Wednesday, November 13, 2019

All About PARPS

Over the past few weeks many questions about PARP inhibitor use in the treatment ( front line, recurrent and maintenance) therapies for Ovarian Cancer were asked in many of the  private online groups that I participate in.  I can understand the questions and confusion because of the different PARPs available for women diagnosed with ovarian cancer - Olaparib ( Lynparza) , Niraparib ( Zejula) and Rucaparib (Rubraca) and their uses. 

In this blog post I will describe what a PARP inhibitor is, and provide all the FDA approval information and a few articles that compare the different types.

Let's start with this definition provided by the NCI.

PARP inhibitor
"A substance that blocks an enzyme in cells called PARP. PARP helps repair DNA when it becomes damaged. DNA damage may be caused by many things, including exposure to UV light, radiation, certain anticancer drugs, or other substances in the environment. In cancer treatment, blocking PARP may help keep cancer cells from repairing their damaged DNA, causing them to die. PARP inhibitors are a type of targeted therapy. Also called poly (ADP-ribose) polymerase inhibitor."

I'm more a visual person so here is a video by Dana Farber that you might find helpful.




Now lets look at each PARP and when , who and why it was approved. The FDA pages include references to the clinical trials that the approval was based on. Remember there are still clinical trials enrolling that may use a PARP in combination with other treatments. 

Olaparib:Lynparza

2014 
FDA Approval Summary: Olaparib Monotherapy in Patients with Deleterious Germline BRCA-Mutated Advanced Ovarian Cancer Treated with Three or More Lines of Chemotherapy. https://www.ncbi.nlm.nih.gov/pubmed/26187614

2017
On Aug. 17, 2017, the U.S. Food and Drug Administration granted regular approval to olaparib tablets (Lynparza, AstraZeneca) for the maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer, who are in a complete or partial response to platinum-based chemotherapy.
 https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-olaparib-tablets-maintenance-treatment-ovarian-cancer

Prescribing info
https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/208558s000lbl.pdf

Niraparib:ZEJULA

2017
On March 27, 2017 , the U.S. Food and Drug Administration approved niraparib (ZEJULA, Tesaro, Inc.), a poly ADP-ribose polymerase (PARP) inhibitor, for the maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in complete or partial response to platinum-based chemotherapy.
https://www.fda.gov/drugs/resources-information-approved-drugs/niraparib-zejula

Here is additional information from an article in the AACR Journal
https://clincancerres.aacrjournals.org/content/24/17/4066

2019
On October 23, 2019,the Food and Drug Administration approved niraparib (ZEJULA, Tesaro, Inc.) for patients with advanced ovarian, fallopian tube, or primary peritoneal cancer treated with three or more prior chemotherapy regimens and whose cancer is associated with homologous recombination deficiency (HRD)-positive status. HRD is defined by either a deleterious or suspected deleterious BRCA mutation, or genomic instability in patients with disease progression greater than six months after response to the last platinum-based chemotherapy.
https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-niraparib-hrd-positive-advanced-ovarian-cancer

Rucaparib: Rubraca

2016
On December 19, 2016, the U.S. Food and Drug Administration granted accelerated approval to rucaparib (RUBRACA, Clovis Oncology Inc.) for treatment of patients with deleterious BRCA mutation (germline and/or somatic) associated advanced ovarian cancer who have been treated with two or more chemotherapies.

2018
On April 6, 2018, the Food and Drug Administration approved rucaparib (Rubraca®, Clovis Oncology Inc.), a poly ADP-ribose polymerase (PARP) inhibitor, for the maintenance treatment of recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in a complete or partial response to platinum-based chemotherapy.
https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-rucaparib-maintenance-treatment-recurrent-ovarian-fallopian-tube-or-primary-peritoneal

This NCI  blog post PARP Inhibitors as Show Promis as Initial Treatment for Ovarian Cancer pulls together the use of PARPs for initial treatment.
https://www.cancer.gov/news-events/cancer-currents-blog/2019/parp-inhibitors-ovarian-cancer-initial-treatment

While this 30 minute webinar is geared toward medical professionals, it provides an overview of all three PARP inhibitors and their use.

If you have other resources you would like to share on PARP inhibitors please leave a link the the comment section and I will update this page.

Dee
Every Day is a Blessing! 

Tuesday, October 15, 2019

A Multitude of Feelings

September came to an end at here we are at almost the midpoint of October. I had been thinking about this post for quite a long time now but was unsure of how to even begin.

In a book I was reading by Elizabeth Berg one of the characters stated she had a multitude of feelings and I thought to myself that is just what I need to call my post about September.

September brings a multitude of feelings to me. I love the Fall so the crisp cooler air is wonderful.  The September of 2005 I was just getting my head around being diagnosed with stage 3b ovarian cancer. I was in 2nd / 3rd cycle of chemotherapy and I remember the windows being open and hearing kids outside playing while I rested.

September also brings out the teal ribbons and walks and other events to raise awareness of ovarian cancer. I have seen an increase in the number of buildings that turn teal so many times during September and that makes me happy.

