In our last instalment, we discussed the vast array of types of ovarian cancers, along with their survival rates. This instalment, on a more hopeful note, will look at the current available treatment options and some potential solutions which are currently in development.

Risk factors
There are multiple factors that can increase the risk of developing ovarian cancer and a few actions you can take to protect against it.

Family history – This plays a big role in cancer development, so it is important to know if anyone in your family has had cancer before.

Menstruation – The risk of developing ovarian cancer is affected by how many periods one has in their life. Decreasing the amount of periods one has throughout their life, whether through medication or naturally, will reduce risk by decreasing the number of menstrual cycles the body goes through. People who start their first period at a later age or have the menopause at an earlier age will naturally have fewer menstrual periods for their bodies to go through.

Oral contraceptive pill – Using oral contraceptives can also decrease your risk, with greater the protection the longer the pills are taken. This decreased risk can reportedly last up to 30 years after stopping. The oral contraceptive pill is also associated with reduced risk of endometrial and colorectal cancers, although the COC pill has shown a slight increase in risk for breast cancer.

 Tubal ligation (“Sterilisation” / “Having your tubes tied” – This procedure can also reduce your risk of developing ovarian cancer.

As with most cancers, maintaining a healthy weight through diet and movement and not smoking will also reduce your risk. In the UK, you can contact your NHS GP for support with both quitting smoking and reaching, or maintaining, a healthy weight.

Current Therapy Options
Treatment options vary depending on the stage the cancer is diagnosed at, where it is, the size and type and also the patient’s overall health. The most common treatments are surgery and chemotherapy. There are other options including radiotherapy, targeted medications and hormone therapy, depending on the type of ovarian cancer.

Chemotherapy and surgery are often used together. Patients could have “neoadjuvant chemotherapy”, which involves receiving chemotherapy to reduce the tumour to a size where it can be safely surgically removed, then usually the patient would have more cycles after surgery (called “adjuvant” chemotherapy) to ensure any remaining cancer cells are fully destroyed. Sometimes surgery would be performed before any chemotherapy is given, depending on the clinical situation.

Targeted therapies can be used for some types of advanced ovarian cancers or cancers that have come back. PARP inhibitors are oral medications that block the poly-ADP ribose polymerase (PARP) enzyme, preventing cancer cells from repairing their DNA. This type of targeted therapy is highly effective in cancers with BRCA mutations, including ovarian, breast, prostate and pancreatic cancers.

Radiotherapy is often used as a palliative measure in advanced cases or in conjunction with other methods rather than a standalone treatment. Occasionally, it can be used to treat recurrent, isolated or in specific cases of early-stage cancers. The challenge with this treatment method is keeping the radiation dose to surrounding normal tissue to a safe level while delivering a sufficient dose to tumour cells. There is also a small but present risk of radiation-induced cancer which must be considered. There are currently trials exploring the combination of radiation and immunotherapy in ovarian cancer which may show improved response rates compared to applying the treatments individually. Targeted treatments, such as PARP inhibitors, alongside radiotherapy has already been evaluated positively in early phase trials of other tumour types and could also be a future direction of study for ovarian cancers.

Investigational products (potential treatments in development)

In the UK, there is currently research into an ovarian cancer vaccination called OvarianVax. It has not yet reached clinical trials but has produced promising early-stage research. Scientists have discovered that there are immune cells in the fallopian tubes with the capacity to ‘remember’ cancer cells. The project proposes that these cells could be trained to recognise ovarian cancer before ever experiencing it. With the right funding, these scientists predict clinical trials (for people with BRCA mutations) could be underway in less than 5 years.

CAR-T cell therapy is a particularly interesting treatment option on the horizon. Chimeric antigen receptor T-cell (CAR-T) therapies are an evolving, investigational immunotherapy which genetically modifies patient’s T-cells to recognise and destroy cancer cells. They have already seen dramatic success in the treatment of hematologic malignancies (blood cancers) which has led to their investigation in the treatment of solid tumours, such as ovarian cancer. Since ovarian cancers are often confined to the abdomen, a treatment which can be administered locally would be ideal to contain and minimise side effects elsewhere. Scientists at Standford have already treated 6 patients who have shown promising results and revealed side effects that we can now recognise and prepare for. In the future, some scientists are predicting this treatment could be customised based on tumour characteristics – essentially personalised cancer treatment – which would make treatment vastly more effective.

The Future…

The complexities of ovarian cancer demand not just further research, but multifaceted treatment strategies. Since early diagnosis is not as common in ovarian cancer as it is with other cancers, it is sometimes very difficult – and even impossible – to treat. With more advanced stages of ovarian cancer, treatments will aim to limit the cancer, relieve you of its symptoms and prolong your life.  During this awareness month (March), encourage your friends and relatives to educate themselves about the symptoms and risk factors of this disease. We are striving to improve treatment options and efficacy but catching and diagnosing cancer early is the best way to ensure you get the most effective treatment possible. Happy Ovarian Cancer Awareness Month!