Hope on new treatments for ovarian cancer

In recent years, as part of the rotation in Obstetrics-Gynecology from the Pritzker School of Medicine at the University of Chicago, American female medical students attend an optional seminar at lunchtime, during which ovarian cancer survivors tell the story their cancer will come back.

Last year, listening to women's experiences became a mandatory part of their medical studies. The hope is that by humanizing the disease, this relatively rare cancer will be on the radar of a new generation of doctors and will change the patient's common narrative: "My doctor did not take my symptoms seriously until it's too late. "

"We thought it was important that the students did not become familiar with the biology of ovarian cancer, but we wanted them to know that every patient is an entire person with a story behind them." "said Nita K Lee, oncologist gynecologist at the University of Chicago.

The change of study program in medicine is a sign that the subject of ovarian cancer is taken more seriously.

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This is part of a wave of promising advances, including new research on blood tests to detect early stage disease, new genetic knowledge of dozens of cancer subtypes and new treatments.

This year, in an effort to raise awareness, disease control and prevention centers have beefed up their consumer-focused website on ovarian cancer and have planned to launch television ads.

Compared to other successes, ovarian cancer has always been lacking. It is more deadly and underfunded.

Until recently, the disease had not benefited from new treatments for more than 40 years.

Ovarian cancer was diagnosed in approximately 22,240 US women in 2014 and 14,070 women died in the same year, according to government surveillance data.

The reason: more than three quarters of cases are diagnosed when cancer has progressed and survival rates are low: barely 47% of patients survive at least five years.

This means that, unlike the 3.4 million American breast cancer survivors dressed in pink who form an army of activists in search of money and attention, there are far fewer women with cancer of the ovary – barely 225,000 in the United States – who are close to represent their cause.

Even their signature color – teal – is underestimated.

"Sometimes it's hard to feel like a son-in-law wearing a teal dress," said activist Ellen Engle, a project manager in Potomac, Maryland, who had been diagnosed with breast cancer. Stage 4 ovary four years ago at the age of 47 years.

She is a director of the Ovarian Cancer Support Group on Facebook.

"We hear so many stories of women seeing their symptoms gone," she says. "They are told that they are menopausal or suffering from irritable bowel syndrome."

Engle leaves educational cards warning women against the often overlooked symptoms of ovarian cancer – abdominal bloating, appetite changes, pelvic pressure, lower back pain or frequent urination – in the Women-only bathrooms at airports, fast food establishments and even a recent Elton John concert.

Bobbie Rimel, a gynecologic oncologist at Cedars-Sinai Medical Center in Los Angeles, further explains that women associate persistent symptoms of stomach bloating with gluten or lactose sensitivities that they try to treat.

"I see in my office so many people who let it go for five or six months because they thought they could solve it," she says. "But I get to understand that it's a cancer, and it's really sad."

However, it is not only up to patients and doctors to be more vigilant. The field lacked good diagnostic tools. The most commonly used test, developed in the early 1980s to measure a protein called CA 125, detects only 80% of cases and is subject to false positives as the protein may also increase during menstruation and pregnancy.

It is most effective when it is associated with a transvaginal ultrasound, which can detect an ovarian mass. But as current imaging technology does not determine if this mass is cancerous, women are usually diagnosed after surgery to remove some or all of the ovary.

"I do three to six surgeries for each cancer I discover," says Rimel. "And often, I do not find them early enough to make a difference in patient survival."

In search of a breakthrough in screening that would dramatically improve mortality rates, scientists are looking for clues in women's blood to find out if they detect cancer before it becomes deadly.

In February, researchers at the University of Kansas announced that they had developed an inexpensive method of finding cancer markers in cellular byproducts, called exosomes, in a drop of blood.

Robert Bast, an ovarian cancer researcher at the University of Texas, discovered the CA 125 test and is working on developing a different blood test to measure multiple markers simultaneously and to shave at least one year after the test. when patients have traditionally been diagnosed.

"We want to be able to detect a small amount of cancer earlier than waiting for the tumor to produce enough cells in the abdominal cavity," Bast said.

