New FDA Approved Drug for Ovarian Cancer Recurrence - Impact on Patients

On November 14, 2022 the FDA granted accelerated approval of mirvetuximab soravtansine-gynx (Elahere, ImmunoGen, Inc.) and antibody drug conjugate. (https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-mirvetuximab-soravtansine-gynx-fra-positive-platinum-resistant) . Women who have received one to three prior treatments and have folate receptor alpha (FRα) positive, platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer can receive the drug. The FDA also approved the companion assay device (VENTANA FOLR1 (FOLR-2.1) RxDx Assay ) for determining folate receptor alpha (FRα). The device is made by Ventana Medical Systems, Inc.

The approval was based on the results of the SORAYA Study NCT04296890), a single-arm trial of 106 women who had up to three other treatments and also received bevacizumab. Patients who had ocular, corneal, grade 1 neuropathy or lung infection issues were excluded. The Overall Response Rate (ORR) was 31.7% and median Duration of  Response (DOR) was 6.9 months. 

Women who are given the drug will receive a dose of 6 mg/kg adjusted ideal body weight every 3 weeks by IV. I wondered what adjusted ideal body weight was, so  I found this formula for calculating it. Adjusted body weight(ABW) = Ideal Body Weight(IBW)  + 0.25 * (ABW - IBW)                         Source: (https://pubmed.ncbi.nlm.nih.gov/22836946/)

Some side effects women in the study experienced included vision impairment, fatigue, nausea, abdominal pain, peripheral neuropathy, diarrhea, decreased albumin, constipation, dry eye, decreased magnesium, etc. There is a warning for ocular toxicity. You may learn more at https://ascopost.com/issues/december-10-2022/fda-grants-accelerated-approval-to-mirvetuximab-soravtansine-gynx-for-fr-positive-platinum-resistant-epithelial-ovarian-fallopian-tube-or-peritoneal-cancer/ .

 I often wondered how fast drug approval translates into actual use in the clinic. It has been one month since the approval took place. The following is anecdotal information but I thought it was interesting enough to share. In that one month's time,  I have offered peer support to three women dealing with recurrent ovarian cancer. Two of those women brought up to me that their oncologists told them about the new drug "with the very long name". It seems like no one called it , Elahere. One has been already tested to see if she was folate receptor alpha (FRα) positive. One was told about it but will continue with her current treatment which is going well for her. But she was happy to have another option  for the future. One did not mention the new drug during our conversation. 

In the ASCO Post Article noted above Ursula A. Matulonis, MD, Chief of the Division of Gynecologic Oncology and the Brock-Wilson Family Chair at Dana-Farber Cancer Institute and co-leader of the SORAYA study stated “There have been no approved therapies for platinum resistant ovarian cancer since 2014, so [this] action by the FDA is a very significant milestone.”  I agree and I am happy to see how quickly oncologists are sharing the information about the drug with the patients. 

 

Dee

Every Day is a Blessing!

 

 

 

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.

https://www.fda.gov/drugs/resources-information-approved-drugs/rucaparib

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! 

Last Research News of 2016 - Rubraca and FoundationFocus™ CDxBRCA

Another FDA approval for an ovarian cancer treatment happened this week.

"Rubraca is approved for women with advanced ovarian cancer who have been treated with two or more chemotherapies and whose tumors have a specific gene mutation (deleterious BRCA) as identified by an FDA-approved companion diagnostic test." - FDA (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm533873.htm)

Rubraca (rucaparib) is a PARP (poly ADP-ribose polymerase)  inhibitor made by Clovis Oncology. The approval is based on two trials. One of the trials is the ARIEL2 trial. In that trial the duration of response was 11.6 months. 

Along with Rubraca, the FDA also approved the  FoundationFocus™ CDxBRCA companion diagnostic to identify those women diagnosed with ovarian cancer who have a BRCA mutation.  This is the first next-generation-sequencing (NGS)-based companion diagnostic approved by the FDA. The test by Foundation Medicine, Inc.  can test for both germline and somatic BRCA mutations in tumor tissue. Germline are inherited mutations and somatic are acquired mutations. 

