Online tool helps ovarian cancer patients feel more in control of symptoms

This is an edited version of an article published on ScienceDaily February 8, 2022.

An online symptom management tool that harnesses the problem-solving benefits of expressive writing could help women with ovarian cancer better manage complex symptoms, according to a new study led by a University of Pittsburgh and UPMC nurse-scientist.

Published in the Journal of Clinical Oncology, the study found that patients who used nurse-led and self-directed versions of the tool reported a better sense of control over symptoms compared to enhanced usual care.

"Women with ovarian cancer experience an average of 14 concurrent symptoms, so symptom management is very complex. It can be overwhelming for patients and challenging for providers, who may not have time to address these symptoms in a typical 15-minute appointment," said lead author Heidi Donovan, Ph.D., R.N., professor of health and community systems in Pitt's School of Nursing and obstetrics, gynecology and reproductive services in the School of Medicine. "That's why we developed a symptom management approach outside of a normal clinical setting, from the comfort of a woman's own home."

According to Donovan, ovarian cancer is a "low incidence, high impact cancer." In 2022, about 20,000 women will be diagnosed with ovarian cancer in the U.S., and more than 12,000 will die. For many patients who are treated successfully, the cancer recurs after two to three years.

"There's a vast difference in quality of life between patients who manage symptoms successfully and those who don't, both throughout chemotherapy and afterwards," said Donovan, who is also director of the Gynecologic Oncology Family CARE Center at UPMC Magee-Womens Hospital. "Effective symptom management requires that patients follow directions from providers but also be willing to communicate, make adjustments and try new strategies."

Donovan and her team developed a new symptom management approach called Written Representational Intervention to Ease Symptoms, or WRITE Symptoms, which guides patients to reflect on how they experience a symptom: what causes it, what makes it worse, how it feels, how it impacts their daily life and how they've tried to manage it.

"The WRITE approach blends health psychology with educational principles," explained Donovan. "The process of talking or writing about a symptom in a systematic way can help women understand which management strategies work and which don't. Using evidence-based symptom management techniques, we then help patients develop strategies for addressing target symptoms. Later, patients review the strategies and assess if changes need to be made. It's a very iterative process."

The researchers recruited 497 patients with recurrent or persistent ovarian, fallopian tube or primary peritoneal cancer. After participants completed surveys about symptom burden, controllability and quality of life and selected three target symptoms they wanted better control of, they were randomly assigned to one of three groups.

One group completed a nurse-led version of the WRITE intervention, in which nurses guided patients through the process via an asynchronous web-based message board. The second group directed themselves through a fully computer-mediated version of WRITE. The third, or enhanced usual care group, did not complete WRITE and acted as a control.

The analysis found that both WRITE interventions improved women's sense of control over their symptoms after eight weeks, and these measures were significantly greater compared with enhanced usual care.

"To see the same benefits in both the nurse-led and fully computer-mediated versions of the program is really powerful," said Donovan. "We also found that the self-led program was much more efficient: People were able to develop a symptom management plan in about 30 minutes compared to a few weeks with the asynchronous, nurse-led version."

The researchers are now developing a mobile health app that will train family members and other caregivers to help their loved ones with ovarian cancers better manage symptoms. Based on the computer-mediated version of WRITE, the app will guide users through questionnaires and problem-solving exercises, and it will feature disease-specific modules and core modules that could apply to patients with any chronic disease. For patients who need extra support, there will also be an option to connect with providers. According to Donovan, this app could be offered to families of gynecology cancer outpatients in the next year or so.

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Materials provided by University of Pittsburgh. Note: Content may be edited for style and length.

Conjugate Therapy Produces Remissions in One-Third of Patients with Drug-Resistant Ovarian Cancer, Study Results Show

This is a news release from Dana Farber Cancer Institute, published on March 19, 2022

In a clinical trial involving patients with ovarian cancer previously treated with platinum-based chemotherapy, a novel “conjugate” therapy produced a substantially better response than standard treatments, investigators at Dana-Farber Cancer Institute...

The agent, mirvetuximab soravtansine, generated an objective response – a measurable decrease in cancer burden – in nearly 33% of patients participating in the trial. That compares with response rates in the single digits for current treatments in patients whose ovarian cancer doesn’t respond to platinum-based chemotherapy.

The novel agent is one of a growing number of antibody-drug conjugates, or ADCs, which consist of a drug linked to an antibody that directly targets the cancer cell. Mirvetuximab connects an antibody targeting the folate receptor alpha molecule on high-grade serous ovarian cancers to a drug molecule called DM4 that disrupts microtubule formation. (Microtubules are major components of the cytoskeleton that give shape and structure to cells.) The folate receptor protein is far more abundant in some tumor cells than normal cells, making it an attractive target for cancer drugs.

The trial, titled the SORAYA study, enrolled 106 patients with platinum-resistant high-grade serous ovarian cancer that highly expressed folate receptor alpha. All patients were required to have previously received bevacizumab, a drug that blocks tumors from forming blood vessels to take in more oxygen and nutrients. The participants had been treated with up to three prior treatments for their ovarian cancer.

After a median follow-up of 8.1 months, 32.4% of participants had an objective anti-cancer response, including five who had a complete response, or the disappearance of all signs of cancer. The median duration of response is currently 6.9 months.

Mirvetuximab was well-tolerated by study participants. The most common adverse side effects associated with the treatment were blurred vision, keratopathy (a non-inflammatory condition of the eye), and nausea.

“These data have the potential to be transformative for ovarian cancer patients and their physicians,” said Ursula Matulonis, MD, chief of the Division of Gynecologic Oncology at Dana-Farber and co-principal investigator of the SORAYA study, who will present the findings at the SGO. “In the platinum- resistant setting and particularly in later-line treated patients, response rates with available therapy are in the single digits with significant toxicities. With an objective response rate above 30%, a duration of response of around six months, and a treatment-related discontinuation rate of 7%, mirvetuximab shows impressive activity and tolerability for patients with platinum-resistant ovarian cancer.  These data support the future of mirvetuximab as the potential standard of care for patients with folate receptor alpha positive ovarian cancer.” 

Niraparib Plus Bevacizumab Shows Promise in High-Risk Ovarian Cancer Population

 This is a shortened version of an article written by Kyle Doherty and published in OncLive March 19, 2022

Niraparib (Zejula) in combination with bevacizumab (Avastin) was efficacious following 1 line of platinum-based chemotherapy among patients with newly diagnosed advanced ovarian cancer regardless of biomarker status, according to data from an updated analysis of the phase 2 OVARIO study (NCT03326193) presented during the 2022 SGO Annual Meeting on Women’s Cancer.

Melissa Hardesty, MD, MPH, added that combination had a safety profile consistent with the known adverse effects of each treatment as monotherapy.

At the June 16, 2021, data cutoff point, patients who received the PARP inhibitor niraparib plus the vascular endothelial growth factor-A inhibitor bevacizumab (N = 105) achieved a median progression-free survival (PFS) of 19.6 months (95% CI, 16.5-25.1). The 18-month PFS rate was 62% (95% CI, 52%-71%) and the 24-month PFS rate was 53% (95% CI, 43%-63%). Median follow-up was 28.7 months (interquartile range, 23.9-32.5).

“OVARIO enrolled a high-risk population,” said Hardesty, a gynecologic oncologist with Alaska Women’s Cancer Care in Anchorage. “More than half of the patients remained progression-free at 24 months. Clinical benefit [by PFS] was observed in the overall population, and across biomarker subgroups in a continuum.”