Monday, September 24, 2018
Health

Research, new treatments offer hope for ovarian cancer patients

In about a month, the streets of downtown St. Petersburg will be bathed in blue — a blue-green shade of teal, actually — as hundreds of walkers, runners and supporters converge at Albert Whitted Park for the Celma Mastry Ovarian Cancer Foundation's One Step Closer to the Cure Run/Walk.

Teal is the official color of ovarian cancer awareness. Organizers hope to raise $75,000 to help fund a financial assistance program for local patients in need.

Ovarian cancer is difficult to detect early, difficult to treat and difficult to survive. According to the American Cancer Society, more than 21,000 women are diagnosed annually; more than 14,000 die from the disease.

Most women are diagnosed late, after the disease has spread to surrounding tissue and organs. Still, with appropriate treatment, almost half of patients survive five years after diagnosis. Ongoing research gives patients and doctors hope for even better outcomes.

Among those who are encouraged is Dr. Rob Wenham, director of research for gynecologic oncology and interim chairman of the gynecologic oncology department at Moffitt Cancer Center in Tampa.

He gets frustrated when patients, especially older ones, come in for a second opinion only as a last resort, having been told there is nothing that can be done for them.

"That's simply not true," Wenham said, noting that a study published this year found that less than half of women over age 65 receive the chemotherapy and surgery needed following diagnosis, thinking treatment is futile.

"One of my patients was diagnosed and told to just go home and wait to die, primarily because of her age over 65," he said. "She came to see us at the insistence of family members but not expecting much, got into treatment and two and a half years later she's still alive and doing well."

One key to survival is seeing specialists — a gynecologic oncologist and a surgeon specially trained to treat ovarian cancer.

"Specialists have improved survival to over five years for advanced ovarian cancer," Wenham said, "yet only half of women see a specialist. With the right surgery and chemotherapy we can approach 10 years survival. So don't throw your hands up and think nothing can be done."

Other developments in the field:

• Two new drugs have been approved in the last year and a half, the first new therapies in almost nine years. One attacks blood vessels that feed tumors, shutting off their blood supply. Another, one of the newer targeted therapies, attacks specific gene defects that are common in the cells of ovarian cancer patients. Researchers are looking at how this can be combined with chemotherapy to make chemo more effective, improving survival with few side effects.

• Researchers are looking at different ways to deliver chemotherapy. More recently, doctors tried injecting chemo directly into the abdomen, essentially filling the belly with cancer-fighting drugs. But the approach is tough on patients and very toxic, so some doctors are going back to intravenous delivery in smaller doses, given more frequently.

• A diagnostic test that could detect ovarian cancer early still eludes scientists. A new major study involving 200,000 women compared no screening to annual ultrasounds or annual CA125 blood testing (currently used to detect recurrence of the disease). None of the three methods significantly improved survival.

• Determining a woman's risk for ovarian cancer has been challenging, but doctors continue to make progress. They know that women with the BRCA1 and BRCA2 gene are at increased risk. Recent research has found other genes may be involved, and identifying women who have them may help with prevention.

• Doctors are also learning more about the role of fallopian tubes in ovarian cancer. Not having fallopian tubes reduces ovarian cancer risk by 50 percent or more. If a patient is having her ovaries removed or a hysterectomy, she may want to consider removing her tubes as well. "That's not traditionally practiced right now," Wenham said, "but, if they are not needed, all women, not just those at high risk for ovarian cancer, may want to consider having them removed."

• Immunotherapy — using the patient's immune system to attack cancer — is a newer area of ovarian cancer research which can include using a patient's tumor to make a vaccine, extracting tumor-fighting cells from the tumor to give back to the patient and giving medications that turn the immune system back on. These approaches have worked well in fighting melanoma and lung cancers. Trials testing immunotherapy in ovarian cancer patients are under way now, including at Moffitt.

Contact Irene Maher at [email protected]

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