 

Sources :

Cure Today: http://www.curetoday.com/articles/rubraca-approved-for-advanced-ovarian-cancer?utm_source=Informz&utm_medium=Cure+Today&utm_campaign=CURE_Breaking_News_12-19-16#undefined.uxfs

Street Insider : http://www.streetinsider.com/Corporate+News/Foundation+Medicine+(FMI)+Announces+FDA+Approval+of+FoundationFocus,+Companion+Diagnostic+for+Rubraca/12356799.html 

Dee

Every Day is a Blessing! 

Staging Ovarian Cancer

Staging determines where the ovarian cancer is found in a women's body. Most ovarian cancers are staged during surgery when tissue samples are taken and examined. But cancers that have spread may be staged using biopsy and CT scans. The stage of your ovarian cancer will be used to determine the best treatments for you. 

Gynecologic oncologists / surgical oncologists use the FIGO scale while staging. Here are the main stages:

Stage I: Tumor confined to the ovary or fallopian tube.

Stage II: The cancer is in one or both ovaries or fallopian tubes and has spread to other organs (such as the uterus, fallopian tubes, bladder, the sigmoid colon, or the rectum) within the pelvis. It has not spread to lymph nodes or distant sites.

Stage III: The cancer is in one or both ovaries. And may have spread beyond the pelvis into the lining of the abdomen and/or has spread to lymph nodes in the back of the abdomen

Stage IV: The cancer has spread to the inside of the spleen, liver, lungs, or other organs located outside the peritoneal cavity. This is known as distant metastasis.

For complete staging please see this SGO FIGO staging document : 
https://www.sgo.org/wp-content/uploads/2012/09/FIGO-Ovarian-Cancer-Staging_1.10.14.pdf
or 
the ACS web page: http://www.cancer.org/cancer/ovariancancer/detailedguide/ovarian-cancer-staging

The tissue / fluid from the staging process is examined by a pathologist for type (Histologic type) and grade.  He/she will describe the cancer as Grade 1, 2 or 3. Grade 1 ovarian cancer tissue is most like ovarian tissue while Grade 3 is irregular and more likely to  metastasize. For ovarian cancer you may hear the terms "Low grade"  or "High grade" to describe your tissue.
(Source:

http://www.ocrf.org/about-ovarian-cancer/treatment-of-ovarian-cancer/staging-and-grading)

Recurrent ovarian cancer: The cancer has come back after it has been treated. It may appear in other parts of the body, but it is still ovarian cancer.

Dee
Every Day is a Blessing!

OC News : Bevacizumab, Rucaparib, Trebananib

During the past few weeks there have been a number of developments in Ovarian Cancer  treatment and research in the news. Below are my top three picks.

Bevacizumab (Avastin) for Recurrent Ovarian Cancer

The FDA approved Avastin, a VEGF inhibitor made by Genentech, for treatment of persistent, recurrent or late stage Ovarian Cancer. Avastin can be used with paclitaxel, pegylated liposomal doxorubicin or topotecan chemotherapy.
FDA announce may be found here. 
Genentech Press Release and results of the Phase III AURELIA study can be found here.

6th EORTC-NCI-AACR  Symposium on Molecular Targets and Cancer Therapeutics in Barcelona, Spain News

Researchers identified a biomarker that can predict which women will respond to rucaparib, a PARP inhibitor. Rucaparib is an oral drug. Dr Elizabeth Swisher said "good responses to rucaparib in women with ovarian cancers exhibiting a form of cell damage called genomic loss of heterozygosity (LOH), in which an entire chromosomal region on one copy of the genome is lost" as well as in those who have BRCA1/2 mutations. (http://www.medicalnewstoday.com/releases/285788.php)

Trebananib Fails to Improve Overall Survival 

The trial, TRINOVA-1, tested  Amgen 's drug, trebananib along with Placitaxel. Results show that there was not a significant improvement in overall survival trebananib was used.
Reuter's article - http://www.reuters.com/article/2014/11/04/us-amgen-study-idUSKBN0IO1EW20141104?feedType=RSSfeedName=healthNews


Dee
Every Day is a Blessing !

