Ovarian Cancer

Ovarian Cancer

Advances in treatment and an improved understanding of ovarian cancer have led to longer lives and better quality of life for women with the disease.

The breakthrough discovery that specific gene mutations – in the BRCA 1 and 2 genes – increase a woman's risk for ovarian and breast cancer has led to important risk-reducing strategies. Additionally, recent studies have shown that ovarian cancer is not one disease, but a spectrum of related diseases with unique genetic characteristics, creating the potential for developing more effective, personalized treatment regimens. 

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2010

Bevacizumab significantly delays progression of advanced ovarian cancer

Bevacizumab significantly delays progression of advanced ovarian cancer

A large study finds that adding the targeted drug bevacizumab (Avastin) to initial chemotherapy treatment, and then using it as longer term "maintenance" therapy, significantly slows the spread of the disease in women with cancer in their ovaries and surrounding tissue. Bevacizumab is designed to interfere with the growth of blood vessels needed to fuel a tumor's growth – a process called angiogenesis. The drug continues to be studied to determine its optimal use and whether it actually extends the lives of women with ovarian cancer.

Pre-surgery chemotherapy proven an effective option for women with advanced ovarian cancer

Pre-surgery chemotherapy proven an effective option for women with advanced ovarian cancer

Major European trial reports that giving chemotherapy prior to surgery (called neo-adjuvant chemotherapy) or after surgery (called adjuvant chemotherapy) is equally effective in women with advanced ovarian cancer. These results resolve long-standing debate and provide an important treatment alternative, particularly for women with larger tumors. In this group, giving chemotherapy first can shrink the tumors so that less extensive surgery is needed later on in the course of therapy.

Regular CA125 testing to monitor for ovarian cancer recurrence is questioned

Regular CA125 testing to monitor for ovarian cancer recurrence is questioned

A major study suggests that women who have completed ovarian cancer treatment may not need frequent CA125 blood tests to monitor for early signs of disease recurrence. (CA125 is a protein found at elevated levels in the blood of women with ovarian cancer and other conditions to track response to treatment). The study finds that overall survival is similar between patients who restart cancer treatment based on recurrence detected by regular CA125 testing and those who restart treatment when physical symptoms of recurrence arise. Debate continues over the implications of these findings and whether CA125 testing is justified in these patients.

2009

Preventive surgery confirmed to reduce breast and ovarian cancer risk in women with BRCA gene mutations

Preventive surgery confirmed to reduce breast and ovarian cancer risk in women with BRCA gene mutations

A major review of previously published studies confirms that surgical removal of the ovaries and fallopian tubes in healthy premenopausal women with BRCA gene mutations reduces the risk of breast cancer by 51 percent and the risk of ovarian and fallopian tube cancers by 79 percent. Among postmenopausal women with BRCA gene mutations, this surgery is found to significantly reduce the incidence of ovarian cancer but not breast cancer.

Without the surgery, women with inherited mutations in the two BRCA genes have up to an 84 percent lifetime risk of breast cancer and up to a 46 percent risk of ovarian and fallopian tube cancers. With these data, women with these mutations have a proven option for reducing their cancer risk, although it comes with many side effects (including early-onset menopause) and prevents women of child-bearing age from having children.

2008

Researchers identify at least two ovarian cancer subtypes

Researchers identify at least two ovarian cancer subtypes

Researchers begin showing that ovarian cancer is not one disease, but many. In particular, researchers identify two types of ovarian cancer tumors, called low malignant potential and low grade ovarian tumors and poorly differentiated tumors, which are especially unique. The former tends to be slow-growing, whereas the latter is far more aggressive. These findings pave the way for research on personalized regimens for each subtype, with the goal of sparing patients with less-aggressive tumors from potentially unnecessary treatment and providing them with more effective therapies.

