Tag Archive for: ovarian cancer
What Are the Symptoms of Ovarian Cancer?
What should women know about ovarian cancer symptoms? Gynecological cancer expert Dr. Nita Karnik Lee reviews potential symptoms of ovarian cancer and emphasizes the importance of regular communication with the healthcare team.
Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.
See More from DETECT Ovarian Cancer
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How Does Biomarker Testing Impact Ovarian Cancer Screening and Detection? |
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Transcript:
Katherine Banwell:
What symptoms should people look for?
Dr. Nita Karnik Lee:
So, this is a very important point. I think the symptoms that people should look for are symptoms that are in the bowel and bladder function area that are different or new to them. This can be changes in urinary frequency, or urgency, or sense of pressure, or not having as much bladder capacity, like having to run to the bathroom more frequently.
Sometimes it can be changes in bowel movements, such as constipation, or not feeling like they’re emptying, or it can be changes in appetite, where people feel full really quickly, where they eat a small amount, and all of the sudden, they just feel like they can’t eat anymore. Obviously, worsening symptoms such as nausea or even throwing up, that’s a little more extreme, but that can happen.
Again, if you’ve had these symptoms for years every time you eat a certain food or something like that, those are probably not new, and that probably is not going to be something cancerous. But if there’s something that’s new or different, the symptom seems to stick out to you that this isn’t your usual routine, and it seems persistent over two or three weeks, and it’s happening almost daily, or at least more frequently than you would expect, then I think that warrants telling your doctor about it, and really advocating, and knowing that not everyone is going to have ovarian cancer, which is good, but knowing that they should do the workup for this just to rule it out.
Katherine Banwell:
How reliable are PAP smears in detecting ovarian cancer?
Dr. Nita Karnik Lee:
PAP smears do not detect ovarian cancer at all. So, people with ovarian cancer have normal PAP smears. It would be very unusual to have an abnormal PAP smear due to ovarian cancer. A lot of the misconception is that patients have said, “Well, I had my annual exam last year. I got my PAP smear every three to five years. That seems negative. So, why did I get this cancer?” But the two are completely unrelated.
How Does Biomarker Testing Impact Ovarian Cancer Screening and Detection?
What role does biomarker testing play in ovarian cancer detection? Dr. Nita Karnik Lee reviews genetic mutations related to ovarian cancer and discusses key steps women with a family history of the disease should consider.
Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.
See More from DETECT Ovarian Cancer
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Transcript:
Katherine Banwell:
What is the role of genetic and biomarker testing as screening tools?
Dr. Nita Karnik Lee:
Genetic testing is very important. When we get, for example, and I’ll kind of back up a little bit to say if somebody gets diagnosed with ovarian cancer, that is actually everyone who has a diagnosis of ovarian, fallopian tube, or peritoneal, because those are all sort of the same cancer, should get genetic testing to see if there’s a hereditary predisposition in their genetics that are passed on.
That’s called germline testing. And those patients, and 20 percent of them, may actually have a hereditary condition that could be passed on. Then that’s where you can see how important it is. If I have somebody, and her children now know that the person has the BRCA gene, for example, then it’s really important for her children, men and women, to get screened, because then they may be able to do preventive measures, such as preventive surgery, preventive medications, or more frequent screening, to be able to prevent cancer from happening.
Katherine Banwell:
Okay. What genetic mutations are associated with ovarian cancer?
Dr. Nita Karnik Lee:
The ones that are most common that you hear about are something called BRCA, or B-R-C-A, 1 and 2. Those make up the majority of those mutations. There are some other less common ones such as Lynch syndrome, which is more associated with colon and endometrial cancer but can have about 10 percent to 12 percent of patients related to ovarian cancer as well.
Nowadays, when we do genetic testing, we do a panel, so there are like 35 genes that are tested. There are a whole lot of different genes that can have an association with ovarian cancer, but the BRCA genes are the ones that most people hear about.
Katherine Banwell:
Should women with a family history of ovarian cancer take extra precautions?
Dr. Nita Karnik Lee:
That’s a very good question. So, if you have a family history, it’s probably important to talk to your doctor and to maybe even see somebody in cancer genetics who can draw out a family tree for you to see how high is this risk? If people have an ovarian cancer patient, one – or a breast cancer patient – some of it also matters what was the age that that patient got diagnosed. Some genetic mutation syndromes, actually the patient gets diagnosed much younger than average.
