Issue 32 / 1 September 2014

NEW drug developments and individualised treatment are bolstering efforts to improve the prognosis for patients with epithelial ovarian cancer, say Australian experts.

Professor Martin Oehler, director of the department of gynaecological oncology at Royal Adelaide Hospital, said the past 20 years had seen little improvement in the detection and treatment of ovarian cancer, but there were now many advances in the pipeline and the research community was “very positive and hopeful”.

Professor Oehler was commenting on research published in the MJA, which he coauthored, that found a crude 5-year survival rate of 35% for women with invasive epithelial ovarian cancer. (1)

The nationwide population-based study of 1192 women diagnosed with invasive epithelial ovarian cancer in 2005 found increasing age and disease stage were most strongly associated with poorer survival.

“Our estimates confirm the ongoing poor prognosis of the disease and emphasise the need for primary and secondary prevention and better treatments for ovarian cancer to improve long-term outcomes”, the researchers wrote.

Professor Oehler told MJA InSight ovarian cancer was a “terrible disease” because by the time most women were diagnosed, the cancer was advanced.

“Once the disease has spread from the ovary to the abdomen, it’s very difficult to treat”, he said.

International research efforts were focused on early detection. Professor Oehler said although technical limitations had so far prevented the development of a blood test to detect ovarian cancer, researchers were now looking to the disease’s immune signature to aid early detection.

Oncologist Dr Anne Hamilton, of the Peter MacCallum Cancer Centre, Melbourne, told MJA InSight “the building blocks” were now starting to fall into place and new drug therapies were showing promise.

She said the Pharmaceutical Benefits Scheme listing of the antiangiogenic drug bevacizumab for patients with suboptimally debulked disease would make a modest improvement in the survival of the patients with the worst prognosis.

“We’re not expecting huge gains in the survival statistics [with this listing] but we’re hoping [it has] some impact.”

Dr Hamilton said the Australian Ovarian Cancer Study, for which she is a scientific advisor, was studying the genetic changes leading to the formation of cancers.

“[The study has] already identified subgroups of ovarian cancer and what that’s giving us now is an ability to try to tailor treatment to six different types of ovarian cancer rather than one”, she said.

Professor Oehler said personalised treatment was the future for ovarian and many other cancers.

Researchers have realised that ovarian cancer is a very heterogeneous disease consisting of distinct subtypes of different origin that vary significantly with regard to molecular biology and clinical behaviour. With this increased knowledge we are now able to develop more innovative and targeted treatments.”

Professor Oehler said that, for example, poly-ADP-ribose-polymerase (PARP) inhibitors were showing promise in the treatment of ovarian cancer in women with BCRA1 and BCRA2 mutations.

Dr Hamilton said these drugs may also prove to be effective in patients with non-hereditary cancers.

“There’s increasing evidence that many ovarian cancers have alterations in the BRCA pathways without it actually being an inherited mutation … so those cancers are still susceptible to the PARP inhibitors”, she said.

Professor Oehler said other advances in ovarian cancer treatment included the intraperitoneal delivery of chemotherapy and the development of immunotherapy. (2)

Dr Hamilton said the only prevention strategy currently available was oophorectomy for patients with BRCA1 and BCRA2 mutations.

“We only really do that for patients with the BRCA1 and BRCA2 mutations, because they run very high lifetime risks of getting ovarian cancer compared to women who don’t carry those mutations”, she said.

1. MJA 2014; 201: 283-288
2. Maturitas 2013; 77: 128-136

(Photo: Sam Ogden / Science Photo Library)

5 thoughts on “New hope in ovarian cancer

  1. Dr Jennifer Bradford says:

    Please do not use pictures of young women in an article on ovarian cancer.

    Ovarian cancer is overwhelmingly a disease of older women.  Even though your journal is for doctors, it is read by many others in our community.  Pictures like the one above may falsely reassure older women, and falsely alarm younger women.

     

  2. Grace Gawler says:

     Today’s Courier Mail headline states “Delayed diagnosis and inability to access best treatment mean ovarian cancer kills more in rural areas”.Yes, it is an issue for rural women… all cancers are an issue for this demographic. And yes, it is wonderful that we are looking for medical solutions in ovarian cancer; however more attention needs to be given to the lifestyle connection in ovarian cancer; particularly for young women (rural or not) who are smokers. Mucinoid ovarian cancer in a systematic review (IARC) showed a doubling in risk of this type of cancer in current smokers. The known susceptibility genes (e.g. BRCA1 and BRCA2) explain less than 40% of the excess risk of familial ovarian cancer. However, there has been little discussion in the public domain regarding susceptibility genes and cigarette smoking; a potentially explosive risk for young women with the combination. A popular case featured in the national and international news this year, but unfortunately the media focus was on the disease itself and the patient’s experience, with media failing to discuss the genetic suseptibility and smoking connection ‘time-bomb’. Many young women would do well to quit smoking for many reasons – but preventing ovarian cancer is certainly one good reason. IARC states that there is sufficient evidence that smoking causes ovarian cancer. A similar risk increase for mucinous tumours for current and past smoking was subsequently shown in the UK Nurses’ Health Study. It is always important that science and new hope with treatments translates to the public, but if a cancer type can be prevented by a lifestyle change, we should continue to promote the idea and educate our young women.

  3. Elizabeth Molnar says:

    Thank you for your balanced article. 

    Is deficiency of Vitamin D a contributory factor?

  4. James Currie says:

    Perhaps we should be less reticent in talking about the potential benefits of the oral contraceptive pill. In the popular press we hear nothing but breast cancer (falsely), and to VTE, in relation to the OCP.

    To Jenny, I have cared about every loss of my patients over the years, but the young women who died of ovarian cancer stand out in my mind.

  5. Randal Williams says:

    I agree with Gronia re cigarette smoking, which is associated with over 20 cancers including cervix and ovary, and needs to be highlighted more in discussion, especially in popular women’s magazines. Prevention of ovarian cancer is the best approach as  it is usually diagnosed too late. Apart from not smoking, oophorectomy in women with identified genetic predisposition, and routine oophorectomy during postmenopausal hysterectomy are appropriate strategies.

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