2006

Direct chemotherapy approach increases survival

Direct chemotherapy approach increases survival

Researchers report that adding intraperitoneal chemotherapy – delivering chemotherapy directly into the abdomen through a catheter – to intravenous chemotherapy following surgery extends survival by over a year for women with advanced ovarian cancer, compared to surgery and intravenous chemotherapy alone. This report confirms two earlier studies and based on the combined findings, the National Cancer Institute encourages physicians to discuss the newer approach with certain patients with advanced disease. This combination regimen causes more side effects than intravenous chemotherapy alone, including some that are life-threatening, so researchers continue to study lower-dose and alternative drug approaches that provide may provide similar benefits with fewer side effects.

Researchers find some ovarian cancers begin in the fallopian tubes

Researchers find some ovarian cancers begin in the fallopian tubes

After assessing tissue samples from women with BRCA gene mutations who had their ovaries and fallopian tubes surgically removed to reduce their cancer risk, researchers discover signs that some ovarian cancers may actually begin in the fallopian tubes and spread to the ovaries. (Women with BRCA gene mutations have a significantly higher risk of developing ovarian and breast cancers, and some choose to undergo preventive surgery.) These fallopian tube cancers, called tubal intraepithelial carcinomas, have different characteristics than cancers arising in the ovaries, suggesting that traditional ovarian cancer therapy may not be the best option. This poses an additional challenge for cancer screening, since cancers that arise in the fallopian tubes are even harder to detect than ovarian cancers, which can sometimes be detected with a pelvic ultrasound.

2005

Researchers work to decode the ovarian cancer genome

2003

New chemotherapy regimen – docetaxel and paclitaxel – provides important treatment option

New chemotherapy regimen – docetaxel and paclitaxel – provides important treatment option

A large study finds that combination chemotherapy with docetaxel (Taxotere) and carboplatin (Paraplatin, Paraplat) is as effective as the standard paclitaxel (Taxol) and carboplatin regimen for newly diagnosed, advanced ovarian cancer. The docetaxel combination has different side effects than the paclitaxel combination, offering patients a potential treatment alternative. However, docetaxel is not FDA approved for ovarian cancer and has not been widely used for this purpose in the United States.

1999

FDA approves liposomal doxorubicin for advanced ovarian cancer

FDA approves liposomal doxorubicin for advanced ovarian cancer

Liposomal doxorubicin (Doxil) receives accelerated FDA approval to treat advanced ovarian cancer that has progressed after prior treatment. The drug is unique because the active chemotherapy agent is encased in a microscopic fat bubble that releases the drug at the tumor site, delivering more of the chemotherapy directly to the tumor and less to other parts of the body, thereby limiting side effects. Full approval is granted in 2005 based on follow-up studies showing that the drug shrinks ovarian tumors and extends survival compared to standard topotecan (Hycamptin) chemotherapy. By the end of the 1990s, patients with advanced ovarian cancer have a growing number of chemotherapy options to select from.

1996

New chemotherapy drug for advanced ovarian cancer

1994

BRCA1 and BRCA2 gene mutations linked to increased breast cancer risk

BRCA1 and BRCA2 gene mutations linked to increased breast cancer risk

Researchers discover that women who have mutations in the genes known as BRCA1 and BRCA2 have a 50 to 85 percent increased risk of developing breast and ovarian cancers. These mutations are found to be particularly common among women of Ashkenazi Jewish descent. The identification of this important genetic cancer risk factor enables women with these mutations to undergo more frequent screening, and in some cases to undergo preventive surgical removal of the breasts, ovaries or both. Preventive use of tamoxifen (Novaldex) or raloxifene (Evista) becomes an additional option after the drugs are proven effective for this purpose in the following years.

1992

Taxanes emerge as vital chemotherapy option for ovarian, breast cancer

Taxanes emerge as vital chemotherapy option for ovarian, breast cancer

A new family of treatments debuts with the FDA approval of paclitaxel (Taxol) for advanced ovarian cancer. The drug receives one of the fastest-ever approvals, on the heels of data showing it shrinks ovarian tumors by more than half in many women who had stopped responding to all other therapies. Later studies show it extends survival by over a year when used as an initial therapy for advanced ovarian cancer, along with the chemotherapy drug cisplatin. This approach is later replaced by a regimen involving paclitaxel and another chemotherapy drug, called carboplatin (Paraplatin, Paraplat), which results in fewer side effects.

