If you start really investigating your choices to aggressively treat the ovarian cancer you’re fighting, you are likely to come across Bevacizumab, of which Avastin is the brand name. It is somewhat commonly used as part of a maintenance regimen to keep ovarian cancer in remission, as well as during initial treatment and full blown recurrence.
How Avastin Works
"When you talk about genetic profiling, ovarian cancer is a disease characterized by what we call genomic instability," says Dr. Beth Karlan, gynecologic oncologist at the UCLA Medical Center. “Lots of targets, DNA all gone awry.”
Read MoreThe Drug Lynparza Can Sometimes Be Used With Avastin
The PARP inhibitor Lynparza (olaparib), approved for women newly diagnosed with ovarian cancer and with a germline or somatic mutation in BRCA1/2, can be used in combination with Avastin for women with HRD.
About PARP Inhibitors
A growing number of women diagnosed with epithelial ovarian cancer are eligible for treatment with a class of drugs called PARP inhibitors. PARP inhibitors are options for women as maintenance therapy after first chemotherapy or platinum sensitive recurrence, or as treatment for recurrence. The benefit a woman may see from this class of medication varies greatly, with the biggest determinant being the presence of an inherited or tumor mutation in BRCA.
How PARP Inhibitors Work
One of the key things to know about PARP inhibitors is that your genetic makeup and specific features of your cancer will have a significant impact on how effective these drugs may be. Experts tell SurvivorNet that every woman with ovarian cancer should get a genetic test to determine if they have a mutation called BRCA, because the mutation enables PARP inhibitors to function much more powerfully. Importantly, there is increasing data that even women without BRCA mutations can still derive some benefit from these drugs.
PARP inhibitors interrupt the process of single stranded DNA repair, an essential part of cell replication. Defects in DNA repair ultimately cause cell death. PARP inhibitors work best when there is a second error in DNA repair, such as that caused by a mutation in BRCA. BRCA is a critical player in homologous recombination, a highly effective double stranded DNA repair process. BRCA is not the only important part of homologous recombination, other genes are involved. The label homologous recombination deficient (HRD) indicates a tumor which has one of many possible errors in the double stranded DNA repair process of homologous recombination.
Using PARPs To Treat Recurrence
Unfortunately, too often, ovarian cancer comes back.
For women with ovarian cancer who have had a recurrence and responded to platinum-based chemotherapy, Lynparza, Zejula and another PARP inhibitor called Rubraca (rucaparib) are FDA approved for use as a maintenance therapy, regardless of whether a woman has a BRCA mutation or HRD.
For some women who have had prior chemotherapy treatments, Rubraca, Zejula or Lynparza may also be options. These uses are based on factors such as number of prior therapies and BRCA mutation or HRD.
The different PARP inhibitors do have some varying side effects, which oncologists need to evaluate carefully.
Avastin Side Effects
One of the major side effects of Avastin is high blood pressure, which needs to be monitored very carefully with the administration of the drug in ovarian cancer patients. Karlan says that many women who are treated with Avastin need to start taking hypertension blood pressure medicine.
There are risks when any medicine raises a woman's blood pressure, according to Dr. Karlan. These risks include stroke and bleeding. Dr. Karlan says that if a patient is on Avastin, it is important to take notice of headaches and blurred vision. Sometimes, she says, Avastin can be so effective that it helps shrink the tumors at such an incredible rate and women sometimes wind up with a hole in their bowela fistula or bowel perforation that can require surgery to rectify.
There are other common side effects that can come with Avastin, including inflammation, dried skin, back pain, nosebleeds, rectal bleeding, watery eyes, and taste change. These side effects are also common with other cancer drugs, along with the caution that pregnant or potentially pregnant women should avoid Avastin, as should women undergoing surgery.
Because of the potential side effects and the way certain drugs work, it’s important to think carefully about choosing one’s course of treatment.
"When you decide what is next treatment it's not just a list you go down and check off," explains Dr. Karlan. "It has to be individualized to the status of the tumor and your baseline health and what you're at risk for, to select the best treatment for you."
Avastin’s Other Uses
Avastin can also be used to treat other kinds of cancer including recurrent glioblastoma, metastatic colorectal cancer, advanced nonsquamous non-small cell lung cancer, metastatic renal cell carcinoma, cervical cancer and ovarian cancer.
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