Actress Cobie Smulders, 41, Kept a Huge Secret – Amid Her ‘Avengers’ and ‘Stumptown’ Roles, She Beat Ovarian Cancer – Treating Ovarian Cancer and How To Catch It Early

Smulders is a beloved actress who’s starred in numerous movies and television shows including “How I Met Your Mother,” “Avengers: Infinity War” and “Avengers: Endgame.” However, off-screen, she privately battled a cancer diagnosis. She eventually went public with her diagnosis to help encourage other women battling ovarian cancer, but it is important to remember sharing your cancer diagnosis is a personal decision you should make when you’re comfortable.

As for Smulders, at the ripe age of 25, she started experiencing unusual symptoms.

“I had felt like something was off. My energy was low, I was just so tired all the time, and I felt a constant pressure on my abdomen that I could not explain,” she described.

Taking heed of her body’s signaling something was amiss, she went to see her doctor which led to her ovarian cancer diagnosis.

The term ovarian cancer refers to several different tumors that grow in the ovary. Many ovarian cancers begin in the fallopian tubes, and as the fallopian tubes brush over the ovary, these cells stick to the ovaries and form a tumor. Ovarian cancer symptoms usually don’t appear until the cancer has advanced to later stages, making treatment difficult.

The signs of ovarian cancer may include feeling bloated or full, pain in the pelvis or abdomen, nausea, vomiting, or changes in bowel habits. What makes identifying these symptoms more difficult is they can mirror symptoms associated with your monthly menstrual cycle.

WATCH: Understanding ovarian cancer.

Smulders, a mother of two, had to juggle undergoing cancer treatment and keeping up with her work schedule. She was diagnosed in 2008 and around that time she worked on “The Slammin’ Salmon.” Following treatment, Smulders said she was given a “clean bill of health.”

“The thing is, I don’t know if I will ever be free of my cancer – or, to be more specific, free from the fear of my cancer’s return. Still, it has become for many people a livable disease, something that you learn to manage. And that’s what I have done,” Smulders said.

Treating the Cancer that Whispers

Ovarian cancer is called the “cancer that whispers” because women often don’t experience symptoms until their cancer has already reached its late stages making treatment more difficult. However, when it comes to the standard of care for treating ovarian cancer, surgery is often considered to be the first step.

If a doctor is confident that he or she can remove the ovarian tumor completely without initial cycles of chemotherapy, the doctor will go ahead with a surgical procedure. “If we think we can do that, we do what we call a debulking procedure or cytoreductive surgery,” gynecological oncologist Dr. Rauh-Hain explains. “That’s usually through an open incision.”

This surgical procedure often does not remove the tumor entirely. Ovarian cancer patients undergoing the debulking procedure, often undergo chemotherapy after the surgery to make sure the cancerous tissue is fully treated in a process called adjuvant chemotherapy. This process treats microscopic diseases that cannot be seen with the eye that the clinician knows to persist in the body after an optimal surgical cytoreduction.

Dr. Dana Chase, gynecologic oncologist at Arizona Oncology says that “80% of patients” go into remission after chemotherapy for “at least a period of time.”

The standard treatment for ovarian cancer is made up of two drugs working in combination for “initial chemotherapy” — Carboplatin and Paclitaxel. The typical course of chemotherapy is made up of three to six treatment cycles based on what stage of cancer the patient has, but different drugs have different treatment cycles.

After initial treatment, patients may receive maintenance therapy to help ensure the cancer does not return.

“We use some maintenance therapies with chemo and then continue them after chemo, such as Avastin while others we use after chemo, such as Olaparib,” Dr. Chase says.

WATCH: How PARP inhibitors impact ovarian cancer treatment.

PARP inhibitors are options for women as maintenance therapy after the first chemotherapy or platinum-sensitive recurrence or as a treatment for recurrence.  PARP inhibitors stop rapidly dividing cancer cells from repairing their own genetic damage, preventing them from replicating.