Scars

Recently the #bcsm community discussed the invisible scars of breast cancer. It was an interesting and fast paced chat on Twitter. Later one survivor described her scars in a blog posted on Nancy’s Point  http://nancyspoint.com/breast-cancer-is-a-string-of-losses/ . I tweeted that gyn cancer survivors have invisible scars too and then decided to write about it here. 

Scars can be both visible and invisible. I have a number of visible scars. I have a scar on my neck from thyroid surgery in 1982. From my initial hysterectomy and debulking surgery in 2005, I have an eight inch vertical scar that begins at my belly button. From my liver resection and spleenectomy in 2008, I have two scars. One that travels 10 inches horizontally across my abdomen below my rib cage and another 4 inch vertical scar that meets up with the scar from my hysterectomy.The scars together have the shape of a capital letter T. 

These scars are starting to fade since my last surgery. But harder to fade are the scars that are invisible to others.These scars are very individual just as every woman diagnosed with ovarian cancer has a similar but different journey with the disease. Some of these scars can be physically painful while others can be emotionally painful. 

My first invisible scar is the neuropathy in my toes. Sometimes my toes are numb and sometimes my toes feel as if someone is sticking a knife into them. No one can tell when my toes are  bothering me but me, unless of course you have caught me taking off my shoe and rubbed my toes. 

I have trouble remembering the names of everyday things. Instead, I describe what it is I am talking about. I have written about this happening a few times in this blog. I read things and reread things and reread things again. I write entries for this blog and leave blank spaces because I can’t remember specific words. It takes me multiple tries to write what it is I want to say. ( Three days to draft, reread, rewrite this entry.) When I give talks I write the speech and then practice it over and over again. I am happy when my family can tell me the word I am missing and help me out.  But at times not remembering has brought me to tears.  I am sure that the invisible scar of chemobrain as survivors call it or cognitive impairtment as professionals call it  is due to the life-saving 16 chemotherapy treatments that have put me in remission. 

Instant menopause has brought it’s own set of invisible scars. Sure I was 50 and not having another child when my ovaries, uterus etc were removed but that doesn’t mean  the physical changes that have occurred due to the surgery are any less painful. Some women in their 20s and 30s are dealing with loosing their fertility. Some of us are experiencing hot flashes sooner than expected and some of us are dealing with issues that are difficult to talk about even with our physicians. 

Then there is the invisible scar due to worrying about a recurrence or waiting for the other shoe to drop. This scar is invisible to others most of the time. It is my own personal worry. Is that gas or bloating? Is that pain under my ribs from scar tissue or is It back? Why am I urinating more frequently? Most times I can talk myself back from the edge by telling myself that I have a plan which includes seeing my doctor frequently enough that if It does come back we will treat It quickly. Sometimes this scar does become visible as “scanxiety”. I am not a pleasant person to be around when it comes time to have a CA-125 blood test or a CT scan. Until the results are in and I get the all clear for 4 more months I am a nervous Nellie. 

I also have an invisible scar from loss. Being in the club of ovarian cancer survivors automatically brings along with it loss.  Support groups and involvement in local ovarian cancer organizations has afforded me the opportunity to share this journey with some pretty incredible women. We have helped each other along the way with hugs, phones calls, e-mails and laughs. But along with this joy there is the pain of their loss. Every death takes it toll. Would I rather to have never met these woman? No not at all. It was wonderful having them in my life. 

Those around us may think that since we aren’t in active treatment cancer no longer impacts our lives. But for those of us living with a cancer diagnosis and treatment may be sad or scared or nervous long after. We may put on a happy face to our family or friends because we don't want them to worry. Sometimes we can deal with these scars ourselves and sometimes we need help from support groups, social workers or therapists. We are not weak when we reach out for help  but rather we are exhibiting strength in recognizing these invisible scars. 

Dee 

Every Day is a Blessing! 

ASCO from a Distance Part II

I continue to work my way through the ASCO Annual meeting abstracts and news reports. These might be of interest to my readers.