 At one event I to took part in I told a story about how the support group at my cancer center started and I felt proud to be a part of exactly the type of support other women diagnosed with ovarian cancer need. I was so happy to talk about my gyn oncs who spearheaded my advocacy work by pointing me toward the LiveSTRONG organization.  But during the talk I also mentioned my sister who died from breast cancer in 1995. Right as I said those words I knew I was tearing up.  I had to stop take a big deep breath and continue. Yes,  all these years later I still miss picking up the phone and talking to her.

At the final KOH walk, while walking along the Jersey shore boardwalk I was overwhelmed by the fact that here it was 2019 and I was alive. I had beat the odds and in the 35% of women diagnosed with late stage ovarian cancer who lived 5 years. And I felt grateful for my family and friends and especially my "teal sisters"  who walk this cancer journey with me. They understand how years later I can still be anxious and even scared when I need bloodwork or have a doctor visit. Sure I deal with neuropathy , digestive issues and chemo brain but gosh darn it I am still here!

I was glad going into the last event a fundraiser to support research in Ovarian Cancer at my cancer center. This one was run by my friends at Graceful Hope Foundation. Seeing the support and old friends was wonderful. But there is always that time during the dinner when we have to remember those women who died due to ovarian cancer . And they mentioned Dawn. And it hit me again I shook my head up and down and teared up as I thought we lost yet another wonderful mother , sister and friend . It is sad to think back to all the women brought together by this disease who were my friends -  Gail, Lois, Patty, Sharon, Pam, Rita Kay, Carole, Janice, Corinne, Linda Ellen, Jayne and many more.

Even after so many years I experience a multitude of feelings in September.

Dee
Every Day is a Blessing!

Tuesday, October 1, 2019

ASCO Advocacy Summit

I am a patient advocate member of ASCO and last week I joined oncologists and members of ASCO in Washington, DC as part of the ASCO Advocacy Summit. We had training  sessions on Wednesday and on Thursday we visited our Senators and members of the House of Representatives.
ASCO On the Hill.

I was paired with Dr Charles Miller from Hawaii so we visited the offices of both NJ and Hawaii legislators.

Visiting with Congressman Case (Hawaii)
The bills we asked our legislators to support:
HR 913 Clinical Treatment Act - We stressed the importance of participation by Medicaid patients in clinical trials and the stumbling blocks to participation they currently experience. Meidcaid insures one-fifth of the US population. Yet only 12 states currently allow Medicaid coverage of clinical trial routine care. In those states that cover clinical trials there has been a minimal effect on overall care costs. We asked that patients on Medicaid receive coverage for routine care when enrolled in a clinical trial.

HR 3107  Improving Senior Timely Access to Care Act - Seniors on Medicare Advantage plans are  experiencing delays in  medically necessary testing and treatment due to slow prior authorization policies. Denials are sent without explanations of the determination. We asked that a uniform e- authorization be created for Seniors on these plans and that an explanation of denial be provided so that timely access to care can take place.

HR 2279 / S 2546 Safe Step Act -  Step therapy protocols requires patients to try and fail medications suggested by the payer before the medication prescribed by the doctor can be used Allowing this process in cancer care would delay access to the best treatment for cancer patients and also increase side effects and reduce quality of life. I was happy to learn that Rep Bonnie Watson Coleman (NJ)  has already co-sponsored the House Bill. 

While I did not speak to Senators Booker, Menendez or Congresswoman Watson Coleman in person their aides were very interested in hearing how these bills would effect the people in New Jersey.

You may not be able to travel to DC to speak to your legislators but if any of these bills are important to you it is easy to reach out to your Senators or Congressmen via e-mail or phone and ask them to support the bills that are important to you.

Thank you ASCO for allowing me to be the voice of cancer patients in NJ.

Dee
Every Day is a Blessing! 




Tuesday, September 17, 2019

You Need to Know That...

An estimated 22,530 women will be diagnosed in the U. S. in 2019 
An estimated 13,980 women will die from the disease in 2019. 

There is no screening test for ovarian cancer.

There are symptoms:
Bloating, 
Feeling Full quickly, 
Frequent Urination, 
Abdominal/ Pelvic Pain, 
Fatigue

A women's risk of ovarian cancer in the U.S. is 1 in 7. 

The risks to develop ovarian cancer are :
Middle age or older ( half of the women diagnosed are over 63 yrs.)
BRCA mutation or Lynch Syndrome
Eastern European or Ashkenazi Jewish 
Have endometriosis
Never gave birth



Sources: CDC, American Cancer Society , OCRA

I hope you will consider sharing this information and donating to support ovarian cancer research. Thanks! 

Dee
Every day is a Blessing!

Wednesday, August 28, 2019

What Will You Do During Ovarian Cancer Awareness Month?

September is right around the corner.

Did you know that September is Gyn Cancer Awareness Month in the US? Gynecologic cancers include Ovarian  Cervical, Vaginal, Vulvar, Endometrial/Uterine, Primary Peritoneal and Fallopian Tube cancers.

During September things can get really busy as the number of awareness events increases exponentially.