Other researchers are exploring new genetic sequencing techniques to understand how microRNAs, short molecular segments that deactivate a part of a person's genome, are expressed differently in women with cancer. 39; ovary.

The team of Kevin Elias, a gynecologic oncologist who runs a laboratory at Brigham and Women's Hospital in Boston, is designing a clinical trial to analyze blood samples of women taken before they notice symptoms and for which a cancer has been diagnosed.

The goal is to see if the microRNA models could have predicted who would have the disease later and estimate the magic moment to surgically intervene to remove the tumors.

"We are trying to determine the waiting time to catch women at high risk who are curable," Elias says.

He says that a resulting test will be first offered to 20% of women with inherited risk of ovarian cancer, and then to the general population.

We also hope that new biological knowledge about ovarian cancer will lead to more effective personalized treatments and prolong survival.

"We are learning that ovarian cancer is not a disease, it is composed of many subtypes with distinct pathways and risk factors," said Beth Karlan, a gynecologic oncologist at the David Geffen School of Medicine at the University of California at Los Angeles. Angeles.

For example, one type of ovarian cancer tumor might be the size of a grapefruit that does not spread, while another subtype of the size of a pea will metastasize quickly.

"We can not continue to treat women the same way," she says.

The US Food and Drug Administration has recently approved targeted oral therapies, known as PARP inhibitors, that kill cancer cells.

Although their use is intended for patients with ovarian cancer with BRCA genetic mutations, which account for 15% of cases, researchers are looking into whether they can help women with the disease. other types of ovarian cancer.

And another drug called bevacizumab – sold under the name of Avastin – that stops the growth of blood vessels that feed cancer cells has been effective in combination with chemotherapy in women with cancer. Recurrent ovary. (Last summer, it was approved as first-line treatment after surgery.)

Other targeted agents and immunotherapies activating the immune system to fight cancer are currently undergoing clinical trials. Nevertheless, the range and success rates of current treatment options are extremely limited.

In the meantime, women should take advantage of new genetic sequencing tools to identify their cancer subtype and ask their physician to participate in the proper clinical trial instead of "going from chemotherapy to chemotherapy regimen." hoping that something works, "said Laura, head of biotechnology at San Diego Shawver, who founded the Clearity Foundation in 2008.

The non-profit group helps women with ovarian cancer get a genetic profile of their tumors to better adapt them to appropriate treatments.

"Women need to know that this technology exists and is generally covered by insurance," she said.

The frustrating part, says Shawver, is that by the time many women undergo multiple chemotherapy regimens – the current standard of care for recurrent ovarian cancer – they may no longer be eligible for a clinical trial. new drugs.

In addition, their tumors may have evolved over several treatments, so that drugs that may initially work for their subtypes are less effective.

"Your best chance of healing is your first treatment and not when five other options have failed," said Shawver.

Before Liz Laats died of ovarian cancer three years ago at the age of 46, the mother of three children in the San Diego area had undergone 88 cycles of chemotherapy at the age of during 10 years, which had exhausted her to the point of suffering from chronic bone pain.

"In the beginning, the doctors gave her the treatments that they thought had been most beneficial to most people, but they did not know how to treat her specifically," says her husband, Andy Laats, who told her took her to more than two dozen doctors. around the United States.

"We kept thinking," There must be a smarter doctor somewhere who knows. "But all you have to do is try to connect these points," he said, adding that Liz had tried "the best of many shit options", including drugs tested in the context of Clinical trials that had worked in mice or patients with lung cancer.

"It looked like the game Chutes and Ladders, you have little hope and then you fall," said Laats.

Despite uneven progress, Lee from the University of Chicago hopes that the next generation of doctors know that the history of ovarian cancer is changing for the better in a modest and meaningful way.

"I do not want to disguise this terrible disease, but I also want students to see that women are living longer," she said of the school's collaboration with the Survivors Teaching Students program. by the Ovarian Cancer Research Alliance.

"I want them to see the pictures of their families and the journeys they undertake.I want them to know that women are booming.And I want them to know that They might be able to identify the disease early enough to save a life & # 39;