Treatment Advances in Ovarian Cancer
- Recent years have seen the introduction of several new ovarian cancer treatments
- Bevacizumab (brand name Avastin) is a targeted therapy for the first-line treatment, recurrence, and maintenance therapy of ovarian cancer
- PARP inhibitors may improve progression-free survival time
- Other new treatments, including a dendritic cell vaccine, are in the development pipeline
There had been some trials around experimental procedures like intraperitoneal chemotherapy, giving the chemotherapy drug paclitaxel (Taxol) directly in the abdominal cavity, but some patients who received this treatment had to deal with side effects like belly pain, nausea, and vomiting.
Read MoreBevacizumab
Bevacizumab (brand name Avastin), belongs to a group of targeted drugs known as angiogenesis inhibitors. Unlike chemotherapy, which indiscriminately kills all quickly dividing cells, including cancer cells, bevacizumab hones in on cancer more specifically, by targeting the blood supply it needs to grow.Bevacizumab blocks a protein called vascular endothelial growth factor (VEGF), which promotes the growth of blood vessels that feed the cancer. By blocking VEGF, the treatment essentially starves the tumor of the nutrients it needs to survive.
This drug can be an option for women with ovarian cancer who are just starting treatment, those whose cancer has returned, and as a maintenance therapy to keep the cancer at bay. Avastin may be paired up with chemotherapy and PARP inhibitors, namely olaparib with effective results. The drug comes as an infusion that you get into a vein every two to three weeks.
Side effects from bevacizumab can include:
- High blood pressure
- Fatigue
- Bleeding
- Headache
- Blurred vision
- Appetite loss
- Low white blood cell count
- Holes in the colon (perforations)
PARP Inhibitors
Another new treatment targets ovarian cancer cells' self-repair mechanism. PARP (short for poly (ADP)-ribose polymerase) inhibitors block an enzyme cancer cells use to fix their own DNA. Without the ability to repair this damage, the cancer cells can't multiply.
PARP inhibitors are particularly effective in women whose cancers have a BRCA gene mutation, which already compromises the cells' ability to repair DNA damage. However, one PARP inhibitor, niraparib was also recently been approved for use in women who lack this gene mutation.
Three PARP inhibitors are FDA-approved for ovarian cancer:
- Niraparib (Zejula)
- Olaparib (Lynparza)
- Rucaparib (Rubraca)
Studies indicate that these drugs, when used as first-line treatment, maintenance therapy, or both, can significantly extend the amount of time before the cancer returns or gets worse.
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.
Side effects of PARP inhibitor drugs include:
- Nausea
- Vomiting
- Diarrhea
- Fatigue
- Appetite loss
- Taste changes
- Low red blood cell counts (anemia)
Treatment Pipeline
In addition to these approved treatments, several other ovarian cancer therapies are working their way through clinical trials. One promising approach is immunotherapy, which turbo-charges the body's own immune system response to help it better target and kill cancer cells.
Currently, the standard of care when ovarian cancer returns after treatment is chemotherapy. Early research suggests that adding a type of immunotherapy called a dendritic cell vaccine (DCVAC) to chemotherapy improves survival. In women whose ovarian cancer relapsed, the addition of DVAC decreased the risk of death by 62% and increased overall survival by about 13 months.
Other types of immunotherapies, including checkpoint inhibitors, are also under investigation, as are combinations of immunotherapy and other targeted treatments. If you're interested in trying one of these new therapies, ask your doctor about enrolling in a clinical trial.
These and other innovations are transforming ovarian cancer treatment today, and will likely continue to do so in the future. "I think what I’m going to be doing 10 years from now is going to be way different than I’m doing right now," Dr. Metzinger says.
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