Ovarian CancerYour Guide to Managing Ovarian Cancer

Why the Latest Screening Tests and Treatments Offer Hope for Ovarian Cancer

Research is finding new ways to prolong the lives of women with ovarian cancer.
Why the Latest Screening Tests and Treatments Offer Hope for Ovarian Cancer
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Updated on December 20, 2024
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When 58-year-old Karen Howley LaCamera went to the emergency room in January 2018 with acute pain in her abdomen, she thought she was having another gallbladder attack. The doctors in the ER ordered a CT scan and told her she’d probably need surgery to remove her gallbladder if things didn’t improve. She was released later that night. But when she got home, the ER doctor called to tell her that the problem wasn’t her gallbladder. It was a tumor the size of an orange sitting on her ovary.

Several tests and surgeries and a biopsy later, LaCamera, who lives in Sudbury, Massachusetts, was diagnosed with advanced ovarian cancer. “I was just like, Wow,” she recalls. “When I look back, I think about the symptoms I disregarded.”

LaCamera says she “always felt discomfort and excused it.” She had frequent urination and pain in her abdomen, pelvis, and back. She also had bloating, or as she called it, a tummy roll. “No matter what I did for exercise, I couldn’t get rid of it,” she says. She thought it was just because she was getting older.

When LaCamera went in for surgery, doctors found that the cancer had spread to 11 organs.

LaCamera isn’t alone in missing the symptoms of ovarian cancer.

“The common symptoms of ovarian cancer are nondescript,” says B.J. Rimel, MD, director of cancer clinical trials and an associate professor of obstetrics and gynecology in the division of gynecologic oncology at Cedars-Sinai in Los Angeles.

That’s why the cancer is usually not caught until later stages, when it can be deadly. “It’s a really tricky thing. My heart breaks for all these women who go from doctor to doctor, [looking for answers],” Dr. Rimel says.

Ovarian cancer is the second most common gynecologic cancer in the United States. It also accounts for more deaths than any other cancer of the female reproductive system.

Catching Ovarian Cancer Early

Research has led to better ways to detect high-risk gene mutations and assess a woman’s ovarian cancer risk. If caught at stage 1 (localized), the five-year survival rate for ovarian cancer is about 93 to 97 percent, depending on the type of ovarian cancer. If the cancer has spread to distant parts of the body, the survival rate drops to 31 to 71 percent.

Currently, the CA-125 blood test, which measures the amount of the protein cancer antigen 125 in the blood, isn't accurate enough to screen for ovarian cancer. That’s because conditions such as menstruation, pregnancy, and uterine fibroids can increase the level of the CA-125 protein and lead to false-positive results. The test is only reliable for monitoring women with known ovarian cancer, says Rimel.

But a research study has shown that a screening blood test for ovarian cancer developed by Brigham and Women’s Hospital and the Dana-Farber Cancer Institute in Boston is more sensitive and specific, with far fewer false positives. “It could be a game changer in detecting early-stage ovarian cancer,” says Dipanjan Chowdhury, PhD, chief of the division of radiation and genomic stability in the department of radiation oncology at Dana-Farber and a coauthor of the study.

The test monitors part of the genome known as microRNA, which are secreted into the blood by cancerous or precancerous cells. Specific patterns of microRNA can be used to detect ovarian cancer. With blood samples collected at Dana-Farber and other institutions, from about 1,000 people, Dr. Chowdhury says the test was able to diagnose the disease 99.1 percent of the time.

But an accuracy rate of 99.9 percent or higher is what’s needed, Chowdhury says, to test the general population. “If you test 100,000 women with this accuracy [of 99.1 percent], we’re going to falsely diagnose 890 women with this test right now. That’s not okay. It is too high.” The ongoing MiDe Study at the Center for BRCA and Related Genes Clinical Trials and Research at Dana-Farber aims to check the accuracy of the test on high-risk patients and potentially improve it.

Additional Research to Improve Ovarian Cancer Diagnosis

One promising study showed that the biomarker detected by the microRNA blood test may be even more accurately detected in urine.

There are also a host of other molecular biomarkers still being considered for diagnosing ovarian cancer, according to a review, which noted that specific combinations of biomarkers have also been shown to have better diagnostic performance:

  • Human epididymis secretory protein (HE4): Overexpressed in ovarian cancer tissue, not in the surface epithelium, or outmost layer of the ovaries
  • Folate receptor alpha (FOLR1): Found in 76 percent of women with late-stage ovarian cancer
  • CA72-4: Detects types of ovarian cancer missed by CA-125 and HE4
  • Transthyretin (TTR): Detects early stages of ovarian cancer
By examining genetic differences between cancer cells within the same tumor, scientists can home in on the best treatment.

