Patient Empowerment | Advice From an Ovarian Cancer Expert
How can you feel empowered in your ovarian cancer care? Dr. Heidi Gray highlights the importance of allowing others, like your doctor, to help alleviate fear and regain a sense of control while navigating your journey with hope.
Dr. Heidi Gray is the Division Chief of Gynecologic Oncology and the Director of Gynecologic Oncology Clinical Trials at UW Medicine. Learn more about Dr. Gray.
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Transcript:
Katherine Banwell:
Dr. Gray, as a provider, how do you empower patients who have been diagnosed with ovarian cancer?
Dr. Heidi Gray:
That’s such an important question. I think that it’s incredibly important. My role is to help alleviate fear. I think when patients have a new diagnosis of cancer the rug’s been pulled out from under them. The patient describes it like being in a car crash.
You’re numb. It’s hard to even know where to go next. There’s so much fear, because you don’t know what’s next and the loss of control. So, I really spent a lot of time trying to just address that and acknowledge but also help move people forward, because I think it’s always helpful to be able to have a plan or have a sense of what’s going to happen next or have some control around that.
Of course, I also need to instill a lot of hope for patients. You never know what any one patient’s journey is going to be. The way information is, as I said, you can get all of these information and numbers, and it can be completely scary. Any one patient, their journey is different from the next one from the next one, and it’s very important to be hopeful and thoughtful about what that might look like or thinking about what that might look like.
How Do Biomarkers Impact Ovarian Cancer Treatment and Care?
How do biomarkers impact ovarian cancer care? Dr. Heidi Gray discusses how genetic biomarkers like BRCA-1, BRCA-2, and HRD inform treatment options, affect prognosis, and guide therapies like PARP inhibitors.
Dr. Heidi Gray is the Division Chief of Gynecologic Oncology and the Director of Gynecologic Oncology Clinical Trials at UW Medicine. Learn more about Dr. Gray.
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Transcript:
Katherine Banwell:
What are the most common biomarkers associated with ovarian cancer?
Dr. Heidi Gray:
So, the most common biomarkers, first of all, are the genetic mutations that are associated with higher risk. So, many folks are familiar with BRCA-1 and BRCA-2. There are a couple of lesser-known genetic mutations that fall into that family that also can put patients at an inherited risk.
Other biomarker testing that we do is for something called HRD, which is a test to look at a profile of the cancer that is similar to having the BRCA-1 and BRCA-2 mutations. It is a spectrum of different testing that may make those cancers more susceptible to PARP inhibitor therapy.
Katherine Banwell:
Are there biomarkers associated with prognosis?
Dr. Heidi Gray:
Let me back up a little bit. So, the biomarkers associated with prognosis – yes. So, in patients who have BRCA-1 or BRCA-2 mutations, they actually tend to have better prognosis longer term and better responsiveness to chemotherapy and other therapies.
Patients who also have HRD may also have a little improved responsiveness to some of the therapies as well.
Katherine Banwell:
How do these biomarkers impact ovarian cancer treatment options?
Dr. Heidi Gray:
Good question. So, the biomarker testing again, particularly for the BRCA-1, BRCA-2, and then the HRD spectrum, there have been several very large studies that have looked at using a variety of drugs that fall under this group called PARP inhibitors, P-A-R-P inhibitors.
These drugs specifically target cancers that have these mutations – or more susceptible to these mutations and interestingly have found that when we use these PARP inhibitors in a maintenance therapy, so after patients have completed their primary treatment, surgery, chemotherapy, and then go on maintenance therapy to prevent recurrence, they have very, very long improvement in survival and pushing out recurrence very far, significantly so, more than we’ve seen for anything in ovarian cancer in recent years.
So, it’s very, very exciting.
Katherine Banwell:
What question should patients ask about test results?
Dr. Heidi Gray:
It is interesting now because as many patients have experienced, they sometimes get their test results before their provider has had a chance to review them as part of the patient access program that has been in place. So, I find that many patients have had time to sit with their results or question or go on the Internet about them before they see me. So, some of it is helping direct, okay, where are you getting your information from and all of that, because I think that that is something newer now.
But I think it’s important for patients to be asking do I qualify for genetic testing, what are those results, what are the implications for myself and/or my family members? Then the molecular testing, as I said, is a very important next step that we do recommend for all, certainly advanced ovarian cancers or recurrent ovarian cancers, to help better guide therapy.
Essential Testing Following an Ovarian Cancer Diagnosis
What essential testing should follow an ovarian cancer diagnosis? Dr. Heidi Gray explains that patients should undergo both genetic testing, which identifies inherited risk factors, and molecular testing, which evaluates specific tumor mutations.
Dr. Heidi Gray is the Division Chief of Gynecologic Oncology and the Director of Gynecologic Oncology Clinical Trials at UW Medicine. Learn more about Dr. Gray.
See More from INSIST! Ovarian Cancer
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Transcript:
Katherine Banwell:
Dr. Gray, what essential testing should people with ovarian cancer have following diagnosis?
Dr. Heidi Gray:
That’s a great question. We’re learning more and more about this disease. Therefore, we also have a lot more variety of tools to look at to be able to match better therapies for patients. Historically, when patients were diagnosed with ovarian cancer, it was based on just the pathology at the time of surgery and some lab testing called the CA-125, which many patients with ovarian cancer are familiar with.
The next level of testing that we are doing for ovarian cancer is really to look at how aspects of either the patient themselves or of the cancer themselves that might better match therapies. So, the first line of testing we recommend for all women for ovarian cancer is genetic testing. Genetic testing is blood-based testing.
It is testing for if you have an inherited gene or a mutated gene, that’s being passed along through families that may have put you at risk of developing ovarian cancer and potentially breast cancer. That is recommended for all women and patients who have been diagnosed with ovarian cancer because we know about 15 percent to 20 percent of these cancers are due to a genetic cause.
The other level of testing that we have incorporated is what we call molecular testing. Other terms for it are “tumor-based testing” – I think you use the term “biomarker testing.” Some people use the term “precision medicine,” and that is a little different. That is testing that is actually testing the tumor itself. It’s looking at a variety of different factors but particularly looking at mutations in the cancer itself, in the tumor itself, so different than the genetic, which is an inherited thing. This is in the tumor itself. There is some overlap of that.
But it has an expanded profile of different targets that we can match therapies to.
Katherine Banwell:
Would you define biomarker testing for us?
Dr. Heidi Gray:
Yeah. So, biomarker testing is just that. It is more expanded testing, particularly tumor testing is one aspect of it. There can also be some blood testing, genetic testing. Then there is a new realm also of looking at cell-free DNA or ct or tumor DNA in the blood as well too that is gaining a lot of interest.
