Thanks to new and more effective treatments and screening measures, women with ovarian cancer are being treated sooner and experiencing longer, more productive lives. More than 30 to 40 percent of patients today are living past the five-year mark, a major advance made possible by a host of breakthroughs-many of them developed and tested by physicians and scientists at UAB.

Ovarian cancer is a complex disease, and that is why a truly comprehensive approach to treatment is so important, says gynecologic oncologist Mack Barnes, M.D., co-director of UAB's Multidisciplinary Ovarian Cancer Clinic. Taking on the problem with all available resources, he explains, gives patients the best chance of remission with a high quality of life.

"Once you get to the point of being concerned about ovarian cancer, particularly if there is a physical finding like a cyst, that's when patients need immediate access to a sophisticated ovarian cancer program," Dr. Barnes says. "We want to attack ovarian cancer from every angle we can." That includes being able to give either the best current therapy or to offer access to experimental therapies in clinical trials, he notes. "We think those are the advantages of our program."

Expert Advice

The best approach once ovarian cancer has been diagnosed, Dr. Barnes says, is to bring in a gynecologic oncologist. Studies have shown that these specialists handle surgeries most appropriately. "If patients have what we refer to as an optimal debulking-no matter how much cancer is there when you start the surgery, you remove most of what you can see-their overall survival is much better, as opposed to what's referred to as suboptimal surgery."

Once surgeons have removed as much visible cancer tissue as possible, chemotherapy is often used to treat any remaining cancer cells. Through the 1990s, chemotherapy was delivered intravenously using the drugs paclitaxel and cisplatin, offering most ovarian cancer patients a life expectancy of about three years. But more recently, scientists began to ask, "‘In those people who have had optimal surgery, what if we gave them chemotherapy directly into the abdominal cavity?'" Dr. Barnes says. "That's what we refer to as intraperitoneal chemotherapy." Studies have shown that intraperitoneal, or IP, chemotherapy can increase survival to an average of 57 months, versus 40 months with traditional IV chemotherapy. "In these patients who undergo optimal surgery, it should be standard that they are at least offered IP chemotherapy," Dr. Barnes says.

Treatments for Tomorrow

A main focus of UAB's more experimental treatments is recurrence. Cure rates drop as cancer continues to return, "although we are able to get second and third remissions with further treatment," Dr. Barnes says. But it is still not clear which drugs work best to treat recurrence, he adds. "That's why these experimental treatments and clinical trials are so important."

Researchers at UAB are studying a number of new ways to treat cancer. One promising approach involves monoclonal antibodies-laboratory-produced molecules that interfere with cell function or stimulate the immune system. Avastin [note: Dr. Alvarez recommends using "bevacizumab" here rather than commercial name] is one such drug currently under investigation at UAB. "It's an antibody that inhibits blood vessel growth, and it's been used in breast and colon cancer," Dr. Barnes says. UAB researchers are testing Avastin's ability to improve ovarian cancer treatment when it is combined with existing drugs.

Another exciting new research area is the use of gene therapy. "We know that cancer, fundamentally, is caused by genetic abnormalities in our cells," says Ronald Alvarez, M.D., director of UAB's Division of Gynecologic Oncology. Some people inherit those abnormalities, says Dr. Alvarez. "Others, over the course of a lifetime-through the aging process or environmental exposures like smoking-acquire mutations that make those cells undergo uncontrolled growth."

Gene therapy, Dr. Alvarez explains, uses genetic material as a weapon either to kill cancer cells "or to make cancer cells behave themselves." In one current approach, new genetic material is inserted into a virus. When the virus infects cancer cells, it releases that genetic material, killing or otherwise disabling the cancer cells. Dr. Alvarez and David Curiel, M.D., Ph.D., director of UAB's Division of Human Gene Therapy, are now leading clinical trials to test a new treatment for ovarian cancer using this method. "This is really a whole new treatment paradigm," says Dr. Alvarez. "But my hope is that in the future, we'll be able to make a virus that will not only put this cancer in remission, but also keep it in remission."

Keeping Options Open

Monoclonal antibodies and gene therapy techniques are just a few of the approaches being tested at UAB. "We try to maintain a whole menu of clinical trials for situations when cancer comes back," Dr. Barnes explains. Whether it is assessing family risk of developing ovarian cancer, evaluating a suspicious pelvic mass, using aggressive surgical techniques, or offering patients access to the most current clinical trials, the goal is the same, says Dr. Barnes. "We're trying to offer the most comprehensive approach to patients affected with this disease."

Caperton Gillett