Researchers have also developed a new ultrasound scoring system that may be an easier way to determine whether tumors in the fallopian tubes and ovaries are potentially cancerous and need a further workup, says Deborah Baumgarten, MD, a diagnostic radiologist at Mayo Clinic in Jacksonville, Florida.

“This can potentially spare women from having unnecessary surgery,” says Dr. Baumgarten.

When investigators tested the system in 878 women at average risk of ovarian cancer, they found it was sensitive enough to pick up malignancies 93 percent of the time, with 73.1 percent accuracy.

And a review found that adding a CT scan, which provides additional information, such as detailed anatomical visualization, assessment of lymph node involvement, and the evaluation of metastases, improved the accuracy of ultrasound images. Ultrasound can also be combined with biomarkers such as CA-125 to increase the sensitivity of early-stage ovarian cancer detection.

Fighting a Barrier in Treatment: Drug Resistance

People undergoing treatment, such as LaCamera, can sometimes develop a resistance to common chemotherapies, targeted therapies, and immunotherapies.

While platinum-based chemotherapy is the first line of treatment for most ovarian cancers, it doesn’t always work, and the cancer either progresses or reoccurs. Drug resistance in chemotherapy is one of the main obstacles to beating cancer, because people who develop a drug resistance usually have a cancer recurrence very quickly, according to Alessandro Santin, MD, cochief of gynecologic oncology and the clinical research team leader in gynecologic oncology at Yale Cancer Center, in New Haven, Connecticut. That’s why he and other researchers across the country are evaluating the use of novel drug combinations to treat ovarian cancer when other drugs fail.

Dr. Santin and his colleagues studied the effectiveness of combining the chemotherapy drugs ixabepilone and bevacizumab, compared with ixabepilone alone, for platinum-resistant ovarian cancer.

They noticed an improvement in the time it took for the cancer to progress or worsen and in the overall survival rate in the 76 study participants who received the combination therapy, compared with the 37 who received ixabepilone alone. Cancer in the combination therapy group did not grow or spread for 5.5 months, versus 2.2 months in the single therapy group, while the overall survival rates were 10 months and 6 months, respectively. “We’re not going to cure these patients. We want to prolong life here,” says Santin.

Other research looked at the safety and efficacy of camrelizumab plus famitinib in 37 people with recurrent ovarian cancer and various degrees of resistance to standard platinum-based chemotherapies. Nine participants (24.3 percent) had a positive response to the combination therapy. Either it shrank their tumors or the cancer remained stable while on the medication. Though the results were “encouraging” and side effects were “manageable,” the drug combination needs to be tested against individuals who do not receive the medication.

The drawback of chemotherapy is that it attacks not only cancer cells, but also normal cells. Targeted drug conjugates are another area of research where chemotherapy drugs can selectively kill cancer cells while leaving healthy cells alone. These drugs are activated by the microenvironments where specific tumors are found.

In 2022, the antibody drug conjugate (ADC) mirvetuximab soravtansine was approved for ovarian cancer resistant to first-line chemotherapy. This drug targets FOLR1 (an overexpressed antigen found in 90 percent of women with ovarian cancer). This is an area of rapidly expanding research, with more than 20 ADCs in clinical trials.

Finding the Treatment That Works

Since her diagnosis in 2018, LaCamera has had two surgeries and five different chemotherapies, including two clinical trial therapies. It was in a research study that she was enrolled in from February to September 2020 that she experienced encouraging results.

 She had surgery the following month to remove a residual tumor and went into remission in early 2021.

“That was the magic one,” she says.

Without the help of her doctors identifying a suitable clinical trial, LaCamera says she wouldn’t be alive today. “But we need better detection to beat this insidious disease.”

The Takeaway

  • Ovarian cancer is the second most common gynecologic cancer in the United States, but it often goes undiagnosed until later stages, when it can be particularly deadly.
  • Research has led to improved detection of high-risk gene mutations to better assess ovarian cancer risk in women.
  • Ongoing clinical trials and other research continue to produce innovations to further improve the diagnosis and treatment of ovarian cancer.
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Resources
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