This Woman's Battle Against Cancer Raises Awareness
Photo source: American Association for Cancer Research
Fighting against cancer is a gigantic battle for anyone who faces it, and it can be hard to even think about anything else during. However, some women are such powerful warriors that they not only fight the fight themselves, but also strive to raise awareness.
Teri's story
Many women in Teri Woodhull's family had breast cancer, so she knew her risk was high. As a result, when she was 30, she decided to have a preventative bilateral mastectomy done to protect herself. Unfortunately, it did not enable her to evade cancer altogether.
Almost eighteen years after she got the mastectomy, Teri was diagnosed with stage 3b high-grade serous epithelial ovarian cancer. At the point of her diagnosis, she learned that she had the BRCA mutation.
Teri explained that she had spent most of her life becoming very educated on the matters of breast cancer, given her history, but she had not known previously of the role BRCA could play in the potential of developing ovarian cancer. Now, Teri wants more women like her to be aware that a history of a BRCA mutation not only influences your odds for breast cancer, but ovarian cancer, too.
Treatments
After her diagnosis, Teri underwent a procedure called debulking surgery, where the tumor is extracted as much as possible. She also took part in a clinical trial for a drug called Avastin and engaged in vigorous chemotherapy. After about ten months, doctors concluded that she no longer showed any signs of the disease.
Dr. Robert L. Coleman, M.D., is the vice chair of clinical research and a professor at the Department of Gynecologic Oncology at the University of Texas MD Anderson Cancer Center in Houston, and he explained why antiangiogenics like Avastin may be particularly effective in certain circumstances, like Teri's, "in multiple clinical scenarios, Avastin, alone and in combination with other chemotherapeutics and biological agents, has demonstrated a significant impact on response, symptom control and survivorship. However, as with most treatment approaches in the disease, resistance and adaptation emerges, driving the great need to understand the effects of treatment in the microenvironment and how to improve efficacy. New anti-angiogenesis drugs and anti-angiogenesis drug combinations are an active area of contemporary research."
However, unfortunately, the cancer didn't stay away for Woodhull. She was being closely monitored after the Avastin clinical trial, and two years after its conclusion cancer was found in her abdominal cavity. In response, she began standard chemotherapy.
During chemotherapy, new masses developed, as depicted by a CT scan. Now, she started seeking clinical trials for PARP inhibitors that she could be a part of. She eventually found a Zejula study in San Francisco. The treatment was supposed to prevent the condition from worsening, sometimes referred to as a "maintenance drug." This time, she found more long-term success. Her tumors shrunk by twenty percent, and the cancer has since been controlled for about a year and a half.
Thomas J. Herzog, M.D., who is a clinical director of the University of Cincinnati Cancer Institute in Ohio explained some of the viewpoints and potential efficacy behind PARP inhibitors, "in essence, I think we need more experience with these and ... how they play out in the real-world use in terms of toxicity, convenience and everything else we consider for patient use. I personally think that costs may end up being a deciding factor ... with respect to PARP inhibitor selection, because from what we know right now ... they behave more similarly than they do differently regarding efficacy. "
There are some side effects behind the inhibitors, such as mood disturbances, blood clots, fatigue, and nausea - especially when taken in large doses or being combined with chemotherapy.
However, many point out that the PARP inhibitor may have an advantage for those who do not have the hereditary BRCA mutations, as some develop certain alterations and DNA repair effects along the line. Swisher is a professor in gynecologic oncology, and also the director of the Breast and Ovarian Prevention Program at the Seattle Cancer Care Alliance and an adjunct professor in medical genetics at the University of Washington School of Medicine. She explains, "even though (the BRCA mutation) helped the cell become a cancer, it makes the cancer more vulnerable to certain types of treatments, such as PARP inhibitors and also chemotherapy. When you give chemotherapy, you're damaging DNA in your normal cells and your cancer cells. Now, if the cancer cell has less ability to repair the DNA than your normal cells, the normal cells can recover from the chemo and the cancer cells can't."
Future treatments
Now, monoclonal antibodies are beginning to be used to treat ovarian cancer, in order to attack folate receptor alphas, which appear on ovarian cancer cells quite frequently. How this method works is that they are able to stop the receptors from feeding the cancer, therefore stunting its growth.
More progress has also been made in the discovery of ovarian cancers and their overexpression of the cyclin E1 gene. By finding out this crucial piece of information, researchers will be better able to develop an effective form of treatment, such as the CDK2 inhibitor and Velcade (bortezomib).
Some experts also note that tumors that overexpress cyclin E are often resistant to the PARP inhibitors used to treat them; therefore, research is being dedicated to finding a way to make them more responsive. In 2016, it was found that histone deacetylase inhibitors such as Farydak (panobinostat) were able to make some progress in that field.
Some also note the potential of genetic testing in making progress. As more information is uncovered about ovarian cancer, it becomes increasingly clear that this is a necessity.
Swisher explains how learning more about the inheritance of genetic mutations enables prevention strategies, which can save years of more intensive treatment, and effectively be life changing. Swisher explains its importance, "there's about 20 percent of ovarian cancer that's hereditary, and we are trying to improve access to genetic risk assessment so that we could be preventing all the predictable cancers that are hereditary. Now, as cancer treatments move forward, they can take a look and know what treatments would be of benefit of you and which would not based on your profile. It's really amazing.
If genetic testing becomes more widely available, the cost will also drop - ending the barrier in place barring many women from seeking effective care.
Swisher concludes, "we are very interested in making it much more widely available. We want to do two things: We want to decrease the number of women who get ovarian cancer and we want to improve the cure rate of those who do get it."
Along with making the practice more widely available comes enhancing the information circulating about the process. Much like Teri, who wants to spread the word of how the BRCA mutation may impact women as it did for her, Swisher wants women across the globe to know what kind of risk they might be at, and how they can prevent it. Unfortunately, minorities, those of lower socioeconomic statuses, and those in rural areas are disproportionately impacted - meaning that spreading awareness is crucial.
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