Day 19 A Month of Teal: Treatments for Recurrence - Chemotherapy/ targeted therapies

Depending on how your disease presents itself on recurrence you may be offered surgery, chemotherapy or a clinical trial. I was offered surgery and chemotherapy or a clinical trial. A majority of women will have chemotherapy but I strongly urge women to consider a clinical trial.

Below is a list of drugs you may be offered:

Chemotherapy Drugs for Recurrence platinum sensitive:

• Cisplatin or carboplatin + paclitaxel 
• Carboplatin + gemcitabine
• Carboplatin + pegylated liposomal doxorubicin
• Carboplatin + epirubicin
• Cisplatin + doxorubicin + cyclophosphamide  ( recurrence 12+yrs)

Carboplatin and Taxol are considered the standard for first time platinum sensitive recurrence

Chemotherapy Drugs for Recurrence Platinum Resistant

• Paclitaxel
• Topetecan
• Gemcitabine
• Pegylated liposomal doxorubicin
• Pegylated liposomal doxorubicin + trabectedina 
• Etoposide
• Hexamethylmelamine (Altretamine)
• Irinotecan
• Oxaliplatin
• Vinorelbine
• Fluorouracil and capecitabine
• Tamoxifen
• Pemetrexed
• Bevacizumab
• The U.S. Food and Drug Administration has approved the use of bevacizumab ( Avastin)  in combination with pegylated liposomal doxorubicin, paclitaxel, or topotecan.  Two trials OCEANS and AURELIA showed the improvement in PFS ( progression free survival).
• Olaparib (PARP inhibitor)- maintenance (9/12/17 FDA Approval) / after 3 or more chemotherapy treatments and a BRCA mutation (2014 FDA approval)
• Rucaparib ( BRCA mutations, 2 or more chemotherapy treatments, 2016)
• Niraparib(Maintenance therapy BRCA mutation not required)

For additional information about each of these treatments and evidence for their use  please see
https://www.cancer.gov/types/ovarian/hp/ovarian-epithelial-treatment-pdq#link/_789 
https://www.cancer.gov/news-events/cancer-currents-blog/2017/fda-olaparib-ovarian-cancer-maintenance?cid=eb_govdel

or the NCCN guideline page
https://www.nccn.org/patients/guidelines/ovarian/index.html#63/z 

Dee
Every Day is a Blessing ! 

 

 

Ovarian Cancer Treatment: Targeted Therapy

In recent years the FDA has approved a number of targeted therapy drugs for the treatment of ovarian cancer.
"Targeted cancer therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules ("molecular targets") that are involved in the growth, progression, and spread of cancer. "

Some targeted therapies interfere with proteins or receptors in ovarian cancer cells and stop their growth and others will prevent the growth of blood vessels which supply the cancer cell.

Bevacizumab ( Avastin)
"A recombinant humanized monoclonal antibody directed against the vascular endothelial growth factor (VEGF), a pro-angiogenic cytokine. Bevacizumab binds to VEGF and inhibits VEGF receptor binding, thereby preventing the growth and maintenance of tumor blood vessels. "NCI definition

Bevacizumab may be used along with carboplatin and paclitaxel as an option for women with Stage III, IV ovarian cancer as well as for women with a recurrence. ( NCCN guidelines)  

Olaparib (Lynparza)
"A small molecule inhibitor of the nuclear enzyme poly(ADP-ribose) polymerase (PARP) with potential chemosensitizing, radiosensitizing, and antineoplastic activities. Olaparib selectively binds to and inhibits PARP, inhibiting PARP-mediated repair of single strand DNA breaks; PARP inhibition may enhance the cytotoxicity of DNA-damaging agents and may reverse tumor cell chemoresistance and radioresistance. PARP catalyzes post-translational ADP-ribosylation of nuclear proteins and can be activated by single-stranded DNA breaks. "NCI definition


This oral treatment is approved for women with advanced ovarian cancer who have the BRCA1 or BRCA2 mutations and have had 3 prior chemotherapy treatments.

Dee
Every Day is a Blessing!


