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Efforts of patients’ associations and scientific societies should now be directed to enabling treatment with PARP inhibitors in all patients with ovarian cancer, regardless of their genetic status and the presence of mutations in the BRCA1 genes, 2. Ovarian cancer may slowly become a chronic disease, but for this it is necessary the possibility of using modern therapies – says prof. Włodzimierz Sawicki, president of the Polish Society of Oncological Gynecology.
Ovarian cancer is one of the most difficult gynecological cancers to diagnose and treat. It does not give any specific symptoms for a long time, which is why in over 70% of cases, it is diagnosed at an advanced stage when it is spread over the entire abdominal cavity, so the prognosis is usually not good. – The problem is dramatic: every day in Poland 10 women learn that they suffer from ovarian cancer; are life and family tragedies. Every year we have 3700 cases and over 2600 deaths; only 30 percent patients survive 5 years from diagnosis – emphasizes prof. Włodzimierz Sawicki, head of the Department and Clinic of Obstetrics, Women’s Diseases and Oncological Gynecology at the Medical Faculty of the Medical University of Warsaw.
Difficult to diagnose and treat
The first symptoms are non-specific and do not indicate cancer: the most common are gastrointestinal complaints, flatulence, abdominal pain, constipation, and a feeling of fullness after eating. – Symptoms are usually not very severe, so a woman often does not even seek help from a doctor, or even from a general practitioner or a gastroenterologist. Certainly, in the case of prolonged problems, a visit to the gynecologist is necessary – says Dr. Anita Chudecka-Głaz, head of the Department of Surgical Gynecology and Gynecological Oncology of Adults and Girls, SPSK 2, Pomeranian Medical University in Szczecin.
Preventive visits to the gynecologist are also necessary, at least once a year. Early diagnosis of the cancer (in the first and second stage of its advancement) gives a chance for its complete cure. However, even adhering to all the rules
prophylactic (gynecological visits, transvaginal ultrasound), it is not enough to detect ovarian cancer early. The reason is that it has no anatomical barriers, so cancer cells spread easily to neighboring organs. There is also no screening test that could detect an ongoing neoplastic process early.
In recent years, however, the “silent killer” – as it is often called ovarian cancer – has a chance for some women to become a chronic disease.
PARP inhibitors: longer remission
– Until recently, treatment of advanced ovarian cancer relied primarily on surgery, sometimes preceded by neoadjuvant chemotherapy, and the administration of post-operative chemotherapy. When a relapse appeared after such treatment, we continued the course of chemotherapy, followed by remission and then relapse again. The cancer at this stage is characterized by consecutive periods of remission and relapse, with shorter periods of remission over time. A breakthrough was the new treatment concept of sustaining remission. It has become possible thanks to new drugs: PARP inhibitors, which significantly affect the extension of the disease-free period, and thus, probably also the extension of overall survival – adds Dr. Anita Chudecka-Głaz.
PARP inhibitors are intended for patients with advanced ovarian cancer, poorly differentiated, sensitive to chemotherapy with platinum analogues. In Poland, one of the PARP inhibitors (olaparib) is already reimbursed both after relapse and in the first line of treatment. – It brought a big change for the patients. Usually, the first relapse occurred after 12 months. With maintenance treatment, the time to relapse is up to 54 months. The problem is that olaparib is only available to patients with a BRCA1, 2 mutation, and only 20-25% have it. women. This means that 75-80 percent. women in Poland have no chance to benefit from this treatment, despite positive studies with another PARP inhibitor: niraparib – emphasizes prof. Sawicki.
Favorable research results
The effectiveness of niraparib has been demonstrated in two clinical trials. The first is the NOVA study that used niraparib for relapse; the second is the PRIMA study: in patients with newly diagnosed ovarian cancer. Both studies included patients with BRCA1 and BRCA2 mutations, patients with other disorders of the homologous recombination pathway, as well as patients without genetic mutations. The NOVA study showed that administration of niraparib increased disease-free survival by more than 15 months in patients with recurrent ovarian cancer.
mutations in the BRCA1 and 2 genes. Patients with other genetic disorders and no molecular disorders also benefited from the treatment. On the other hand, the PRIMA study in women with newly diagnosed ovarian cancer showed that administration of niraparib prolonged the time to disease progression by an average of 5,6 months in all patients, and in those with abnormal DNA repair mechanisms, the time to disease progression increased by more than 11 months. – Although the greatest benefits from the use of niraparib are gained by women with mutations in the BRCA 1 and BRCA 2 genes and with other genetic disorders, this drug also improves the prognosis in patients without molecular changes – emphasizes Prof. Chudecka-Głaz.
Niraparib is already reimbursed in 19 countries today; not in Poland yet. – Today, patients who are unlucky with the presence of mutations in BRCA1, 2 genes are asking how they will be treated, what can be done to delay the relapse. We spread our hands, because the drug is not reimbursed in Poland, and at the same time it costs too much for the patient to buy it herself. Therefore, the efforts of both patient organizations and scientific societies should now be focused on making this therapy available to all patients, regardless of their genetic status – adds Prof. Sawicki.
Normal life despite the disease
Guidelines of the European Society of Clinical Oncology (ESMO), American Society of Clinical Oncology (ASCO) recommend the use of PARP inhibitors as maintenance therapy in patients with ovarian cancer. These are oral therapies, which is a great advantage: the patient comes to the center only for checkups and for the supply of drugs for the next weeks. The treatment is therefore very safe, especially during the COVID-19 epidemic, and with a lower percentage of serious side effects. Women can be socially and professionally active, fulfill themselves at work, lead a normal family life. A longer time of disease remission also means a longer life. Research with PARP inhibitors is relatively new, so we do not yet know what the efficacy will be in terms of overall survival. It can be seen, however, that it will be significantly longer. There has not been such a breakthrough in the treatment of ovarian cancer, such as the use of PARP inhibitors, for decades – admits Prof. Sawicki.
Oncologists’ dream is for advanced ovarian cancer to become a chronic disease that can be controlled by medication and lead a normal life. However, the selection of appropriate therapy for patients requires a lot of knowledge and experience, which is why both experts and patients would like to introduce Ovarian Cancer Units, i.e. centers for comprehensive treatment of ovarian cancer. – In such centers, the patient should be able to diagnose and treat at the highest level: both in terms of surgery, chemotherapy and proper supportive care. This is where gynecologists should refer patients when they suspect ovarian cancer. Work on the new system is carried out by a national consultant in the field of oncological gynecology together with a group of gynecologists-oncologists – says Dr. Anita Chudecka-Głaz.
Access to PARP inhibitors also for patients who do not have mutations in the BRCA1, 2 genes and the improvement of treatment organization are important factors that have a chance to result in the results of ovarian cancer treatment in Poland being the same as in Western European countries, and the disease itself more and more often will indeed be a chronic disease.
Press material containing authorized statements, prepared by the Association of Journalists for Health in connection with the 2th edition of the Quo vadis medicina? Fri, Gynecological neoplasms during SARS-CoV-2021. Rapid diagnosis, modern treatment – a chance for life “, XNUMX.