On Wednesday, September 11th the #gyncsm community, which I co-founded with Christina Lizaso, will celebrate the community's 6th Anniversary. Our topic will be The Breast and Ovarian Cancer Connection. Join us and a representative from the National Society of Genetic Counselors at 9pm Eastern Time.

This year there are a number of awareness and fundraising events in NJ that you can participate in.

I already mentioned the Rutgers Cancer Institute of New Jersey Patient Education event on September 12thin the previous blog post. Check it out here.

There is an Education event sponsored by Summit Medical Group on September 7, 2019. For more info and to register  call 908-277-8889 or sign up online at: summitmedicalgroup.com/events 
 

 As for walks I will be doing the Kaleidoscope of Hope Ovarian Cancer Foundations walk in Bradley Beach on September 28, 2019. They also hold a walk in Morristown ( Sept. 15) and Lyndhurst (Sept. 22) . Check their website ( https://kohnj.org/funded-research/) for research they have supported.
If you would like to donate to the walk please visit https://www.classy.org/fundraiser/2226659

The NJ Chapter of NOCC is joining the Downtown West Orange Alliance for the  Mayor's 5 K and Walk. You can find more information at http://ovarian.org/component/events/event/955

The Teal Tea is holding Falling For Teal Fashion Show on Sept 22nd. You may find more info at https://www.tealtea.org/event-falling-for-teal-fashion-show .

Graceful Hope will be holding their 6th Annual benefit dinner to benefit Rutgers Cancer Institute of NJ in Elizabeth on September 28th. See their Facebook page for more information. https://www.facebook.com/GRACEfulHope/

For my Central and South Jersey Friends , the Sandy Rollman Foundation is holding a number of events in September including an Ovarian Cancer Awareness night at the Phillies (9/12) , a General Hospital Philly events (9/14) and OvaryAct Gala (9/20). Please check their website for more information ( https://sandyovarian.org/ ).

Of course you can help raise awareness by hanging teal ribbons. See the Turn the Towns Teal website for how you can help ( https://www.turnthetownsteal.org/ ).

If you are holding an event in NJ to raise awareness or funds for research . Please let me know and I will update this post.

Dee
Every Day is a Blessing!

Monday, August 12, 2019

Gyn Cancer Education Session - Sept 12, 2019 , NJ

I am honored to have been asked to speak at this patient education program on Gynecologic Cancer Awareness on September 12, 2019. The program is free and dinner is included. See graphic for information on how to complete the required registration.

I hope to see some familiar faces in the crowd.

Dee
Every Day is a Blessing!

Sunday, August 11, 2019

Blog Hop Challenge

A cancer advocate I admire, Nancy Stordahl, writes the blog Nancy's Point about breast cancer and loss. Every summer she holds a blog challenge. This year it is a blog hop challenge.

From Linky Tools : "What is a blog hop?
A blog hop is a linky list that is SHARED ON MULTIPLE BLOGS. When several blogs put the same linky list code on their blog, the exact same list appears on each blog. Blog readers see the same list on each blog, and can "HOP" from blog to blog seeing the same list of links to follow: BLOG HOP!"


 I am up for the challenge so here goes:

2019 Blog Hop Challenge Questions
1.  Who are you? If applicable, share anything you want about your cancer (type, stage, when diagnosed, whatever.) Share something about yourself such as where you live, the name of your blog and it’s “mission” (no links here, though, or you might end up in spam), a challenge you have faced or are facing now, or whatever you want.
I am an ovarian cancer survivor and research advocate. I have been writing this blog since 2007 not as frequently as I did in the beginning but I try my best to stay on top of new research developments and share them and other news with my followers. I love dogs and painting.   

2.  Have you ever participated in a blog hop before?
Nope, first timer. 

3.  What’s your favorite sort of blog post to write and/or read – personal story, informational, how to, controversial, political, opinion, rant or other?
I like to read personal stories and informational blogs especially about new research like CAR-T and new screening tests.

4.  Describe yourself in three words. Yes, just three!
organized, kind, resilient 

5.  Name three of your favorite books from your youth (whatever age that means to you.) that had an impact on you.
Cheaper by the Dozen, Call of the Wild, Island of the Blue Dolphins 


6.  What are you reading right now, or what’s on your to-read list for when you have time?
 Memory Man BaldacciI have about 20 books on my to read list on Goodreads.

7.  What’s your favorite dessert of all time?
Cannoli 


8.  Tell us about a special pet you have, had, or would like to have. (Never wanted a pet, that’s okay too.)
Amber,  an awesome All-American dog . She loves to jump and do agility.

 9.  What’s something people don’t know about you and might be surprised to learn?
 I wanted to be an astronaut when I was in high school.  

10.  Do you believe healthcare is a privilege or a right?
Most certainly it is a Right.

11.  What’s your favorite thing about blogging and/or reading blogs?
Being able to share information about cancer and the emotions I have experienced as an ovarian cancer survivor.

12.  What’s something you really suck at?
card games

13.  What’s something you’re pretty good at?
baking

14.  How do you escape from cancer (or life in general) worries?
Reading, painting landscapes and animals, spending time with my family and dog.


Thanks for reading!

Dee
Every Day is a Blessing