A randomized multicenter phase III study comparing weekly versus every 3 weeks carboplatin (C) plus paclitaxel (P) in patients with advanced ovarian cancer (AOC): Multicenter Italian Trials in Ovarian Cancer (MITO-7) -- European Network of Gynaecological Oncological Trial Groups (ENGOT-ov-10) and Gynecologic Cancer Intergroup (GCIG) trial"
The standard chemotherapy for ovarian cancer is carboplatin(C) and paclitaxel(P) every three weeks. This study compared that standard treatment plan with weekly C & P at lower doses. There were 822 women in the study. The study concluded " Compared to standard CP every 3 weeks, weekly CP did not demonstrate a significant benefit in PFS, but was associated with better QoL and toxicity. " (QoL - quality of life PFS Progression free survival)
I had the standard 3 week C&P when I was first diagnosed. If the weekly treatment were to be offered to me today I think I would choose the extra infusion visits for the better quality of life, less fatigue, neutropenia, low platelets etc.

Phase II study of trabectedin in pretreated patients with recurrent epithelial ovarian cancer (REOC). 
This non-randomized study of 16 women examined the use of single agent Trabectedin in women with recurrent ovarian cancer. Trabectedin is also known as Yondelis and is an agent derived from the sea squirt. It works by cleaving DNA of the tumor cells and cause them to die. It is approved in Europe for soft tissue tumors in platinum sensitive women. Women were given dexamethasone prior to the Trabectedin to reduce toxicity. Although there were no complete responses there were partial responses and stable disease reported. The conclusion was:  "Trabectedin 1.1mg/m2 given as a 3-hour i.v. infusion every 3 weeks was well tolerated and has confirmed a very interesting antitumor activity in this heavily pretreated population and it seems also to be a very tolerable regimen. The co-treatment with dexamethasone improves the safety of Trabectedin by reducing drug-induced myelosuppression and hepatotoxicity. Trabectedin has a manageable toxicity profile, and can be safely administered thanks to its secure action profile also in patients with no other viable therapeutic options.  " Trabectedin was tested with Doxil but was rejected by the FDA due to liver toxicity. I wonder if other drugs combined with Trabectedin or the use of dexamethosone would help move this agent down the  path to approval for recurrent ovarian cancer. 

Here is some interesting research on the psychosocial issues facinc adult vs childhood survivors. 

Psychosocial health in survivors of adult versus childhood cancer. 
This study compared depression, anxiety, post traumatic stress disorder etc in adult and child cancer survivors. They concluded "Survivors of adult onset cancer face a significantly higher amount of psychologic distress, particularly depressive and somatic symptoms, compared to their childhood counterparts and age-expected norms. Analyses are ongoing to evaluate other demographic, disease, and treatment related risk factors that may contribute to this age-related phenomenon in order to develop interventions."I wonder if they will look at the fact that most adults have financial/ work issues to increase their stress.

Dee
Every Day is a Blessing! 

ASCO from a Distance

I've attended the ASCO Annual meeting in person for the past two years. This year I observed from a distance checking on the latest ovarian Cancer news by following ASCO post on Facebook, Tweets by those I follow and the Daily news e-mail. I also checked the online listing of abstracts for ovarian cancer. I've put together a few abstracts I found most interesting.


Randomized, double-blind, phase III trial of pazopanib versus placebo in women who have not progressed after first-line chemotherapy for advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer (AEOC): Results of an international Intergroup trial (AGO-OVAR16).
Pazopanib is a multikinase inhibitor and an oral formulation. The 940 patients in the randomized trial were initially diagnosed Stage III or IV and had 5 or more cycles of platinum- taxane chemotherapy. Women who took the pazaponib had an average  Progression Free Survival (PFS) of 5.6 months longer than women give a placebo. Patients did experience some adverse reactions. The Study concluded"Conclusions: Pazopanib maintenance therapy provided a statistically significant and clinically meaningful PFS benefit in patients with AEOC; OS data are not mature. The safety profile of pazopanib in this setting was consistent with its established profile. Clinical trial information: NCT00866697. "

My thoughts: Will the overall survival (OS) for the women in the pazopanib arm correlate to the PFS time? Will OS be 5 months? longer? shorter?
note:After reading a Medpage article and comments, I learned that the 800 mg pill taken daily cost $54 each.

