Stephenson Cancer Center physician is senior author on major study

May 03, 2019

OKLAHOMA CITY - A gynecologic oncologist at the Stephenson Cancer Center at OU Medicine was a national leader of a newly published research study that reveals good news for women with ovarian cancer - longer survival times plus a treatment option that causes fewer difficult side effects.

Joan Walker, M.D., was the senior author of the large clinical trial, which enrolled 1,560 patients from around the nation, including 38 Oklahomans. The research was recently published in the Journal of Clinical Oncology, a leading peer-reviewed journal.

The clinical trial compared three different treatments for ovarian cancer, as well as the way they were administered - either through an IV or through a port in the abdomen. All patients in the study underwent surgery to remove their tumors. Among patients whose surgeries removed all but 1 centimeter or less of cancer, the results were heartening -- about 75 months of survival compared to 68 months of survival for patients in a similar previous study. For patients who had no residual cancer left after surgery, their survival increased to 100 months. In addition, the treatment regimen with the fewest side effects was just as effective as the ones with more side effects.

"To have our patients live for more than five years is pretty remarkable," said Walker, who holds the Louise and Clay Bennett Endowed Chair in Cancer at the Stephenson Cancer Center. "This clinical trial gives our patients with ovarian cancer more hope that long-term survival is possible, and with a treatment that is much more tolerable."

The foundation for the current clinical trial was laid years ago. In 2006, Walker was the author for a similar study that compared chemotherapy given either through an IV or through an abdominal port. The results of that study were very promising at the time - 68 months' survival - but side effects like nausea, vomiting and neuropathy were so significant that less than half of eligible women opted for the treatment. That's when Walker and her colleagues set out to discover a treatment that was at least as effective but with fewer side effects.

Their work led them to the recently published study. Eligible patients enrolled on the study had been diagnosed with stage two, three or four ovarian cancer. After surgery, they were randomized into three treatment regimens. One delivered two types of chemotherapy - paclitaxel and carboplatin - through an IV. The second regimen featured the same types of chemotherapy, but with one given through an abdominal port. The third regimen added a third type of chemotherapy, cisplatin, that was given through an abdominal port. In addition, patients on each regimen received the drug bevacizumab through an IV.

After receiving their treatments, patients were followed for 84.8 months. In addition to the improved survival rate, several other findings bring reason for new hope. Because the outcomes were the same for each regimen, patients can most likely choose the route with fewer side effects, Walker said. Giving chemotherapy through an abdominal port is often difficult for patients. A catheter delivers the drug through the port, which is painful, and the site sometimes becomes infected.

In addition, the IV therapies can be delivered in an outpatient setting, whereas patients previously had to be hospitalized. Medical oncologists can also administer the drugs in addition to gynecologic oncologists, which makes the treatments accessible to more people.

As with most clinical trials, the results serve as a jumping off point for subsequent studies. Walker plans to analyze the genetics of each participant's tumor to see if their mutations might make a subset of them respond better to one treatment regimen over another. The trial also underscores the importance of surgery for ovarian cancer.

"Surgery is a very important part of patient's outcome," she said. "Earlier diagnosis of ovarian cancer, by recognizing the symptoms, will make surgery more successful. Identifying people with genetic mutations putting them at risk of cancer is also very important. Patients with ovarian cancer and anyone with a strong family history of breast, ovarian and pancreatic cancers should see a genetic counselor and get testing for known cancer-causing genes."

Walker also will be among many people continuing to study the effectiveness of bevacizumab for ovarian cancer, as well as which types of chemo pairings might make it more effective. Bevacizumab was approved for ovarian cancer treatment in June 2018 by the Food and Drug Administration. When the clinical trial began, it had not been approved but was provided by the National Cancer Institute. It essentially starves the tumor by blocking the production of blood vessels that feed it.

Although establishing new treatments through clinical trials takes time, the resulting increases in survival demonstrate amazing progress, something Walker has witnessed during her long career, she said.

"When I was a resident, we were giving one drug for ovarian cancer, and the survival was about 15 months," she said. "Then we would find another drug or another combination, and the survival time kept increasing. To reach our current survival times is pretty profound."

University of Oklahoma

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to