UMMC makes strides toward preventing, delaying ovarian cancer

Published on Sunday, September 1, 2019

By: Cynthia Wall

New breakthroughs have led to new drugs to treat and delay ovarian cancer recurrence and more innovations appear to be on the way.

A targeted therapy approved about four years ago is making a difference and may be followed soon by similar therapies now in a testing and approval process, said Dr. Mildred Ridgway, associate professor of gynecologic oncology at the University of Mississippi Medical Center.

“We’ve been using it the past three years as an alternative in the recurrent setting with real promising results,” Ridgway said. “Patients are tolerating it extremely well.”

Ridgway, who also leads the UMMC Cancer Center and Research Institute’s Interdisciplinary Gynecologic Cancer Program, said the drug olaparib (marketed as Lynparza) is also approved for use in trying to prevent or delay ovarian cancer recurrence.

The drug initially was approved for use after a patient was treated with chemotherapy and their ovarian cancer recurred. In December, the Federal Drug Administration approved its use in a maintenance setting, so patients would complete chemotherapy and take this drug to prevent a recurrence.

Now, the drug and other targeted therapies – ones that more precisely identify cancer cells and interfere with their growth and reproduction – are being studied as a possible frontline or first treatment.

The drug is a targeted therapy, meaning it works in a cancer cell’s inner workings. This drug is for women who have a BRCAm mutation in their cancer cells.

Ridgway said chemotherapies initially used to treat ovarian cancer are effective, “but the risk of recurrence remains high.” This drug and other poly polymerase or ADP-ribose PARP inhibitors give women a longer time between recurrences and have fewer side effects than chemotherapy.

This drug is offered after chemotherapy for maintenance in women whose tumors have the BRCAm mutation; however, there are promising results for women who do not have the BRCAm mutation.

Dr. Kelly Wilkinson, assistant professor of hematology and oncology, said targeted therapies such as olaparib bring hope that cancer physicians can one day say “this is a cancer that is less likely to come back rather than more likely to recur.”

Another hope is that work to develop a test to screen for ovarian cancer can help women find it earlier when treatment is more effective, said Wilkinson, a medical oncologist.

Genetic testing may be offered to women after diagnosis with certain cancers to see if a targeted drug would be effective. If they have particular genetic mutations, the knowledge may inform close family, such as siblings or children, to be screened more often for the same type of cancer.

“I hope the more genetic testing we do, we’ll see more patients who know they are at higher risk for some cancers,” Wilkinson said.

Nationally, ovarian cancer leads to more deaths than any other gynecologic cancer, accounting for 5 percent of cancer deaths among women.

While having more therapies is advantageous, Ridgway still recommends women do all they can to avoid a gynecologic cancer or to see a doctor as soon as they notice signs that something may be wrong.

She recommended the following actions:

• Get a recommended Pap test for cervical cancer regularly.

If doctors find cells that are beginning to look like cancer, they can remove them before they become malignant. If it is already malignant, finding a cancer early means treatment likely will be more successful.

More women need to be screened, Ridgway said. Of any action, “the most important is to remember your annual exam and follow appropriate Pap testing guidelines,” she said.

• Know your own body and see a doctor when something changes.

For example, Ridgway said vaginal bleeding after menopause isn’t natural. It may not be cancer, but women should let a doctor test to find out what it is.

• Teenagers should receive the Human Papillomavirus vaccine to prevent gynecologic and anal cancers.

Doctors recommend boys and girls get the vaccine at age 11 or 12 and anytime up to age 26.

The combination of actions, screening, better treatments and vaccinations may help lower deaths from gynecologic cancers, she said.

While Mississippi has about an average number of new cases of cancer annually, the deaths from them are higher than the national average. That’s in part because cancer has advanced before women seek help, Ridgway said.

According to records compiled by the Mississippi Cancer Registry, of the 139 cervical cancers diagnosed in 2016 – the latest year for which verified information is available – almost half, 73, were diagnosed in a late stage.

The registry shows that for 2016, Mississippi hospitals reported the following for gynecologic cancer incidence (number diagnosed) and mortality (number who died of the given disease):

Cancer                                        Incidence                                   Mortality

Ovarian                                      134                                               121

Cervical                                      139                                                 55

Vulva                                             63                                                 14

Uterine                                       564                                                 88

Vagina                                          14                                                   6

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