The average age for ovarian cancer is about 60. Some patients will get it. For some genetic mutations, it’s still about that range. So, I think it’s important because even if you don’t have a genetic mutation, having a family member with ovarian cancer slightly increases your risk.
Knowing those symptoms, knowing that your history will help your doctor dictate how quickly are they thinking about something else is really important, ultrasound, but we know that ultrasound is not perfect.
How Is Ovarian Cancer Detected?
Dr. Nita Karnik Lee discusses how ovarian cancer is diagnosed, shares challenges in screening tests and procedures, and reviews ongoing research in the field. Dr. Lee also shares key questions to ask one’s healthcare team about ovarian cancer detection.
Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.
See More from DETECT Ovarian Cancer
Related Resources:
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How Does Biomarker Testing Impact Ovarian Cancer Screening and Detection? |
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Transcript:
Katherine Banwell:
Dr. Lee, what are the screening tests and procedures to detect ovarian cancer?
Dr. Nita Karnik Lee:
So, one of the important things to realize is that we do not actually have a screening test for ovarian cancer. That’s really important for the general public who maybe is at average risk. Patients who have a strong family history or a genetic, hereditary condition, sometimes we do use ultrasound and CA125, but that’s not considered a screening test for average-risk patients. We’re very limited in that sense for ovarian cancer. There’s a lot of research that’s being done about this.
Katherine Banwell:
Have there been advances in screening or screening technology that patients should know about?
Dr. Nita Karnik Lee:
I think the issue with screening and ovarian cancer is because we have not had any, and there have been really large studies that have been done both in the U.S. and in Europe, trying to see does ultrasound work every six months. Does CA125 and ultrasound work?
There’s some combination of blood tests that have started to become a little bit more researched in terms of going further along, but there’s really nothing that’s the perfect answer. One of the really important things that we talk about is knowing family history to see if there’s something that can be done to help patients who have a family history.
And then also being really aware of subtle symptoms of ovarian cancer that can trigger you going to your doctor and then really pushing and advocating for yourself and your family member to get a workup done, which can often include an exam, an ultrasound, and maybe even something like a CAT scan or CT scan if any of the symptoms are a little more worrisome.
Katherine Banwell:
What questions should patients ask their doctor about detection?
Dr. Nita Karnik Lee:
I think that when we’re thinking about detection, or if somebody has these symptoms coming up, definitely asking, like, hey, you know what? I’m seeing you as an internist, but I haven’t had a pelvic exam. So, making sure you’re seeing a gynecologist or an internist or family medicine doctor who can do a vaginal and a rectal exam is one important step. Perhaps getting an ultrasound or perhaps getting a CAT scan if the symptoms are more significant.
Unfortunately, we still see a lot of women who have these sort of vague symptoms, maybe they’re GI-related, and they get a workup for like six months on an EGD, or a colonoscopy, or they tried Pepcid. And all of those things are good, and they’re not unreasonable to do, but I think something else that can be done in addition would be a pelvic ultrasound, as an example.
I would say that if somebody doesn’t have any of those symptoms, but they have a family history, that’s why we’re in a little bit more of a bind as to know what the right thing to do is. We know that for patients who have a known BRCA mutation and are not ready for risk reduction surgery, we often will use ultrasound, but we know that ultrasound is not perfect.
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.
See More from INSIST! Ovarian Cancer
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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.
Comprender su Papel en su Cuidado del Cáncer de Ovario
¿Qué medidas pueden tomar los pacientes de cáncer de ovario para ser proactivos en su cuidado? Este vídeo animado comparte consejos para hablar, participar en decisiones y consejos para aprender más sobre el cáncer de ovario.
See More from COLLABORATE Ovarian Cancer
Related Resources:
Becoming Empowered and [ACT]IVATED After An Ovarian Cancer Diagnosis |
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Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches |
Transcript:
Dra. Thompson:
¡Hola! Soy la Dra. Thompson, y me especializo en el tratamiento de los cánceres ginecológicos, que son un grupo de cánceres que afectan los órganos reproductivos de las mujeres.
