Refine and Retry, Getting Ovarian Cancer Treatment Right for Patients

One of the biggest challenges in ovarian cancer involves early detection. The disease often presents with vague symptoms that can be overlooked not only by a patient but also by health care providers.

A swollen abdomen, increased urination, pelvic pain and difficulty eating can be confused with other medical conditions, such as ovarian cysts and irritable bowel syndrome. That’s why women often wait to see a physician or the ones who do go for an examination are misdiagnosed — and why ovarian cancer is usually found at a more advanced stage.

This complexity has researchers looking for better screening options, which are still not up to par. For example, testing for cancer antigen 125 (CA 125), a potential biomarker for

the disease, is oncologists’ best tool at this point, but its reliability is debatable.

Physicians are doing their best to use CA 125 to assist as many women as possible by looking at the protein’s rate of change over time, which is often used in cases of patients facing disease recurrence, something you will read about within the pages of this special issue of CURE®.

Although advances in imaging, such as ultrasounds and scans, can play an important role in detecting the often-silent disease, it’s imperative that, to help spread awareness, physicians and patients alike be vocal about these symptoms that persist without an easy explanation.

Research is also leading to treatment advances in ovarian cancer, especially following recurrence. Although still being investigated, hyperthermic intraperitoneal chemotherapy, or “hot chemotherapy,” plus surgery has been shown to improve survival. Interest is also growing in neoadjuvant chemotherapy — giving chemotherapy before surgery. Typically, chemotherapy has been given after surgery, but using it prior may give women time to help shrink the tumor before undergoing radical surgery, and the reduced tumor helps lower surgical morbidity.

New medication options, such as Avastin (bevacizumab), a monoclonal antibody approved by the Food and Drug Administration two years ago, can be used to treat advanced disease or recurrence and help prevent ovarian cancer progression. Used as maintenance therapy, PARP inhibitors are showing promise for women who have a BRCA gene mutation.

These drugs can treat patients after progression on chemotherapy or help maintain a remission after a response to chemotherapy. And instead of just relying on BRCA mutations, researchers have also begun studying DNA repair deficiency to determine who might benefit from a PARP inhibitor even without BRCA mutations.

Innovations like these build on one another and lead to advancements for women who may not see gains from current available therapies. For instance, because physicians can use chemotherapy preoperatively, maybe they can try using new biological drugs the same way. If patients don’t respond, per- haps that’s when new drugs are employed.

Refining existing treatments and adapting the regimen sequence may allow women to derive a benefit much earlier in their treatment course. Ongoing studies to better understand the basic mechanisms of ovarian cancer will help bring about new and more precise treatments.