Chemotherapy or upfront surgery for newly diagnosed advanced ovarian cancer: Results from the MRC CHORUS trial 

The first treatment for Ovarian Cancer is normally Primary surgery( PS)  followed by adjuvant platinum-taxane chemotherapy(P-CT). This study compared survival rates for PS/ P-CT versus neoadjuvant chemotherapy (NACT) where chemo is given first and then surgery occurs after there is tumor shrinkage. There were 550 women in the study. The median OS was 22.8 months for PS vs 24.5 months for NACT. They study concluded " NACT was associated with increased optimal debulking, less early mortality and similar survival in this poor prognosis group. CHORUS results are consistent with EORTC55971 and strengthen evidence that NACT is a viable alternative to PS. Clinical trial information: ISRCTN74802813"

My thoughts: Knowing that there are no issues with NACT is important information for doctors to have when they are deciding what is best for their patients.

Comparative effectiveness of treatments for recurrent ovarian cancer.
In the past recurrent OC has been treated with chemotherapy but in some cases secondary cytoreductive surgery has been done (SCS). This study compared survival between chemotherapy vs SCS vs both or neither. There were 1623 women in the study. "Conclusions: Patients with recurrent ovarian cancer treated with both secondary surgery and chemotherapy survive longer than patients treated with either chemotherapy or surgery. Women who are Black, or older at time of recurrence have worse survival. "

My Thoughts:After reading this abstract I am happy I  chose SCS followed by chemotherapy when I recurred in 2008.

I with continue to read through the abstracts and will share more of my favorites in the future.

Dee
Every Day is a Blessing!

Metastasis

I 've been thinking a lot about cancer metastasis and women with metastatic breast and recurrent ovarian cancer.

First, the definition of metastasis is

me·tas·ta·sis

   [muh-tas-tuh-sis] 

noun, plural me·tas·ta·ses  [-seez] 

1.

Pathology .

a.

the transference of disease-producing organisms or of

malignant or cancerous cells to other parts of the body 

by way of the blood or lymphatic vessels or membranous surfaces.

b.

the condition produced by this.

Source: dictionary.com

October is Breast Cancer Awareness month and October 13th is Metastatic Breast Cancer Awareness Day. Some women on twitter, facebook and in blogs  (http://womenwcancer.blogspot.com/, http://chemo-brain.blogspot.com/, http://www.tamiboehmer.com/) are upset with all those pink ribbons, pink products and walks and celebrations of survivors when there are women living with metastatic disease. Women with metastatic breast cancer seem to feel forgotten.

If caught early (Stage 0-II) the five year survival rate  for breast cancer is  74-93%. ( http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-survival-by-stage ) But some women are initially diagnosed with Stage IV disease where the disease has spread through the lymph system to other organs of the body and their five year survival rate is 15%. For other women their cancer returns a few years after diagnosis  and cancer cells are found in their lungs, liver,  bone or brain.  These women are living with the disease and will be in treatment for life. They are metastatic breast cancer survivors.

The number of women diagnosed with ovarian cancer each year is much less than the number  diagnosed with breast cancer  (  226,000 versus 25,000). Big difference.  The survival rates for stage III and stage IV ovarian cancer are 35% and 18% respectively. Not such a big difference with our late stage breast cancer sisters.  There is no screening test for ovarian cancer so  62% of all women diagnosed with the disease are diagnosed late stage.

Here is the thing, statistics show that 70-80% of women diagnosed with late stage ovarian cancer ( disease beyond the ovary)  will recur. Some women will have treatment ( surgery , chemotherapy, radiation) and go into  remission. Others never go into remission. These women  live with the disease as a chronic illness, they will be in treatment for life. I know a number of women who are living with the disease today trying new chemotherapies and entering clinical trials. And for the rest of us who have recurred once or twice well we worry when our next recurrence will occur. Not so different from our metastatic breast cancer sisters.