Hoy, estoy aquí con Sarah, quien vive con cáncer de ovario.
Sarah:
¡Hola a todos! En este video, la Dra. Thompson y yo hablaremos sobre el importante papel que los pacientes desempeñan en su cuidado y compartiremos los pasos que pueden tomar para sentirse seguros al tomar decisiones CON su equipo médico.
Dra. Thompson:
Sarah y yo sabemos de primera mano que esto comienza con encontrar un equipo médico que los apoye. Sentirse a gusto al hablar sobre sus pensamientos y preocupaciones es crucial, porque compartir su opinión puede influir en su atención general.
Sarah:
Totalmente. Cuando me diagnosticaron por primera vez, me sentía ansiosa y abrumada, pero la Dra. Thompson me animó a hacer preguntas, lo que me ayudó a sentirme más en control.
También descubrí que buscar atención con un especialista marcó una gran diferencia. Dra. Thompson, ¿puede hablar sobre por qué eso es tan importante?
Dra. Thompson:
Claro, Sarah. Los especialistas, como los oncólogos ginecológicos, tienen la experiencia para ofrecer los tratamientos y recomendaciones más actualizadas para el cáncer de ovario. Pueden brindar un enfoque más personalizado a su cuidado, lo que puede ayudar a manejar la enfermedad de manera más efectiva.
Sarah:
Exactamente—colaborar con un especialista aumentó mi confianza en las decisiones sobre mi tratamiento. También me hizo darme cuenta de la importancia de aprender sobre mi cáncer, para poder participar en las conversaciones sobre mi cuidado.
Dra. Thompson:
Así es, Sarah. Educarse a uno mismo es otro paso clave para sentirse empoderado. Cuando comprende más sobre su enfermedad, su diagnóstico y las terapias disponibles, le ayuda a tomar las decisiones que son mejores para usted.
Y para ayudarle a aprender más sobre su cáncer de ovario, aquí está mi consejo sobre por dónde empezar:
- Conozca su diagnóstico específico: Pregúntele a su médico sobre el tipo y la etapa de su cáncer de ovario. Esta información guiará sus opciones de tratamiento.
- Además, asegúrese de haber realizado pruebas de biomarcadores, incluidas pruebas genéticas: Los resultados de las pruebas ayudarán a usted y a su equipo médico a comprender mejor su diagnóstico y pueden afectar la terapia.
- Priorice su salud mental: Manejar un diagnóstico de cáncer puede ser emocionalmente desafiante. Busque apoyo de profesionales de la salud mental o grupos de apoyo para ayudar a sobrellevar la ansiedad y el estrés.
Sarah:
Estoy completamente de acuerdo, Dra. Thompson. También hay muchos recursos disponibles que proporcionan información valiosa. Aquí hay algunos recursos confiables en los que puede confiar:
- La Red de Empoderamiento del Paciente
- La Sociedad Americana de Cáncer
- La Fundación para el Cáncer de la Mujer
- FORCE – Enfrentando Nuestro Riesgo de Cáncer Empoderados
- SHARE Apoyo al Cáncer
- La Sociedad de Oncología Ginecológica
Dra. Thompson, ¿qué consejo tiene para aprovechar al máximo el tiempo con su médico?
Dra. Thompson: Buena pregunta, Sarah. Aquí algunos consejos:
- Primero, esté preparada: Anote cualquier pregunta o inquietud que tenga antes de su visita.
- Luego, tome notas: Lleve un cuaderno o algo para registrar los detalles durante su cita.
- También, lleve a un amigo o familiar: Tener a alguien con usted puede brindarle apoyo emocional y ayudarle a recordar la información compartida.
- Finalmente, discuta sus objetivos: Sea clara acerca de sus necesidades de tratamiento y cualquier inquietud relacionada con su estilo de vida. No dude en hablar durante la visita y asegúrese de que todas sus preguntas hayan sido respondidas.
Sarah:
Esos son consejos muy útiles. Tener a mi hermana conmigo durante las citas fue reconfortante, y a menudo pensaba en preguntas que yo no había considerado.
