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Ovarian cancer is scary to begin with — hard to detect early and often fatal. It's the worst-case scenario I imagine most often during any pelvic or abdominal weirdness. And last week brought word of disturbing findings, summed up in The New York Times as "widespread failure among doctors to follow clinical guidelines for treating ovarian cancer, which kills 15,000 women a year in this country."
The study found that among women with advanced ovarian cancer, just 25% of those who received substandard care survived five years, compared to 35% of the women whose care conformed with the guidelines.
The Boston Globe's Deb Kotz runs through the major points of the findings here, but for a couple of lingering questions I spoke with Dr. Ursula Matulonis, an expert on ovarian cancer at the Dana-Farber Cancer Institute. Our conversation, lightly edited:
CG: Through no marketing effort of its own, Dana-Farber has just gotten the best imaginable advertising for the sort of specialized cancer center it represents. But not everyone can be treated at Dana-Farber and Sloan-Kettering. Can we not advocate for ourselves or patients we love elsewhere?
Dr. Matulonis: I would say access to a comprehensive cancer center is exactly what you need. You don’t have to have all the care here, but you do need entry into a system where you have the expertise. That runs from the surgeon you see for advanced ovarian cancer, who makes the judgment, ‘Can I do up-front site reductive surgery at this moment or does this patient need chemotherapy first?’
What’s promising about ovarian cancer is that it’s getting the attention that breast cancer has been receiving for the past two decades
Post-surgery, pathology expertise is important. And then, obviously, the medical oncologist, that’s where I come in: ‘Are the chemo doses appropriate? Is the patient getting intraperitoneal chemotherapy or is that not the right treatment?’ That actually is very important and all patients with advanced ovarian cancer should have it as long as all visible cancer or close to it has been removed, because the study shows that if you don’t get that, your survival is worse. So that’s important.
I think women with ovarian cancer need to be advocates for themselves, and the problem is that the diagnosis can happen so quickly. Women need to understand what the symptoms are, and if they really do think they have ovarian cancer, they need to see specialists who deal with it every single day, because that can have an impact on their survival. It’s such a simple thing, access to care, but so important. Even if the cancer is not advanced, that's important.
So does this study highlight a growing disparity between 'have' and 'have not' cancer treatment? I've been wondering if such gaps will grow as cancer care advances in its use of fancy genomic technology, analyzing the genes of various tumors and matching treatments to those genes...
This particular study has nothing to do with fancy genomic cancer treatment. This is basic cancer treatment that the National Comprehensive Cancer Network has stipulated that ovarian cancer patients should have access to. There's nothing fancy about it.
In answer to your question, with the interpretation of the genomics of cancer, it may be an issue moving forward. Right now we're still in a real research phase, especially with ovarian cancer in terms of mutation analysis.
Access to clinical trials for some patients may be difficult; it's important to have access to clinical trials where you do have medications that we know are going to be beneficial for patients, and based upon maybe the type of ovarian cancer, or whatever cancer the patient has, we know that the patient will probably benefit from a drug, or even sometimes the genetics of it.
Where it comes into a disparity is the access to clinical trials where you do have medications that we know are going to be good for patients, and based upon maybe the type of ovarian cancer, or whatever cancer it is, we know that the patient will probably benefit from a drug, or even sometimes the genetics of it.
The study was disturbing news about a frightening cancer — could you possibly just give me some good news about ovarian cancer? Are attempts at earlier detection getting anywhere?
The early detection piece is not particularly promising at this point. CA-125 [a cancer antigen] and pelvic ultrasound haven't been able to pick up on early diagnosis. It picks up cancer but it's more late stage.
What’s promising about ovarian cancer is that it’s getting the attention that breast cancer has been receiving for the past two decades, and as breast cancer has gotten more publicity and more funding, you’ve seen really impressive strides made in diagnosis and treatment, understanding the biology of breast cancer. And my hope is that as ovarian cancer awareness grows, more funding will be directed toward it. As we better understand the genetics of this tumor, we'll be able to treat ovarian cancer better.
And even in the past five years, we’ve seen development of an exciting group of drugs called “PARP inhibitors,” and they really are able to better treat cancers that have problems repairing their DNA. Certain types of cancer — known as serous, specific high-grade serous cancers — have problems repairing their DNA. It’s a kind of a hallmark of this particular subtype of ovarian cancer. Just in the past five years there have been more studies on these drugs, PARP inhibitors, in ovarian cancer, and they’re particularly helpful for women with BRCA-driven cancers. But even in another subset of women who may not have those mutations, there’s something wrong with BRCA, which might mean these drugs could help.
They’re active drugs in phase 2 clinical trials that include women with recurrent ovarian cancer, and what you’ll see in the next year are phase 3 studies to hopefully get a new drug approved for ovarian cancer. I see that on the horizon.
They're active drugs in phase 2 clinical trials, and what you'll see in the next year are phase 3 studies to hopefully get a new drug approved for ovarian cancer. I see that on the horizon.
What percentage of ovarian cancer patients might that affect?
Probably about 70 percent are high-grade serious cancer.
This program aired on March 19, 2013. The audio for this program is not available.
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