I urge breast and ovarian cancer researchers to talk more . Yes I know there are those who research  BRCA 1 & 2 mutations and recent studies with basal cell breast cancer (http://www.genengnews.com/gen-news-highlights/aggressive-breast-cancer-may-respond-to-ovarian-cancer-treatment/81247370/) . But there still may be a clue - a pathway, a gene , a protein as to why our cancer cells function as they do.

And to all those metastatic breast cancer survivors, your recurrent OC sisters are with you on the journey.

Dee
Every Day is a Blessing!




Sources :
http://mbcn.org/
http://www.webmd.com/breast-cancer/features/metastatic-breast-cancer-chronic-condition
http://ovariancancer.jhmi.edu/recurrentqa.cfm
http://www.ovariancancer.org/about-ovarian-cancer/statistics/

OC Awareness #10 - Recurrences

I thought I was doing great back in 2008 . And I was . Until I had my 6month CT scan. My CA-125 was 16 up from 11. A number which is well within the range of a normal result. But the scan showed cancer on my spleen and liver. I had recurred two and a half years after finishing my initial treatment . Eighty percent of women diagnosed with late stage ovarian cancer recur.( Source: http://www.cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/HealthProfessional/page6)

When a recurrence occurs within 6 months of finishing treatment the tumor is said to be refractory and the patient is said to be platinum resistant . When a women recurs after 6 months she is said to be platinum sensitive. The term platinum is used because the standard treatment for the initial diagnosis of ovarian cancer usually involves the use of carboplatin or cisplatin which are platinum chemotherapy drugs. If you are platinum sensitive you will be able to use those platinum drugs again. (Source : http://ovariancancer.jhmi.edu/treatment.cfm)

I already discussed the standard treatment for a majority of late stage ovarian cancers as surgery and then chemotherapy. There are a number of clinical trials looking at chemotherapy then surgery. This allows the oncologist to shrink the tumors before the surgery. The treatment you may be offered when you recur depends on if you are platinum resistant or sensitive you,  the location of the disease,  as well as the number and size of the lesions.

Options for women who have recurred are:
Surgery
Chemotherapy drugs
Biologic / immunotherapy
Clinical trials

In my case, I was considered platinum sensitive and I had many options open to me. I could have surgery then chemo( carbo/taxol) , chemo than surgery, or a clinical trial . This time I chose to have the surgery and then chemo. I had my liver resectioned and spleen removed in November of 2008 and finished chemotherapy April 2009. I have been disease free since then. This plan worked for me but another woman in consultation with her doctor might have chosen a different path for treatment.

There are excellent online resources ( NCI, OCNA  for women who have recurred including these brochures:
Ovarian Cancer Resource Guide for Women with Recurrent Disease- NOCC
The Patient Guide to Living with Ovarian Cancer - The Cancer Support Community ( formerly known as The Wellness Community)

Dee
Every Day is a Blessing!

Research News : OC screening and Secondary Cytoreductive Surgery

Two interesting articles appeared recently in the Oncologist and Cancer Prevention Research .

Impact of Screening Test Performance and Cost on Mortality Reduction and Cost-effectiveness of Multimodal Ovarian Cancer Screening

This study looking at mortality reduction, years of life saved and cost -effectiveness for women who underwent an annual CA-125 and on a rising result underwent a subsequent transvaginal ultrasound . Results showed a  moderate decrease in mortality (13%). The tests were found to meet cost effective guidelines.

The Role of Secondary Cytoreductive Surgery in Patients with Recurrent Epithelial Ovarian, Tubal, and Peritoneal Cancers: A Comparative Effectiveness Analysis

This comparative study showed reported the cytoreductive surgery used to treat  recurrent Ovarian cancer may increase overall survival.

Dee
Every Day is a Blessing!

Secondary Cancers and Recurrent Cancers Do Make Us Worry

It was a busy weekend and I have gathered a number of different ideas for blog posts.  I will begin with some comments prompted by an article in the New York Times Well section. The article by Steven Petrow, a testicular cancer survivor,  was titled "New Cancer Threat Lurks Long After Cure". You can visit here for the entire article.