Sources:
http://www.mdanderson.org/patient-and-cancer-information/cancer-information/cancer-types/ovarian-cancer/treatment/index.html
NCI :http://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet#q1

Sharing my story and thoughts targeted therapies - Inside New Jersey

I was interviewed this spring regarding my experience as a participant in a tumor genomic analysis trial that I took part in last year. The interview was part of an article printed in the "Inside New Jersey" magazine. The title of the article was The Cancer Conundrum: Cases continue to increase, but Treatments and Prognosis are improving. I hope you will take the time to read about the wonderful cancer research taking place in my state. 

Dee
Every Day is a Blessing!

When My Alma Mater and Cancer Center Work Together

In July, Rutgers University, my alma mater, and The Cancer Institute of New Jersey(CINJ) where I have been treated merged. Recently, I have noticed the wonderful collaboration between the doctors/ researchers at CINJ and the professors at Rutgers.

Just the other day I read two articles about that collaboration.

DATA
In Rutgers Today, you will find the article Battling Cancer with Big Data .The article discusses doctors at CINJ collaborating with computer engineers at the Rutgers Discovery Informatics Institute to determine a better way to treat patients with rare cancers and those with poor prognosis.  Manish Parashar is Director of RDI².

“Our team provides the computational engine to review thousands of images, so our      collaborators at the Cancer Institute can analyze these images, search the database, test hypotheses and answer important questions,”Parashar says. “We take the imaged samples and radiology studies from one patient and ask, ’Have I seen a case like this before?’”

Analyzing the data and using matching algorithms can be done in a matter of hours.The team is studying rare pediatric cancers as well as ovarian and pancreatic cancers and sarcomas. A clinical trial is ongoing.

DRUG RESISTANCE
Surviving ovarian cancer: Rutgers scientists attack drug resistant cancer cells presents the research being done by one of my Gynecologic Oncologists, Dr. Lorna Rodriguez and Tamara Minko, professor at Rutgers Ernest Mario School of Pharmacy.  CD44 is a membrane protein which when over expressed causes ovarian cancer metastasis and drug resistance. In their study, which used lab mice, the researchers found that by using small inhibiting RNA molecules to decrease the level of CD44 and the chemotherapy drug paclitaxel  they were able to cause cell death and tumor shrinkage in the mice.
Journal article:

Targeted Nanomedicine for Suppression of CD44 and Simultaneous Cell Death Induction in Ovarian Cancer: An Optimal Delivery of siRNA and Anticancer Drug

I am excited to see what the future of cancer research will look like as my Alma Mater and my cancer center continue to work together.


Dee
Every Day is a Blessing!

OC Awareness Month #8 -Treatments

Today I will review the treatment that a women diagnosed with ovarian cancer might receive. Of course every woman is different so your actual treatment might differ.

*A women diagnosed with ovarian cancer should see a  gynecologic oncologist ( gyn-onc) . Research has shown that women who receive surgery and treatment by a gyn-onc have higher survival rates.

There are different treatments offered to women diagnosed with ovarian cancer. Such as :

Surgery :
Hysterectomy- removal of the uterus and sometimes the cervix
Oopherectomy - removal of the ovaries and fallopian tubes
Oomectomey - removal of the oomentum the fatty covering of the abdomen
Lymph node biopsy-removal of lymph nodes which are examined for cancer

Chemotherapy:
Chemotherapy drugs disrupt the multiplication of cancer cells or kills them outright.The chemotherapy may be give IV, intravenously, where the drug is introduced into a vein or IP , intraperitoneal where the drug is introduced into the peritoneal cavity. Women may receive a combination of two drugs.

The most common drugs given to women with OC are carboplatin, cisplatin and paclitaxel. Additional drugs may be found on this NCI site http://www.cancer.gov/cancertopics/druginfo/ovariancancer.You might also receive targeted therapy , drugs or biologics. Targeted therapy will affect cancer cells but leave normal cells alone.

Radiation:
Radiation may be used to kill cancer cells in some cases of OC. The level depends on the type of OC cancer and stage of the disease.

 Source : http://www.cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/Patient/page4


Tomorrow the stages of ovarian cancer

Dee
Every Day is a Blessing!