Good and Bad News About Ovarian Cancer

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Two new studies this week have upended some basic assumptions about ovarian cancer, questioning both the survival rate of this dangerous disease and the best type of chemotherapy to improve those survival odds.

First, a new study, led by researchers at Dana-Farber/Brigham and Women’s Cancer Center in Boston, found that a potentially lifesaving treatment for those with advanced ovarian cancer is being used on less than half of patients.

And second, researchers at the University of California, Davis say that an examination of the records of more than 11,000 ovarian cancer patients show that women are surviving much longer than previously thought. While most survival studies stop at five years, the California researchers took a longer look and found that almost a third of patients — including older women with advanced cancer — survive at least 10 years.

“The common belief is that it’s a uniformly fatal disease, but that is not correct. It’s surprising how many women are surviving, even those given a poor prognosis,” study coauthor Gary Leiserowitz, M.D., chief of the division of gynecologic oncology at UC Davis Medical Center, said in an interview. The study was published in the journal of Obstetrics and Gynecology.

The Dana-Farber study examined what’s been called  “the gold standard” for treating women with advanced ovarian cancer: a dual technique that administers chemotherapy drugs directly into the abdomen, where they can be sloshed around to kill any cancer cells remaining after surgery, as well as into a vein, the traditional method.

Nearly a decade ago, the National Cancer Institute issued a “ clinical advisory” urging doctors to use this method on women with stage 3 ovarian cancer, meaning it had spread to the abdomen.

The advisory was issued after clinical trials found that the dual route could extend a woman’s survival by 16 months or more.  Ovarian cancer, which is difficult to detect early, kills more than 14,000 women a year, half of them older than 63.

Nine years after the advisory, researchers looked at how many ovarian cancer patients eligible for the dual technique had actually used it. The surprising result: only 41 percent.

“Tragic,” is how oncologist Maurie Markman, president of medicine and science at Cancer Treatment Centers of America, described the study’s results to the New York Times.

“Disappointing. We need to do much better,” the study’s senior author, David O’Malley, a gynecologic oncologist at the Ohio State University Comprehensive Cancer Center, told AARP.

The study, published in the Journal of Clinical Oncology, also examined whether the dual technique worked as well when used by physicians “in the real world, outside of a clinical trial,” as oncologist and study lead author Alexi Wright of the Dana-Farber Cancer Institute put it.

The researchers looked at 823 women with stage 3 ovarian cancer who were treated at six top cancer centers across the country between 2003 and 2012. Of those who received the dual therapy, 81 percent were alive three years after treatment, compared with 71 percent of those who received chemotherapy only intravenously. The researchers also found that side effects from the dual therapy were less severe than had been reported in the clinical trials.

So why is the technique so underused? The reasons are complex, O’Malley said.

“There may be a bias against the [abdominal infusion technique] among physicians” because it can be difficult to administer and it’s not as convenient as traditional IV chemotherapy, he said. Patients  and physicians also worry that the side effects from the abdominal chemo will be more toxic.

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UC Davis’ Leiserowitz agrees. “There is a lot of discomfort for patients,” he says, and even in the clinical trial, only 42 percent of women could finish all six cycles of abdominal chemo. Still, he notes, women who could tolerate even a few cycles did better than those who got IV chemo alone.

To overcome these challenges, doctors need more more training in how to do the procedure, and “they need to do a better job at educating patients” about the benefits and what to expect, O’Malley said.

Doctors should also realize that the dual regimen can be personalized for each patient, he added. Modifications — such as lower chemo doses, giving patients more fluids and antinausea drugs, and other adjustments — can help patients better tolerate a treatment that could extend their survival.

As for patients, they should seek out a second opinion if they’re unsure about the dual treatment. In addition, it’s important to find a cancer center that specializes in ovarian cancer treatment and to discuss the surgery with an experienced gynecologic oncologist, O’Malley advised.

Photo: Annebaek/iStock

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