Dra. Thompson:
Eso es un excelente punto, Sarah. Recuerde, usted es el centro de su equipo de atención. Manténgase involucrada y nunca dude en comunicarse si tiene preguntas o no entiende algo.
No olvide descargar la guía que acompaña a este video. Y para obtener más información sobre el cáncer de ovario, visite powerfulpatients.org.
Understanding Your Role in Your Ovarian Cancer Care
What steps can ovarian cancer patients take to be proactive in their care? This animated video shares tips and advice for speaking up, engaging in decisions and tips for learning more about ovarian cancer.
See More from COLLABORATE Ovarian Cancer
Related Resources:
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Becoming Empowered and [ACT]IVATED After An Ovarian Cancer Diagnosis |
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Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches |
Transcript:
Dr. Thompson:
Hi! I’m Dr. Thompson, and I specialize in treating gynecologic cancers, which are a group of cancers that impact a woman’s reproductive organs.
Today, I’m here with Sarah, who’s living with ovarian cancer.
Sarah:
Hi everyone! In this video, Dr. Thompson and I will discuss the important role that patients play in their care and will share steps you can take to feel confident when making decisions WITH your healthcare team.
Dr. Thompson:
And Sarah and I know firsthand that this starts with finding a healthcare team that supports you. Feeling at ease when discussing your thoughts and concerns is crucial, because sharing your input can impact your overall care.
Sarah:
Absolutely. When I was first diagnosed, I felt anxious and overwhelmed, but Dr. Thompson encouraged me to ask questions, which helped me feel more in control.
I also found that seeking care from a specialist made a big difference. Dr. Thompson, can you talk about why that’s so important?
Dr. Thompson:
Of course, Sarah. Specialists, like gynecologic oncologists, have the expertise to provide the most up-to-date treatments and recommendations for ovarian cancer. They can offer a more personalized approach to your care, which can help manage the disease more effectively.
Sarah:
Exactly—collaborating with a specialist boosted my confidence in my treatment choices. It also made me realize the importance of learning about my cancer, so I could participate in conversations about my care.
Dr. Thompson:
Absolutely, Sarah. Educating yourself is another key step in feeling empowered. When you understand more about your disease, your diagnosis, and available therapies, it helps you make decisions that are best for you.
And to help you learn more about your ovarian cancer, here’s my advice for where to start:
- Learn about your specific diagnosis: Ask your doctor about the type and stage of your ovarian cancer. This information will guide your treatment options.
- Additionally, ensure you have had biomarker testing, including genetic testing: The test results will help you and your care team better understand your diagnosis and may affect therapy.
- Prioritize your mental health: Managing a cancer diagnosis can be emotionally challenging. Seek support from mental health professionals or support groups to help cope with anxiety and stress.
Sarah: I completely agree, Dr. Thompson. And, there are also plenty of resources available which provide valuable information. Here are few reputable resources you can rely on:
- The Patient Empowerment Network
- The American Cancer Society
- The Foundation for Women’s Cancer
- FORCE — Facing Our Risk of Cancer Empowered
- SHARE Cancer Support
- The Society of Gynecologic Oncology
Dr. Thompson, what advice do you have for getting the most out of your time with your provider?
Dr. Thompson: Great question, Sarah. Here are a few tips:
- First, be prepared: Write down any questions or concerns you have before your visit.
- Then, take notes: Bring a notebook or something to record details during your appointment.
- Also, bring a friend or family member: Having someone with you can provide emotional support and help you to remember the information shared.
- Finally, discuss your goals: Be clear about your treatment needs and any lifestyle concerns you may have. Don’t hesitate to speak up during the visit and to ensure all of your questions have been answered.
Sarah:
Those are really helpful tips. Having my sister with me during appointments was comforting, and she often thought of questions I hadn’t considered.
Dr. Thompson:
That’s a great point, Sarah. Remember, you are the center of your care team. Stay engaged and never hesitate to reach out if you have questions or don’t understand something.
Don’t forget to download the guide that accompanies this video. And for more information about ovarian cancer, visit powerfulpatients.org.
Essential Genetic Testing for Personalized Gynecologic Cancer Treatment
How important is genetic testing for gynecologic cancer? Expert Dr. Ramez Eskander from UC San Diego Health discusses the role of genetic testing in gynecologic cancer care – including molecular tumor testing, germline testing, HRD tests, and BRCA mutations – along with proactive patient advice.
