VIRUS THERAPY

No cancer diagnosis is good news, but ovarian cancer can be particularly unsettling since more than eighty percent of patients are diagnosed with the disease after it has already spread. Despite several effective treatments for this type of cancer, most women whose cancer has spread to distant locations in their bodies, or whose tumors return after treatment, find themselves in a tough battle for survival.

In my eight years as a practicing gynecologic oncologist, I have been continually frustrated that recurrent ovarian cancer remains incurable.

It’s difficult to deliver bad news to these patients, particularly after they undergo a failed regimen of chemotherapy and all its side effects. “Isn’t there anything else we can try?” is a question I hear all the time.

Each year nearly 22,000 American women are diagnosed with ovarian cancer. Despite all the progress we’ve made in treating ovarian and other cancers, close to 16,000 women die from ovarian cancer every year.

My practice at the James Cancer Hospital at The Ohio State University is currently testing a new treatment for women whose ovarian cancer has recurred or progressed either during or shortly after chemotherapy treatment. The treatment, Reolysin, is an entirely new agent in the war on ovarian cancer or, for that matter, on any type of cancer: Reolysin happens to be a live, infectious virus.

But before getting into the specifics of how we came to use a virus to treat cancer, it would be useful to provide a bit of background on ovarian cancer and its treatment.

Conventional Treatments

Most women with suspected ovarian cancers undergo surgery to remove the main tumor and to confirm that it originated in the ovaries. Once ovarian cancer is confirmed by examining a slice of the tumor under a microscope, the surgeon typically removes the woman’s ovaries, uterus, fallopian tubes, and sometimes other nearby tissues. Depending on the stage of the cancer, some women will subsequently receive chemotherapy.

First-line chemotherapy for ovarian cancer is comprised of platinum-based drugs (carboplatin or cisplatin), often in combination with a taxane (paclitaxel). New combinations of drugs are helping women live cancer-free longer than at any time in the past. Most women respond well to these drugs, which is good news. Unfortunately, in many patients the cancer returns.

If the patient had responded initially to a chemotherapy regimen, most physicians (including me) will try the same drug or combination of drugs again. If it worked once, it is most likely to work again. But once the tumor returns it is not considered curable.

If the treatment used initially fails to shrink the tumor during the second round of therapy, an oncologist may try any of the half-dozen other chemotherapy agents approved specifically for ovarian cancer, or even prescribe drugs normally used for other cancers. The goal of therapy for recurrent ovarian cancer thus shifts from curing the disease to improving quality of life by slowing or stopping tumor growth. I have many patients who are still in remission after many years of being treated in this way.

Hope Out of Despair

For women whose tumors fail to respond at this stage, one potential and interesting treatment option may be a clinical trial.

A clinical trial is a specialized human study of an experimental drug performed under carefully controlled conditions. Pharmaceutical companies, hospitals, and government institutions use clinical trials to evaluate new treatments and to investigate the optimal use of already-approved drugs.

Participation in a clinical trial can be fulfilling and beneficial to patients in many ways. Participants in clinical trials receive the best evaluation and care available, usually from highly trained physician-researchers. While no study will promise a long-term remission or even prolonged survival, those outcomes do occur in patients treated in clinical trials.

In addition to direct benefits, study patients can take satisfaction in the knowledge that they are advancing medical science, and in so doing may help not only themselves, but other patients with their disease.