Managing Side Effects of Treatment Amid Cancer Treatment
- “The Voice” singer Virginia Lillye, 54, is battling stage 3 ovarian cancer. After completing grueling chemotherapy, she thought she was in the clear until CT scans signaled she would need to restart chemotherapy. She shared an update with fans, noting although she’s restarted chemo, she’s tolerating it better this time around.
- Ovarian cancer is often harder to catch in its early stages because of its subtle symptoms, such as bloating, weight gain, and abdominal pain that can mimic regular menstrual cycle fluctuations. After ovarian cancer patients complete initial treatment, maintenance therapy may be recommended to try and delay possible recurrence.
- Maintenance therapy for ovarian cancer can involve taking an oral pill called a PARP inhibitor every day after chemotherapy and can keep cancer in remission longer. PARP inhibitors prevent cancer cells from repairing their DNA.
- Elahere (molecular name mirvetuximab) is an FDA-approved targeted therapy providing much-needed hope for patients with platinum-resistant ovarian cancer (Your cancer returns within six months of treatment with platinum-based chemotherapies, like carboplatin and cisplatin.) This drug treatment is for women who test positive for a molecular factor called folate-receptor alpha (FRα).
- Ovarian cancer recurrence happens in “almost 25 percent of cases with early-stage diseases and in more than 80 percent with more advanced stages,” according to research published in Gland Surgery medical journal.
- Genetic testing helps doctors determine the most effective maintenance therapy.
View this post on InstagramRead MoreAccording to Daily Mail Australia, Lillye has performed alongside notable rockstars, including KISS member Gene Simmons, Poison’s Richie Kotzen, and Guns ‘N’ Roses’ Gilby Clarke. However, her fans realized she had been missing in action last summer. When Lillye reemerged, she explained her absence stemmed from a cancer diagnosis.“You may have noticed the absence of posts related to gigs and shows,” Lillye said on Instagram.
“Upon returning from an overseas trip, I was admitted into hospital and was given the devastating news that I have stage 3 ovarian cancer,” Lillye continued.
Ovarian cancer has been called the “cancer that whispers” because women often don’t experience symptoms until their cancer has already reached its late stages. The symptoms that do appear at first are hard to identify as cancer.
“Ovarian cancer does not have any specific symptoms,” Dr. Beth Karlan, a gynecologic oncologist at UCLA Medical Center, told SurvivorNet.
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“I have a long road of recovery ahead with round one of chemo ticked off already and am heading for round two,” Lillye said in July 2023.
Her treatment included multiple rounds of chemotherapy and a full hysterectomy.
A hysterectomy is a procedure that removes part or all of the uterus (or womb), often along with the cervix, according to the National Cancer Institute. Women who receive a diagnosis of uterine, ovarian, and cervical cancer may have their cancer treated with a hysterectomy.
Amid treatment, Lillye experienced hair loss. She remained in high spirits, fueled by her husband’s willingness to shave his head alongside her.
“The hair has fallen out, and my husband, being the amazing human that he is, has supportively shaved his locks off, too,” Lillye said.
After a tough surgery and additional rounds of chemotherapy, Lillye said she felt herself getting stronger mentally.
At the start of 2024, Lillye received her last round of chemotherapy, or so she thought. A couple of months later, in March 2024, recurring CT cans detected something concerning.
“My recent CT scan has shown evidence of fluid on my left lung with thickening on the lining. What would normally be considered as not an issue, the fact that my CA125 blood level count has jumped from 13 to 74, has my team worried,” Lillye explained.
In the end, her care team told her she needed to restart chemotherapy.
“Back in the saddle for my target therapy,” Lillye said.
“It’s crazy to think that two weeks ago, this whole chemo journey began again!” she added.
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The silver lining for Lillye is that this latest round of chemotherapy has not packed as powerful a punch as the previous one.
“Other than being a little fatigued, having a dull headache for a day or two, and a little diarrhea, I’ve managed to get on with life and have not been hit by any major chemo issues,” she said.
Despite her cancer journey, Lillye says she’s determined to keep living and enjoying her life.
“I’ve managed to visit friends, spend quality time with family, go out for lunches, and see the 30th anniversary of ‘The Crow’ at the movies… not too bad for a two-week period with going through chemo,” Lillye added.
It’s inspiring to see her choosing to focus on the positives in her life to keep her spirits high while battling ovarian cancer, which tends to come back even if put into remission for a period of time.
Helping Patients Understand Treatment Options for Ovarian Cancer
Coping With an Ovarian Cancer Diagnosis
“Ovarian cancer does not have any specific symptoms,” Dr. Karlan told SurvivorNet.
Many ovarian cancers begin in the fallopian tubes. A few cancerous cells first grow on the fallopian tubes. Then, as the fallopian tubes brush over the ovary, these cells stick to the ovaries and eventually form a tumor.