[ACT]IVATION TIP
“…every patient with ovarian cancer needs to know their BRCA status and needs to know their molecular tumor testing status. Feel empowered to ask these questions. It is data that you should have at hand as you make informed decisions.”
See More from [ACT]IVATED Ovarian Cancer
Related Resources:
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Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches |
PARP Inhibitors in Ovarian Cancer Treatment: Understanding Side Effects |
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Transcript:
Lisa Hatfield:
Dr. Eskander, for patients newly diagnosed with a gynecologic cancer, how important is it to get genetic testing like HRD or homologous recombination deficiency, and how can understanding one’s genetic profile help them and their care team choose the best treatment?
Dr. Ramez Eskander:
This is an incredibly important question. It is pivotal that every newly diagnosed ovarian cancer patient have germline genetic testing and molecular tumor testing because of the impact it can have on their treatment strategy, independent of course, the importance of them being diagnosed. So that if they had a genetically inherited mutation, we call it germline mutation, their relatives can be informed and tested, so they can have risk reducing surgical interventions.
In the ovarian cancer setting, homologous recombination deficiency testing is crucial, because it helps inform the magnitude of benefit that we might see with treatment strategy, in this case, combination of PARP inhibitor plus bevacizumab (Avastin) or PARP inhibitor alone. So these treatment strategies have been proven to improve clinical outcomes. And knowing HRD test status and knowing whether you have a germline mutation is pivotal to putting context around a conversation surrounding maintenance treatment approaches. And understanding the profile is what drives your ability to make an informed decision about your maintenance treatment strategies.
And it can be quite nuanced. For example, if a patient is HRD test-negative, they would have to make a decision about what kind of maintenance therapy with their provider. Do I do maintenance treatment? Should I do bevacizumab alone? Should I do a PARP inhibitor alone? And what might I anticipate with either of these approaches, and what are the pros and the cons? And an HRD test-positive patient, there is clear data supporting the use of PARP inhibitors or PARP inhibitors plus bevacizumab in combination.
So you want to be informed of those data as you look to make a decision. And this to me is germane to the care of patients with ovarian cancer. Every patient should know their status and in a similar manner when we talk about endometrial cancer, I would just like to elaborate that it’s critical to know what is the finding of the testing on the tumor for the endometrial cancer? Is this a mismatch repair-deficient or mismatch repair-proficient endometrial cancer and testing that was done?
Lisa Hatfield:
That’s a lot of information. So I just want to clarify a couple of comments that you made. So when you talk about the germline testing of germline mutations, that has to do with mutations that are present in a patient’s, all the cells in a patient’s body. Is that correct? So like the BRCA1 and 2 genes?
Dr. Ramez Eskander:
That’s correct.
Lisa Hatfield:
And then there are the other types of mutations, some people call them somatic mutations that are just have to do with the DNA sequencing of the actual tumor or cancer cells. So is HRD then, is that a germline mutation, or is that more of a somatic?
Dr. Ramez Eskander:
Perfect question. So HRD itself isn’t a mutation. HRD is looking at changes in the tumor DNA, but you bring up a perfect point. A germline mutation is inherited, meaning that it is in every cell, and it’s a predisposition and increase in cancer risk. Somatic mutations are not inherited. Somatic mutations are mutations in the tumor unique to that cancer. That’s why we talk about informing your family or relatives with a germline mutation, because that was inherited. And other people in the family may have the same inherited mutation. Somatic mutations are not inherited. They arise in the cancer, and they require tumor testing to inform.
Homologous recombination deficiency isn’t looking for a specific mutation, but it’s rather examining the tumor DNA to look for something we call genomic scarring. The analogy I gave is if I’m driving on the freeway and I’m stuck in traffic, I know that I’m stuck in traffic, but I don’t know exactly why. Is there construction on the freeway? Is there an accident? It’s unclear. So the HRD is looking at the genomic signature, and it needs tumor samples to do that, but it’s not honing in on a specific mutation.