The article began with a discussion of Robin Roberts latest diagnosis of myelodysplastic syndrome a secondary cancer most likely caused by the breast cancer chemotherapy treatment she was given. I know a number of survivors who have had multiple cancers. And studies have shown that treating cancer with chemotherapy or radiation can lead to other cancers. This is especially true of child or young adult survivors.  But as the article stated with 14 million cancer survivors in the US and since those diagnosed with cancer  are living longer, the threat of a secondary cancer is real.

My concern is not so much for a secondary cancer but like so many ovarian cancer survivors my concern is a recurrence of the same type of cancer. Ovarian cancer is one of those cancers that is, for lack of a better word, is notorious for coming back. I have had one recurrence already in 2008, two and a half years after finishing treatment for stage III B ovarian cancer. My CA-125 was normal and it was a CT scan that picked up the growths on my liver and spleen. Do I worry that it might recur again?  Nope. Honestly? Yes, I do. Do I think about it all the time? No.  I've learned over the years, a number of good techniques to get me through those tough times. My Gyn-Onc and I have put together a good follow-up plan of check-ups and CA-125's and CT's to catch it early.

So do I worry or think about other cancers?  Not too often. Do I have an annual mammogram? Yes, I do . Do I worry about going for a mammogram like I do a CT scan or the CA-125 blood test. No. Not sure why but Breast Cancer does not scare me. If I could handle treatment for ovarian cancer  twice I know I can deal with any treatment breast cancer could require of me. On a good note, I just went for my annual mammogram and it was clear.

Mr Petrow brings up in his article that 58% of cancer survivors suffer from anxiety, stress, depression and post traumatic stress syndrome. I applaud Mr Petrow for bringing that number to light. I was dealing pretty well until the recent loss of a friend's niece and  two wonderful women from my support group within months of each other. Over the years I grew to know these women for more than their cancers but their love of children,  their families , God, and the simple things of life like holding hands. So after 6+ years as a cancer survivor, I needed to find some extra support. And I did. I feel much better and feel I am getting back to normal - another new normal.

So if you are a survivor do not be shy about talking to your physician or nurse about what you need physically and emotionally to make this journey  smoother.


Dee
Every Day is a Blessing!

A Message for Metastatic Breast Cancer Patients

The other day a friend posted a link on Facebook to an article on the Huffington Post. The article was Rethinking Societal Attitudes about People Who Get Cancer by Dr. Joseph Nowinski, a clinical psycologist. I thought the title sounded interesting so I read the article. Then I read it a few more times.

The article begins with a reference to 1978 when Susan Sontag wrote about myths surrounding cancer. Myths such as, we get cancer because we are angry and that diseases can be cured through will power. Then the article goes on to say that even today for some cancer patients, metastatic breast cancer in particular, there is still a social stigma. A stigma even though "cancer is not caused or cured by our personality." It went on to mention a patient with metastatic breast cancer who could not run a support group because it would cause fear in other patients, and who felt isolated because she had not "beaten" breast cancer because maybe she wasn't happy enough. The last paragraph states "perhaps the warrior metaphors we use to describe those whose cancer has been arrested are better replaced with images of possibility and tenacity."

I invite those metastic breast cancer patients to search for an ovarian cancer survivor to talk to. We may fight the battle with different chemotherapies and surgeries but we also know how to live with cancer. Live with not knowing if we will recur. Live with not knowing when we will recur. Live with recurring. Live with remissions - short and long. Live with not knowing if and when we will recur again. Live in constant chemotherapy. That is the life of an ovarian cancer survivor.

My gynecological cancer support group has newly diagnosed women , women currently with no evidence of disease , women in treatment for a recurrence and women in remission after a recurrence. Over the past 4 years we have shared our successes and our setbacks. We don't know why each of us was diagnosed with ovarian cancer but we offer each other support and hope. As one survivor's bracelet says - "Fight like a Girl ".

Metastatic breast cancer survivors you are not alone! There are ovarian cancer survivors with tenacity too!

Dee

Every Day is a Blessing!