The benefit a woman may see from PARP inhibitors varies greatly, with the biggest determinant being the presence of an inherited or tumor mutation in BRCA. BRCA gene mutation increases a woman’s risk of breast and ovarian cancer. Experts tell SurvivorNet that every woman with ovarian cancer should get a genetic test to determine if they have a BRCA gene mutation because the mutation enables PARP inhibitors to function much more powerfully.

The PARP inhibitor Zejula (Niraparib) has been approved by the FDA for all women with newly diagnosed ovarian cancer irrespective of whether the tumor is HRD. The drug is used after successful treatment with a platinum-based chemotherapy, the mainstay chemotherapy for ovarian cancer.

The PARP inhibitor Lynparza (Olaparib) is approved for women newly diagnosed with ovarian cancer and with a germline or somatic mutation in BRCA1/2.

Rucaparib (brand name Rubraca) is another well-known PARP inhibitor to help treat this cancer.

Advancements in Ovarian Cancer Treatment

Promising advancements have been offering new hope to patients who typically haven’t had many options. Remember, many ovarian cancer patients are diagnosed once the cancer has advanced into later stages. Cancer that has spread to other parts of the body is harder to treat.

MORE: Treating Recurrent Ovarian Cancer

For advanced ovarian cancer that has a tendency to come back and has become resistant to platinum-based chemotherapy, more has to be done during treatment.

Cancer that comes back within six months of treatment with a platinum-based chemotherapy drug is called platinum-resistant. If the cancer returns after six months following platinum-based chemotherapy is finished, it is called platinum-sensitive.

Women with these stubborn tumors have additional treatment options thanks to advancements in ovarian cancer treatment. The cancer drug called Elahere (molecular name mirvetuximab soravtansine) was given accelerated approval by the Food and Drug Administration (FDA) for certain patients with platinum-resistant disease who had received one to three previous treatments.

Dr. Anna Berkenblit, Chief Medical Officer at ImmunoGen, explained to SurvivorNet what Elahere, an antibody-drug conjugate, did for patients in a pivotal trial called MIRASOL.

“We have longer progression-free survival, which means the patients are living longer without their cancer progressing. And most importantly, we have demonstrated that patients are living longer,” she said.

WATCH: Investigating New Ovarian Cancer Treatments

Elahere targets the folate receptor alpha protein, which is located on the surface of the tumor cell. It offers effective treatment for a large population of women with advanced ovarian cancer.

“It is approved now for patients with high folate receptor alpha level expression, and that’s about 35% to 40% of all ovarian cancer patients,” Berkenblit explained.

“Available therapies for these (platinum-resistant) patients are typically single-agent chemotherapies. And now we’ve shown that Elahere is better than the available therapies,” Dr. Berkenblit said.

The MIRASOL trial looked at how Elahere performed compared to giving chemotherapy alone in patients with folate receptor alpha-positive platinum-resistant ovarian cancer.

In the trial, more than one-third of patients (36%) receiving Elahere (who had previously been treated with the targeted therapy bevacizumab) experienced improved progression-free survival (how long a patient goes without their disease worsening) and more than one-fourth (26%) experienced improved overall survival (how long the patient lives).

In another, smaller group of patients who had not previously been treated with bevacizumab, progression-free survival was 34% better, and overall survival was 49% better than when patients received standard chemotherapy.

Questions for Your Doctor

If you have been diagnosed with ovarian cancer and are interested in learning if these new treatments are available to you, ask your doctor a few questions.

• What stage is my ovarian cancer in and what type do I have?
• Will genetic testing help determine what treatment may be best for me?
• Are there other tests, like for the folate receptor alpha protein, that I can take?
• What are my treatment options based on my results?
• What side effects should I expect from the available treatments?
• If my ovarian cancer is platinum-resistant, what treatment options can I explore?
• Will insurance cover these new cancer drugs?

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