I know it can get a little bit complicated. I’ll just add this, A patient who has a germline BRCA mutation, if you test their tumor, the near vast majority are going to have an HRD test-positive signature, because it drives that. So that’s like saying, I know the reason that there’s that genomic instability, it’s a BRCA mutation, but there are patients we call beyond BRCA. There are many things that may cause this independent of BRCA that we may not know of right now, but we can identify the genomic scar, and that qualifies patients as having a homologous recombination deficiency test-positive tumor.
So my tip is every patient with ovarian cancer needs to know their BRCA status and needs to know their molecular tumor testing status. Feel empowered to ask these questions. It is data that you should have at hand as you make informed decisions.
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PARP Inhibitors in Ovarian Cancer Treatment: Understanding Side Effects
Ovarian cancer treatment may cause side effects, so what should patients be aware of? Expert Dr. Ramez Eskander from UC San Diego Health discusses common ovarian cancer treatment side effects, management of side effects, and proactive patient advice for optimal care.
[ACT]IVATION TIP
“…make sure you’re asking appropriate questions, that you’re educated about treatment-related side effects as they relate to PARP inhibitors. And then lastly, to understand that dose interruptions or dose reductions are an expected part of treatment with really any anti-cancer directed therapy, including PARP inhibitors, with a goal to keep patients on therapy, because they’re benefiting from this treatment.”
See More from [ACT]IVATED Ovarian Cancer
Related Resources:
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Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches |
Essential Genetic Testing for Personalized Gynecologic Cancer Treatment |
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Transcript:
Lisa Hatfield:
Dr. Eskander, what are some common side effects of ovarian cancer treatments, particularly with long-term use of PARP inhibitors, and how can patients manage these side effects and maintain their quality of life during treatment?
Dr. Ramez Eskander:
PARP inhibitors, Lisa, are a very important part of the management of patients with advanced stage ovarian cancer. They have become a commonly used treatment in the first line we call it therapy or when patients are initially diagnosed as a maintenance treatment strategy and those PARP inhibitors can be given alone or the PARP inhibitors can be given in combination with another drug called bevacizumab (Avastin) as maintenance therapy. PARP inhibitors is a class I like to say are drugs that can be well tolerated.
One of the most important things that we face as providers is we are responsible to make sure our patients are educated. When we are able to have a conversation with a patient and educate them about potential treatment-related side effects and they feel empowered in managing those side effects, we’re able to make sure that patients can stay on treatment, tolerate, and of course, most importantly, benefit from this study-directed therapy for management of their cancer. As a class, some of the more common side effects of PARP inhibitors are fatigue. It’s actually one of the most common side effects.
We can see gastrointestinal side effects. They can be varied, but it can be constipation or diarrhea or abdominal cramping. We can also see hematologic side effects, which means impact on the blood counts. It can cause anemia, lowering the red blood cell count, lowering the white blood cell count, and in some instances, lowering the platelet count. There are rare, when I say rare in the front line, if you look across trials, less than about 1-1/2 percent of patients can develop a secondary malignancy of the bone marrow that’s called myelodysplastic syndrome or acute myeloid leukemia. Those are very uncommon, but they have been described when we use PARP inhibitors as a maintenance strategy in the front line.
So in these circumstances, again, it’s about education. It’s about making sure that you’re asking your provider, what might I experience, and how are we going to be proactive about mitigating these side effects? And I would like to emphasize that it’s okay when needed, to have a dose interruption, meaning pause the medication for a period of time, or a dose reduction, reduce the dose.
Because by doing so, we can make sure that a patient can stay on a treatment that they tolerate. And so managing these side effects is multi-pronged. It’s your clinician, your treatment team, of course, because it goes beyond the clinician who’s caring for you. It’s about understanding that an interruption in treatment may be needed, or reduction in the dose may be required, because that helps us keep patients on treatment.
Lisa Hatfield:
So if I understand correctly then, PARP inhibitors are something that a patient remains on until disease recurrence. That’s not a limited duration therapy, but it can be interrupted if needed a little bit of a break. So is that correct that it’s until disease recurrence?
Dr. Ramez Eskander:
In the front line when we’re talking about maintenance treatment strategy with PARP inhibitors, there’s actually a defined time period, but that defined time period is quite long on the order of two years. So you’re on a medication for a long period of time. Now, if you get to that two years, and thankfully there’s no evidence of cancer recurrence or active disease, you may be able to discontinue the PARP inhibitor.
