Ovarian cancer is still one of the most frequently diagnosed cancers in Polish women. Every year, about 4 people hear the diagnosis. women. – 70–75 percent of patients come to us in the advanced stage of the disease – alarms prof. Anita Chudecka-Głaz. What are the symptoms of the disease? How is ovarian cancer treated now?
- Ovarian cancer most often occurs in postmenopausal women, but in patients with a BRCA1 / 2 mutation it may attack much sooner.
- What should worry us? – The symptoms are initially nonspecific: digestive and urinary system ailments, flatulence, a feeling of fullness after eating – says the expert
- Prof. Anita Chudecka-Głaz explains what are currently available treatment options for this cancer
- You can find more such stories on the TvoiLokony home page
Journalists for Health Association: How common is ovarian cancer?
Prof. Anita Chudecka-Głaz: Annually, around 295 thousand people suffer from illness in the world. women, and deaths are approx. 180 thousand. (Globocan, 2018). In Poland, we had 3770 cases and 2670 deaths back then. Ovarian cancer ranks fifth in terms of cancer incidence in women and accounts for about 4 percent of all cancer incidence in women. In Europe, we occupy a high 4th or 5th position in this respect. More than 50 percent are postmenopausal patients (on average around 60-63 years of age). Women with the BRCA1 / 2 mutation fall ill at a younger age than the general population.
What are the specific and non-specific symptoms of ovarian cancer?
In the early stage of the disease development, the symptoms are nonspecific: gastrointestinal and urinary system ailments, flatulence, a feeling of fullness after eating. If, especially in postmenopausal age, they persist for six months and occur more than a dozen times a month, there is a high probability (50–60 percent) that they may be caused by ovarian cancer.
Specific symptoms are visible only in the advanced stage of the neoplastic process. The most characteristic is ascites.
How is ovarian cancer diagnosed?
Initially based on imaging tests: ultrasound and computed tomography. Complementary tests may include magnetic resonance imaging or tumor markers. However, the final diagnosis is made only after a histopathological examination.
How much does the prognosis depend on the severity of the disease at the time of diagnosis?
70–75 percent of patients come to us with advanced disease (stage III – IV). The prognosis is then very serious and the chances of a complete recovery are slim. On the other hand, the detection of the disease in stage I or II (usually it is random), gives a better chance of survival.
Optimal treatment results are achieved by surgical removal of all neoplastic lesions visible to the surgeon’s eye, followed by chemotherapy. We hope that thanks to the use of PARP inhibitors in maintenance treatment after the first-line treatment, not only will the patients’ survival time significantly improve, but also their chances of complete recovery.
What’s up regarding ovarian cancer treatment?
A lot is happening in the world, there are new results of research related to PARP inhibitors – a new, revolutionary group of molecularly targeted drugs. The results of these studies are becoming more and more promising.
Do they translate into progress in the treatment of ovarian cancer in Poland?
Unfortunately, not entirely. Since the introduction in 2016 of one drug program for patients with BRCA1 / 2 mutation and relapse of the disease – nothing has changed. We miss, among others the possible use of PARP inhibitors in the treatment of relapses in all patients with ovarian cancer, regardless of their molecular status. It is a pity that our patients do not have access to important drugs registered in Europe, because there is no reimbursement.
How is the health situation of women with the BRCA gene mutation different from those who do not?
Patients with the BRCA1 / 2 gene mutation are in a better position because they have access (reimbursement) to the only drug program with a PARP inhibitor in the case of relapses.
On the other hand, they do not have access to this treatment in the first line of treatment, so right after the end of the first line of chemotherapy – despite the European registration and the excellent results of the research recently shown at the ESMO (European Society of Clinical Oncology) congress. Patients without BRCA1 / 2 gene mutation are at a disadvantage because they have no access to PARP inhibitors reimbursement at all – neither in the first-line treatment, nor in relapses.
What is the relationship between a mutation in the BRCA gene and the risk of developing ovarian cancer?
Patients with a BRCA mutation have a much greater risk of developing this type of cancer than women in the general population, where it is 1-1,5 percent. The risk is 1–25 percent in women with the BRCA60 mutation, and 2–11 percent in women with the BRCA27 mutation.
Why do women without the BRCA1 / 2 mutation have access to treatment with PARP inhibitors?
Theoretically they have, because niraparib is a drug registered in Europe and you can individually apply for RDTL (Emergency Access to Drug Technologies) or pay from your own funds. The monthly cost of treatment, however, is 20-30 thousand. zlotys. I have never met a patient who could afford such an expensive therapy. As long as there is no reimbursement by the National Health Fund under the drug program, this availability will be practically zero.
What are the benefits of using PARP inhibitors?
When these drugs entered the world market in 2014, they were intended mainly for the treatment of cancer relapses. However, subsequent research results showed great benefits from their earlier application – right after the first-line chemotherapy. Recent international results of the SOLO 1 study show that patients with BRCA mutation treated with olaparib had an average disease-free period of 56 months and 42 months longer than in the group that did not receive such treatment. These women could lead a normal life, go to work, raise children or grandchildren. So we fight for great things: to extend the lives of our patients, and in the long run, maybe even to cure them.
Is the economic aspect also important here?
Of course. If patients use a PARP inhibitor after first-line chemotherapy, treatment lasts for 2-3 years. And if they take it only when the disease comes back, it can take up to 5 years. If they had been given a PARP inhibitor right after their first line of chemotherapy, their treatment would have been much cheaper.
What is the availability of PARP inhibitors in other European countries?
In 26 countries, olaparib is registered for patients with a BRCA gene mutation in relapse, and Poland is one of them. When it comes to registration after first-line treatment, 19 countries have such registration, we do not have it.
Another drug, niraparib, is approved for patients with and without BRCA mutation for the treatment of relapses. There are 13 countries with reimbursement in such an indication in Europe, there are no Poland among them – niraparib is not reimbursed in Poland. So we are fighting for the first line for olaparib and for the second line for niraparib. We are expecting post-first-line approval of niraparib in Europe soon, based on the results of the PRIMA study. Another point that will need to be taken care of. Another chance for patients.
Gynecologist oncologist, Head of the Department of Surgical Gynecology and Gynecological Oncology of Adults and Girls of the Independent Public Clinical Hospital No. 2 of the Pomeranian Medical University in Szczecin
Authorized press interview prepared by the Journalists for Health Association in connection with the 2020th Polish National Conference “Polish Woman in Europe”, October XNUMX.
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