“The symptoms include things like feeling full earlier than you usually would when your appetite is strong and feeling bloated, some changes in your bowel habits, and some pain in the pelvis. These are symptoms women may have every month. These are not very specific, but we’ve found this constellation of symptoms from multiple studies,” Dr. Karlan added.
The symptoms of ovarian cancer may include the following, according to SurvivorNet experts.
- A feeling of bloating or fullness
- Pain in the pelvis or abdomen
- Nausea
- Vomiting
- Changes in bowel habits
How Ovarian Cancer Is Treated
The standard of care for ovarian cancer patients is chemotherapy, which helps many patients reach remission.
Ovarian cancer recurrence happens in “almost 25 percent of cases with early-stage diseases and in more than 80 percent with more advanced stages,” according to research published in Gland Surgery medical journal. With recurrence a strong possibility for this disease, especially in the later stages of ovarian cancer, certain drug treatments to deal with it are giving many women hope.
RELATED: Dealing with recurrence.
WATCH: Treating ovarian cancer.
Ovarian cancer is sub-categorized into two groups.
Platinum-Sensitive Ovarian Cancer: Your cancer does not return for more than six months after treatment with platinum-based chemotherapies, like carboplatin and cisplatin.
Platinum-Resistant Ovarian Cancer: Your cancer returns within six months of treatment with platinum-based chemotherapies, like carboplatin and cisplatin.“The mechanism that causes platinum resistance will cause someone to be resistant to other chemotherapies, as well. That’s why we’re looking for what we call targeted therapies – precision medicine,” Dr. Noelle Cloven from Texas Oncology-Fort Worth Cancer Center explained.
RELATED: Recurrent Ovarian Cancer Treatment Is Your Disease “Platinum-Sensitive”?
Targeted therapies or precision medicine specifically target the proteins controlling cancer cells’ growth, division, and spread.
Maintenance Therapy for Ovarian Cancer
Maintenance therapy is continued treatment after the patient finishes their initial treatment. After an ovarian cancer patient completes a round of treatments — such as surgery and chemotherapy — her doctor may recommend some form of maintenance therapy to try and delay possible recurrence. Maintenance therapy can involve taking an oral pill called a PARP inhibitor every day after chemotherapy and can keep cancer in remission longer.
Genetic testing helps doctors determine the best maintenance therapy.
“The biggest question is: How do you choose between bevacizumab (brand name, Avastin) or a PARP inhibitor for maintenance therapy?” Dr. Alpa Nick, a gynecological oncologist with Tennessee Oncology in Nashville, tells SurvivorNet.
The drugs combat cancer cells in very different ways. PARP inhibitors prevent cancer cells from repairing their DNA, while Avastin blocks the formation of new blood vessels, starving tumors of nutrients.
The Food and Drug Administration approved bevacizumab (Avastin) to be used in conjunction with olaparib (brand name LYNPARZA) in HRD (Homologous Recombination Deficiency) positive women who show a response to platinum-based chemotherapy. During clinical trials, the drug combination increased progression-free survival from an average of 17 months to 37 months.
“A patient really has to make a decision upfront, or near the beginning of their treatment, that they want bevacizumab maintenance treatment because they’ll have it with their primary chemotherapy,” Dr. Nick explains.
The drug is administered intravenously and can be given in combination with other chemotherapy drugs. Avastin affects the growth of blood vessels, starving tumors of the blood they need as nourishment.
The American Society of Clinical Oncology (ASCO) guidelines recommend 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.
Surgery offers another important decision point. “When patients have their surgery, we can test their tumor to decide if their tumor has a homologous recombination deficiency,” known as HRD. If it does, that also suggests they would benefit from PARP inhibitor maintenance therapy,” says Dr. Nick.
Elahere (molecular name mirvetuximab) is an FDA-approved targeted therapy that provides much-needed hope for patients with platinum-resistant ovarian cancer. This drug treatment is for women who test positive for a molecular factor called folate receptor alpha (FRα). While many ovarian cancers test positive for the folate receptor, to be eligible for Elahere, you must have very high levels (>75%) of the folate receptor-alpha (FRα).
It is an antibody-drug conjugate. This kind of new anti-cancer drugs, known as “biological missiles,” is leading a new era of targeted cancer therapy.
Dr Lyons explains, “What that means is that the antibody part of the drug conjugates binds to the folate receptor on the tumor cells, and then that gets taken up into the tumor cell. And then the drug that is conjugated with is the part that kills the tumor cells by affecting the tumor cell’s ability to divide.”
Questions for Your Doctor
If you have been diagnosed with ovarian cancer and need guidance to further educate yourself on the disease and treatment, consider these questions for your doctor.
- What type of ovarian cancer do I have?
- What stage is my cancer in?
- Do you recommend I get genetic testing for any gene mutations, such as the BRCA gene mutation?
- What initial treatment options do you recommend?
- What are the possible side effects of the recommended treatment, and how can they be coped with?
- Will insurance help cover my recommended treatment?
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