Genetic Testing For Ovarian Cancer
- Autosomal dominant gene mutations can be found in both women and men, so genetic testing can benefit anyone
- BRCA-1 and BRCA-2 gene defects are inherited mutations which increase risk of ovarian cancer, but respond well to a class of drugs called PARP inhibitors
“Genetic testing is important for several different reasons,” Dr. Kellie Schneider, a gynecologic oncologist at Novant Health in Charlotte, North Carolina, tells SurvivorNet. “Ovarian cancer is a relatively rare cancer so when we see it in a patient we worry there’s something that put them genetically at risk for that cancer. We would want to know for their sake and their family’s sake if we need to be screening for any additional cancers once they are in remission from their ovarian cancer.”Read More
While initially women with a BRCA-1 or BRCA-2 genetic mutation had been shown to respond especially well to PARP inhibitors after recurrence, and then in what’s called maintenance therapy, 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 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. 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.
However, Dr. Amanika Kumar of the Mayo Clinic who spoke to SurvivorNet, cautioned that women still need to speak with their doctor to evaluate the benefit of taking a PARP inhibitor to extend life, because there are very real side effects due to the toxicity of the drug. "Patients with HRD (homologous recombination deficiency) have a far better response than those without and those with BRCA mutations even more so. It is on us as clinicians to help patients understand the risks and benefits of treatment. Patients that have no mutation or HRD may choose not to go on maintenance (in fact I recommend they don't) because there is real toxicity to these meds."
Chemotherapy For Ovarian Cancer Patients
For patients receiving chemotherapy treatments for ovarian cancer, a number of factors will determine the dose you receive, the frequency at which you receive it, and the timing of your treatment (be it before or after surgery). Oncologists will examine patients’ specific stage of cancer and their body's tolerance to side effects.
"Every patient is unique and not one size fits all," says Dr. Scott Rushing, a gynecologic oncologist and surgeon at Compass Oncology, told SurvivorNet in a separate interview. "So we will definitely make some modifications to dosages, depending upon the patient's age, their weight, their kidney function and other medical problems that they may have."
However, while administrating chemotherapy can vary on these factors, the types of drugs given to patients is relatively the same. These chemo drugs are a platinum-based chemo agent, such as carboplatin and a taxane chemo agent called paclitaxel (often known by its brand name, Taxol). They are typically given every three weeks for six to eight cycles, and Dr. Rushing says side effects caused by the drugs usually improve after the first week of treatment.