The different trials had different durations of maintenance therapy. So you can imagine that there can be some fluctuation between trials two years or three years. But needless to say, it’s still a long period of time that you’re on an anti-cancer directed maintenance therapy. When you get to the end of that, however, you would be able to potentially discontinue treatment in conversation with your provider.
So here, in my opinion, the [ACT]IVATION tip is make sure you’re asking appropriate questions, that you’re educated about treatment-related side effects as they relate to PARP inhibitors. And then lastly, to understand that dose interruptions or dose reductions are an expected part of treatment with really any anti-cancer directed therapy, including PARP inhibitors, with a goal to keep patients on therapy, because they’re benefiting from this treatment.
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Optimizing Ovarian Cancer Care: Genetic Testing and Treatment Approaches
What’s vital for ovarian cancer patients to know about treatment options and approaches? Expert Dr. Ramez Eskander from UC San Diego Health discusses chemotherapy, surgery, the importance of molecular testing, treatment approaches for optimal outcomes, and proactive patient advice.
[ACT]IVATION TIP
“…ask the questions of your provider. Understand, did you have genetic testing? Did you have molecular tumor testing? And do the results of that genetic or molecular tumor testing impact the treatment recommendations for maintenance therapy? I want to make sure everybody feels empowered to ask those questions and have those answers.”
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Transcript:
Lisa Hatfield:
Dr. Eskander, for someone who is newly diagnosed with ovarian cancer, what are the most common treatment options available, and how can patients know which treatment plan is best suited for their specific situation?
Dr. Ramez Eskander:
Newly diagnosed ovarian cancer is managed utilizing chemotherapy and surgery. The order can vary depending on the specific patient, how they present, their cancer burden, whether you receive chemotherapy, surgery, followed by chemotherapy, or surgery and chemotherapy. The drugs, the backbone of treatment, are very similar, that is, two chemotherapy drugs called carboplatin (Paraplatin) and paclitaxel (Taxol). I will say that there are other drugs used in the front line. Another drug that’s commonly used is a drug called bevacizumab or Avastin. This is called an anti-angiogenic drug.
And we’ve also identified biomarkers that have really transformed front-line management. Any and every newly diagnosed ovarian cancer patient should have genetic testing because about 15 percent of ovarian cancers can have a genetic predisposition, meaning that you’ve inherited a gene that increased your risk of developing the cancer. And that’s critically important for the treatment of that patient, but also for any family members who would benefit from what we call cascade genetic testing, they would get tested. And if they were identified to have the gene, they could be followed and have risk-reducing surgery.
The reason this molecular testing of ovarian cancer and again, every patient should have genetic testing and molecular testing is critically important is it is informing maintenance treatment strategies. We’ve now conducted several clinical trials that show the utilization of a class of drug called PARP inhibitors. These are oral pills. When we use these medications in patients who have a BRCA mutation, there is a dramatic improvement in clinical outcome.
So every advanced stage ovarian cancer patient should be tested. And for those who have a BRCA mutation, every one of those patients should be treated with a maintenance PARP inhibitor. And maintenance meaning after you finish the chemotherapy drugs that I mentioned, you go on to that maintenance PARP inhibitor. And we’ve also had clinical trials that have expanded that opportunity, because not only are we looking at patients that have a BRCA mutation, but we’ve now expanded and incorporate into patients who are homologous recombination-deficient, or HRD test-positive.
Because studies have shown that when you give the PARP inhibitors in combination with bevacizumab, the drug that I alluded to a moment ago, you can again get a very significant improvement in clinical outcome including an improvement in overall survival. So biomarker testing, genetic testing, chemotherapy plus surgery is a backbone but importantly utilizing that molecular testing to inform maintenance treatment strategies which have clearly improved clinical outcomes, and these are all very critical conversations to have with the physician who’s taking care of you.
And for me, my [ACT]IVATION tip here is ask the questions of your provider. Understand, did you have genetic testing? Did you have molecular tumor testing? And do the results of that genetic or molecular tumor testing impact the treatment recommendations for maintenance therapy? I want to make sure everybody feels empowered to ask those questions and have those answers.
