Ovarian Cancer Awareness- Part 2

In part 2 of our ovarian cancer blog for the “#ACancerAWeek” series, we will look into the current treatment options available to patients and some ongoing advancements in research. Read on to learn more about these ground-breaking discoveries!

Current treatment options

Ovarian cancer treatment has evolved significantly, with a variety of options available depending on the cancer's stage, type, and the patient's overall health. The primary treatment modalities include surgery, chemotherapy, targeted therapies, and hormone treatments.

Surgery is a critical component of ovarian cancer treatment, particularly for early-stage cancers. The type of surgery performed depends on the cancer's stage. Early-stage ovarian cancer surgeries may include removing one or both ovaries and possibly the uterus and fallopian tubes. In some cases, only the affected ovary may be removed to preserve fertility. For advanced stages (stages 2-4), however, both ovaries, fallopian tubes, and the uterus are removed, along with any visible tumour growth in the abdomen to remove as much tumour mass as possible. Chemotherapy may also be a part of the patient’s treatment regimen, administered prior to or following surgery. Platinum-based drugs like carboplatin and cisplatin are commonly used due to their effectiveness in damaging DNA in cancer cells. Carboplatin is often preferred due to its lower toxicity. Taxanes, like paclitaxel and docetaxel are also combined with platinum agents in first-line therapy. For resistant or recurrent ovarian cancer cases, non-platinum agents such as gemcitabine, doxorubicin, etoposide are used. Chemotherapy may be administered alone or in combination with other drugs like paclitaxel for maximum efficacy. For certain patients, intraperitoneal chemotherapy, given directly to the abdominal cavity, may be more effective.

Hormone therapy is another treatment option for ovarian cancer but is not as widely used as surgery or chemotherapy. It is typically reserved for specific subtypes of ovarian cancer, particularly those that are oestrogen receptor (ER)-positive or have a slower growth rate, as these are more likely to respond to hormonal manipulation. Nevertheless, anti-oestrogen therapies (tamoxifen), aromatase inhibitors (anastrazole, letrozole), and Gonadotropin-Releasing Hormone (GnRH) agonists (leuprolide) are some hormonal therapies used.

Recent advances in treatments

Recent years have witnessed significant advancements in the treatment of ovarian cancer, leading to improved outcomes and expanded options for patients. Key developments include new drug approvals, innovative treatment approaches, and ongoing research into targeted therapies and immunotherapy.

PARP inhibitors have transformed the landscape of ovarian cancer treatment, especially for patients with BRCA mutations. These drugs, including olaparib (Lynparza), rucaparib (Rubraca), and niraparib (Zejula), target cancer cells with BRCA mutations, making it difficult for them to repair DNA damage. Recent approvals have expanded their use for maintenance therapy in recurrent cases, helping to delay disease progression after initial treatment.

Antibody-drug conjugates (ADCs) are another novel targeted therapy for ovarian cancer. ADCs combine monoclonal antibodies with potent cytotoxic agents, allowing for targeted delivery directly to cancer cells while minimizing damage to healthy tissues. Mirvetuximab soravtansine (Elahere) is the first FDA-approved ADC for treating advanced, platinum-resistant ovarian cancer characterized by high expression of the folate receptor alpha (FR-α). It targets FR-α, delivering a cytotoxic agent directly to cancer cells that overexpress this protein. In the MIRASOL trial (a phase III clinical trial), patients treated with Elahere demonstrated improved overall survival and progression-free survival compared to those receiving standard chemotherapy. Approximately 40% of patients experienced tumour shrinkage, and the incidence of adverse events was also much lower than with chemotherapy, demonstrating a good overall safety profile. The approval of Elahere marks a significant milestone in the treatment of ovarian cancer, particularly for patients facing platinum resistance. 

Bevacizumab, a monoclonal antibody, works by inhibiting blood vessel formation, effectively starving tumours of nutrients. Studies are investigating the efficacy of combining it with other agents like PARP inhibitors or chemotherapy, to enhance therapeutic outcomes and address resistance mechanisms. Emerging evidence suggests that bevacizumab’s anti-angiogenic properties may synergize with PARP inhibitors, such as olaparib, by exacerbating tumour hypoxia and impairing DNA repair pathways. Trials like PAOLA-1 are investigating this combination, showing promise in improving outcomes for patients with homologous recombination deficiencies.

Immunotherapy, though still in the experimental stage for ovarian cancer, shows promise in enhancing the immune system's ability to target tumours. Checkpoint inhibitors such as pembrolizumab (Keytruda) are under investigation, particularly in cases of advanced ovarian cancer with high tumour mutational burdens. While the results have been less robust compared to their success in other cancers, these therapies offer a potential option for select patients. Additionally, novel approaches like Olvi-Vec, developed by Genelux, are undergoing clinical trials. Olvi-Vec aims to reprogram the tumour microenvironment from immunosuppressive to immunostimulatory, potentially amplifying the immune system's effectiveness against ovarian tumours.

For advanced stages of ovarian cancer, a new treatment option, called Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has recently emerged which combines surgery with heated chemotherapy and is applied directly to the abdominal cavity. After the surgeon removes as much visible tumour as possible, a heated chemotherapy solution is introduced directly into the abdominal cavity. The solution, warmed to approximately 41–43°C, is circulated for 60–90 minutes, allowing the chemotherapy to penetrate the remaining microscopic cancer cells. The heat enhances the effectiveness of the chemotherapy by increasing drug absorption and impairing cancer cell repair mechanisms. HIPEC is used to target cancer that has spread within the abdomen, aiming to reduce recurrence and improve survival outcomes.

Numerous clinical trials are ongoing, focusing on new combinations of existing therapies and novel agents, vaccines designed to boost the immune response against ovarian cancer, and gene therapy approaches aimed at modifying cancer cell behaviour. As research continues to evolve, patients may have access to increasingly effective therapies that improve survival rates and quality of life.

Conclusion

The treatment landscape for ovarian cancer has transformed significantly over the years, offering patients a broader range of options tailored to their specific needs. From traditional approaches like surgery and chemotherapy to innovative therapies such as PARP inhibitors, ADCs, and HIPEC, these advancements highlight the power of modern medicine in improving survival and quality of life. Furthermore, cutting-edge research in immunotherapy, targeted agents, and combination strategies continues to push the boundaries of what is possible, bringing renewed hope to patients and their families. With personalized medicine at the forefront, the future of ovarian cancer treatment looks promising. Stay tuned for the next installment in our #ACancerAWeek series, where we will explore a new type of cancer and understand its causes, symptoms, risk factors and current and emerging treatment strategies. In the meanwhile, stay vigilant and informed!

References:

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