Prayers for Tennis Legend Chris Evert, 68 – What Are Her Options Now That Her Ovarian Cancer Has Returned?

Evert’s surprise announcement came as she revealed she could not cover the Australian Open. She added, “Based on a PET CT scan, I underwent another robotic surgery…doctors found cancer cells in the same pelvic region. All cells were removed, and I have begun another round of chemotherapy.”

A message from @ChrissieEvert

Evert will not be part of ESPN’s 2024 @AustralianOpen coverage pic.twitter.com/LKGmKDBNGU

— ESPN PR (@ESPNPR) December 8, 2023

Evert first revealed she was diagnosed with stage 1 ovarian cancer in 2022. After undergoing treatment, she reached remission as no evidence of the disease was present during scans at the time. However, when dealing with ovarian cancer, there is a high chance of recurrence – 80 percent – despite initial treatment. Most women who are diagnosed with ovarian cancer will respond positively to their first round of treatment and go into remission. However, of that 80 percent, a majority will likely experience a recurrence, meaning their cancer will come back.

“With ovarian cancer, the standard of care is a very, very effective chemotherapy,” gynecologic oncologist at Arizona Oncology Dr. Dana Chase tells SurvivorNet.

“Meaning we give you chemotherapy when you first have your diagnosis of ovarian cancer– 80% chance that you go into remission. So, 80%, I consider pretty good for cancer therapy,” Dr. Chase adds.

It should be noted that Evert carries the BRCA gene mutation, which enhances your chances of developing breast and ovarian cancer.

In an earlier interview with SurvivorNet, Dr. Rebecca Arend, an associate scientist at the University of Alabama-Birmingham, explained the BRCA mutations. “A BRCA mutation is a defect in your ability to repair a double-strand break. If you think about DNA as a double helix, which we’ve all learned about in basic science, if you have a single-strand break, a PARP enzyme is needed to repair that single-strand break. If you have a PARP inhibitor, you can’t repair that single-strand break,” she says.

Dr. Arend continues, “And if you have a single-strand break that’s not repaired, that actually leads to a double-strand break. So, when both of the arms of the DNA helix are broken, then your body has normal mechanisms for repairing that. One of them is called homologous recombination.”

WATCH: Understanding the BRCA Mutation

She explains how this is the body’s normal way of repairing a break. “But if you have a BRCA mutation, you actually cannot repair that break.”

With knowledge of BRCA mutations elevating her cancer risk, Evert received a preventative hysterectomy in 2021 and then underwent a preventive double mastectomy a year later to reduce her cancer risk. A double mastectomy, which is the removal of both breasts, significantly reduced her chances of developing the disease.

RELATED: Is a Preventive Mastectomy Right for Me?

“A double mastectomy typically takes about two hours for the cancer part of the operation, the removing of the tissue,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, tells SurvivorNet. “The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”

Coping with Ovarian Cancer Recurrence

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.

WATCH: Coping with Recurrence.

“Unfortunately, for about 85% of patients, the disease will come back,” says Dr. Kimberly Resnick, gynecologic oncologist at MetroHealth in Cleveland. “For the majority of ovarian cancer patients, their course with ovarian cancer is going to look like a wave, meaning there will be times when the disease rises and when it has to be treated. And then there will be times when they’re in the valley when they’re in remission.”

A CA-125 test is a measurement of a specific type of cancer antigen, a protein that is found in everyone’s blood. High levels of CA-125 in an ovarian cancer patient can often be a biomarker, a warning signal for your doctor that the cancer may have returned. Monitoring CA-125 is considered one of the best ways to track cancer recurrence, so it’s important for women who are in remission to stay on top of their follow-up appointments so their doctor can spot a recurrence as early as possible.

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.

Treatment Options for Ovarian Cancer that Comes Back

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 have very different ways of combatting cancer cells. 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.

WATCH: Ovarian Cancer Treatment Options

“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 providing 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 conjugate 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 actually kills the tumor cells, by affecting the tumor cells 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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