then the ovarian cancer is categorized as “platinum-sensitive,” meaning it responded to a platinum-based chemotherapy treatment, and it’s likely that you’ll be treated with chemotherapy using another platinum-based drug. If the recurrence happens less than six months into remission, the cancer is classified as “platinum-resistant,” and you’ll usually be treated with a different type of chemotherapy.
Patients whose cancer is deemed platinum resistant are encouraged to enter into a clinical trial, as these studies can be beneficial to you while also providing vital information to the medical science community about the efficacy of potential treatments. Experienced doctors can look at clinical trials to see if a woman’s disease has some of the features that might make her a potential candidate for novel agents or combinations.
The Promise of PARP Inhibitors
As many leading oncologists have told SurvivorNet, some of the standard protocols for recurrence are changing. For instance, there is more and more data showing that PARP Inhibitors, a class of drug that inhibits cancer cells from repairing their damaged DNA, may benefit almost all ovarian cancer patients, not just those with a BRCA-1 or BRCA-2 mutation.
Women with a BRCA-1 or BRCA-2 genetic mutation had been shown to respond especially well to PARP inhibitors after recurrence, however newer research has shown that women with the BRCA gene mutation (and indeed almost all women), can consider using PARP inhibitors throughout their treatment.
The Food and Drug Administration has now approved niraparib (brand name ZEJULA) for almost all women regardless of whether they have the BRCA mutation, as part of an initial course of treatment, or what’s called front-line treatment. It’s important to make the decision about starting PARP inhibitors for maintenance as early as possible, since “the magnitude of benefit seems to be the greatest when they’re used earlier in the disease course.”
In clinical trials, one of the three PARP inhibitors, olaparbib has been found to have a particular benefit for maintenance therapy when paired with bevacizumab (brand name AVASTIN). The FDA recently approved bevacizumab 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. The results of the trial showed an increase in progression-free survival from an average of 17 months to 37 months.
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.
Oncologists may repeatedly treat women whose cancer comes returns, and sometimes it can be during treatment for a fifth or six recurrence that they finally achieve a longer remission. Doctors will make treatment decisions by looking at a patient’s prior treatments, the time between treatments, and also an analysis of their tumors.
A recurrence may bring about a mix of emotions—fear, anger, anxiety, and sadness–and these are normal responses. Many NCI-designated cancer centers such as the Moores Cancer Center at UC San Diego Health, have support services teams that include psychiatrists, psychologists, and other supportive care providers with expertise in treating patients and their family members who are dealing with cancer. They work as part of your oncology care team to round out integrated, whole-person care.
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