Over the next decade, paclitaxel also proves effective for all stages of breast cancer – both extending lives and delaying disease progression compared to existing therapies. The drug is derived from the bark of a yew tree, and is the product of a field of research exploring 'natural' products for a range of diseases. Until drugmakers discovered a synthetic method for producing the drug, there was widespread concern that the natural resources needed to produce the drug would not meet demand.

1989

FDA approves carboplatin for ovarian cancer

FDA approves carboplatin for ovarian cancer

The chemotherapy drug carboplatin (Paraplatin, Paraplat) becomes available as a second line of therapy for ovarian cancer, after research shows that it promotes tumor shrinkage. It becomes available as an initial therapy two years later, after being shown to increase survival. This approval offers an effective treatment alternative for patients who cannot tolerate the standard chemotherapy drug, cisplatin, which carries significant side effects. It later becomes the preferred initial chemotherapy, after studies show it is as effective as cisplatin but causes fewer side effects.

1984

Scientists discover "biomarker" tied to ovarian cancer – CA-125

Scientists discover "biomarker" tied to ovarian cancer – CA-125

Researchers determine that levels of a specific protein in the blood, CA-125, are linked to ovarian cancer. The test soon becomes routinely used in women with ovarian cancer to track their response to treatment and to monitor for recurrence. However, efforts to use CA125 testing for early detection or to screen for ovarian cancer in healthy women have proven difficult, because CA-125 levels can rise for reasons unrelated to ovarian cancer (such as liver cirrhosis, menstruation and pregnancy). Large-scale studies on the appropriate use of this marker continue today.

1981

Oral contraceptives found to cut ovarian cancer risk

Oral contraceptives found to cut ovarian cancer risk

Studies first begin suggesting that oral contraceptive use lowers the risk of developing ovarian cancer. Evidence continues to accumulate over the coming years, and in 2008, a review of 45 published studies concludes that "the pill" lowers ovarian cancer risk by 20 percent for every five years it is used. Authors of the 2008 study estimate that oral contraceptives had prevented some 200,000 ovarian cancers and 100,000 deaths worldwide in the 50 years since oral contraceptives were introduced, and may currently prevent 30,000 new cases of ovarian cancer each year.

1978

Cisplatin approved for advanced ovarian cancer

Cisplatin approved for advanced ovarian cancer

The chemotherapy drug cisplatin becomes available as a treatment for newly-diagnosed ovarian cancer, as well as ovarian cancer that persists after initial therapy, after trials show the drug decreases the size of patients' tumors. Later research leads to the development of new and more effective combination chemotherapy regimens that utilize cisplatin, such as cyclophosphamide (Cytoxan) plus cisplatin and a regimen called CHAP, which combines the drugs doxorubicin (Adriamycin), hexamethylmelamine, cyclophosphamide and cisplatin.

First effective combination chemotherapy regimen for ovarian cancer

First effective combination chemotherapy regimen for ovarian cancer

Researchers led by Robert Young develop a combination chemotherapy regimen for advanced ovarian cancer, known as HEXACAF. This regimen combines the drugs hexamethylmelamine, cyclophosphamide (Cytoxan), methotrexate and 5-fluorouracil, each of which was already known to have an effect on ovarian cancer tumors. The combined regimen is found to benefit more patients, cause greater tumor shrinkage and extend survival by more than 12 months over single-drug chemotherapy with melphalan (Alkeran), an earlier drug commonly used to treat advanced ovarian cancer. However, this new combination regimen causes significantly more side effects.

1933

Early ovarian cancer treatment

Early ovarian cancer treatment

Prior to the 1970s, most ovarian cancers were treated with alkylating agents, involving a family of chemotherapy drugs such as melphalan (Alkeran), chlorambucil (Leukeran) and cyclophosphamide (Cytoxan). Surgery and radiation were also used, either alone or in combination with chemotherapy. These approaches were just modestly effective: 5-year survival for advanced-stage disease was 7 percent.