Ovarian cancer – entering a new era

World Ovarian Cancer Day 2021

 

“World Ovarian Cancer Day occurs annually on 8 May and is a day to shine a light on the fight against ovarian cancer. As a medical writer and someone who has been impacted by the disease, I am passionate about raising awareness as part of the global effort to improve the survival of women affected by ovarian cancer.”

The earlier symptoms are recognised, the longer women can survive

Ovarian cancer continues to have the highest mortality rate of all gynaecological cancers in the UK and is the fourth most common cause of cancer death overall in women, ranking after breast, lung and bowel cancer [1].

Research has shown that only 4% of women in the UK are very confident about recognising the symptoms of ovarian cancer [1]. This lack of awareness may account for the fact that 75% of women are diagnosed after the cancer has already spread, making treatment challenging [2]. Sadly, only 46% of women survive for 5 years after diagnosis, but with earlier diagnosis this figure has the potential to increase to 90% [1, 3].

Historically, ovarian cancer has been overlooked in awareness campaigns; however, in November 2020, NHS England launched a nationwide cancer awareness drive that included ovarian cancer for the first time. Symptoms were detailed on television, radio, local billboards and social media, with key messages reaching more women than ever before. [4]

The symptom highlighted by the campaign was persistent abdominal bloating. Other signs of ovarian cancer include [5]:

  • Pain or discomfort in the stomach or pelvic region
  • Feeling full quickly when eating
  • Needing to urinate more frequently or more urgently than usual

An exciting new era of personalised treatment

For several years, the focus of research has been on targeted cancer drugs, which specifically target cancer cells and do not affect healthy cells to a great extent (unlike traditional chemotherapy) [6].

In March 2021, NICE approved two targeted drugs – a PARP (Poly (ADP-ribose) polymerase) inhibitor and an anti-angiogenic drug – for combined use in newly diagnosed women with high­grade serous ovarian cancer (the most common type) who have had a good response to platinum chemotherapy. This represents a huge step forward for personalised treatment of the disease. Newly identified tumours will now undergo genomic testing for homologous recombination deficiency (HRD; see below) to ascertain drug sensitivity and it is thought that around 50% of patients will be suitable for this new combined treatment. This represents a huge step forward for more personalised treatment of the disease. [7, 8]

What is HRD?

HRD is an inability of the tumour to repair DNA breaks, effectively making it more difficult for cancer cells to repair themselves which helps to increase the efficiency of PARP inhibitors [7, 8].

What is a PARP inhibitor?

PARP (Poly (ADP-ribose) polymerase) helps repair DNA, including cancer cell DNA, when it becomes damaged. By inhibiting this repair process, PARP inhibitors promote the accumulation of DNA damage, triggering cancer cell death. [9]

What is an anti-angiogenic drug?

Anti-angiogenic drugs reduce microvascular growth of tumour blood vessels, thereby limiting blood supply to the tumour [9].

Clinical trial results

In a Phase III international trial of over 800 patients with advanced ovarian cancer receiving first-line standard therapy, the combined use of the licensed antiangiogenic drug with the licensed PARP inhibitor provided a significant progression-free survival benefit, which was substantial in patients with HRD-positive tumours [10].

The future looks positive

In 2021, the future looks more positive than ever for patients with ovarian cancer. Symptom awareness is being targeted nationally (something that campaigners have fought long and hard for) and, for the first time, a good proportion of patients will know that the treatment they are receiving is likely to be effective from the outset.

So, on World Ovarian Cancer Day 2021, please share this article and be part of the global effort to raise awareness of this devastating disease.

#PowerfulTogether

References

  1. Ovarian Cancer Awareness Month. Facts and figures. Available at: http://ocam.org.uk/ovarian-cancer-facts-and-figures/. Accessed May 2021.
  2. Cancer Network. Ovarian cancer in elderly women. Available at: https://www.cancernetwork.com/view/ovarian-cancer-elderly-women. Accessed May 2021.
  3. Ovarian Cancer Action. Ovarian cancer: The statistics. Available at: https://ovarian.org.uk/ovarian-cancer/ovarian-cancer-statistics. Accessed May 2021.
  4. Target Ovarian Cancer. Achieving awareness for ovarian cancer. Available at: https://targetovariancancer.org.uk/news/achieving-awareness-ovarian-cancer. Accessed May 2021.
  5. National Health Service. Symptoms: Ovarian cancer. Available at: https://www.nhs.uk/conditions/ovarian-cancer/symptoms/. Accessed May 2021.
  6. Targeted cancer therapies. Available at: https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet. Accessed May 2021.
  7. Ovarian Cancer Action. NICE approves a new combination of treatment for women with advanced ovarian cancer. Available at: https://ovarian.org.uk/news-and-blog/news/nice-approves-new-combination-treatment-women-advanced-ovarian-cancer/. Accessed May 2021.
  8. Target Ovarian Cancer. Pioneering drug combination made available. Available at: https://targetovariancancer.org.uk/news/pioneering-drug-combination-made-available. Accessed May 2021.
  9. Ovarian Cancer Action. Targeted therapy for ovarian cancer. Available at: https://ovarian.org.uk/ovarian-cancer/patient-hub/treatment/targeted-therapies-and-ovarian-cancer/#:~:text=Olaparib%20(Lynparza%C2%AE)%20is%20a,it%20can%20prevent%20its%20progression. Accessed May 2021.
  10. Ray-Coquard I, Pautier P, Pignata S et al. Olaparib plus bevacizumab as first-line maintenance in ovarian cancer. New Engl J Med 2019; 381 (25): 2416–2428.

Suzanne BruntAuthor: Suzanne Brunt, Medical Writer, Porterhouse Medical