Taking the lead with ovarian cancer

Survivor found UCI Health specialists who vowed to try everything

Meg Newton received a novel treatment for ovarian cancer, called HIPEC. After surgery to remove the tumors, a heated chemotherapy solution was infused into her abdomen.

Meg Newton, 62, was on an evening stroll one day last November with her husband, Skip, when she turned to him with words that now seem prescient. For weeks she had been fighting weight gain and a feeling of abdominal bloating.

“I had cut back on food portions and was exercising more,” says Newton, who lives in Canyon Lake near Temecula. “But around my abdomen I kept gaining weight. We were taking the dogs for a walk, and I told my husband,  ‘I feel like I just ate Thanksgiving dinner.’ But I had just had a salad.”

Soon she felt pain in her abdomen and sought the advice of doctors. After being misdiagnosed with liver disease at a community hospital, Newton learned on Nov. 20, 2015, that she had late-stage ovarian cancer.

She called the UCI Health gynecologic oncology specialists and was booked to see Dr. Leslie Randall four days later.

“When I met Dr. Randall I had a great feeling,” Newton says. “She said the cancer was very serious but she was going to do everything she could to give me both quantity and quality of life.”

Randall was able to be reassuring because significant progress has been made in recent years for all types of gynecologic cancers, which include cancers of the ovaries, uterus, cervix, fallopian tubes, vulva and vagina. UCI Health patients are treated at the Chao Family Comprehensive Cancer Center — Orange County’s only National Cancer Institute-designated comprehensive cancer center — by a gynecological oncology team that includes nationally recognized experts.

Ovarian cancer is a challenging disease because there is no screening test, the symptoms are often ambiguous and cancer is usually discovered at a late stage. Patients benefit by seeking care at a medical center that offers the best proven treatments as well as promising investigational treatments.

“We don’t know everything we need to know about ovarian cancer yet,” says Dr. Robert E. Bristow, a UCI Health gynecological oncologist and international expert in ovarian cancer. “But improvements in ovarian cancer have been incremental over time. And the calculations for survival start with whether a woman receives state-of-the-art treatment or not. If she receives state-of-the-art treatment, the odds for survival are a lot better.”

Offering the most innovative therapies

Perhaps the most significant advance in ovarian cancer treatment has been intraperitoneal chemotherapy (IP), in which chemotherapy is pumped directly into the patient’s abdominal cavity via a catheter. The abdomen is massaged to circulate the solution and reach hidden cancer cells. Then the solution is drained and the abdomen rinsed.

IP therapy has been shown to improve the chances for long-term survival and is now considered the standard of care for ovarian cancer patients.  In recent years, some physicians have heated the chemicals to increase their effectiveness — a treatment known as hyperthermic intraoperative peritoneal chemotherapy (HIPEC), performed at the conclusion of surgery to remove the cancer — and used it in patients whose cancers have returned.  UCI Health is taking it one step further by using HIPEC as a frontline treatment for newly diagnosed patients and studying its effectiveness.

“Theoretically, HIPEC disables the cancer to make the cells more susceptible to the chemotherapy,” Randall says. “It also may improve delivery into the cancer cell.”

Newton underwent surgery and HIPEC on March 2 after nine weeks of chemotherapy to shrink the tumors in her abdomen. “I had no qualms about HIPEC,” she says. “It made sense to me that it would get in all the nooks and crannies and kill the cancer. When the doctors said I was a good candidate for HIPEC, I said, ‘I want in.’”

By Memorial Day, Newton felt so good she rode her horse in a parade, inviting Randall to join her to celebrate her recovery. She continues to receive cancer treatment.

“I can’t speak more highly of the care I got there,” Newton says. “I called UC Irvine Medical Center because I knew it was a teaching hospital. They have state-of-the-art equipment, and they’re always looking for something new.”

New therapies for ovarian cancer

HIPEC is not the only new tool aimed at curing ovarian cancer. Some patients receive a medication called Avastin^®, which works by blocking the growth of new blood vessels and substances that promote cancer growth.  The drug is now prescribed to patients whose cancer has become resistant to chemotherapy. But UCI Health researchers are studying whether avastin may also be useful for any patients with stage IV ovarian cancer and are using avastin in combination with other drugs to treat a number of gynecologic cancers.

Moreover, UCI Health researchers will soon launch two new Phase 3 clinical trials to study the effectiveness of an immunotherapy drug, nivolumab, in fighting ovarian cancer. Immunotherapy drugs are aimed at prompting the body’s own immune system to recognize and destroy cancer, in the same way that the immune system fights off a cold or flu virus. The therapy constitutes one of the most promising areas in cancer treatment today and has already proven effective for several types of cancers, including melanoma and lung cancer.

Another ongoing study takes a much different approach. UCI Health cancer researcher Lari Wenzel studies treatment decision-making and quality of life during ovarian cancer treatment and into survivorship. She is also the co-leader of an international study looking at long-term ovarian cancer survivors to try to identify psychosocial and lifestyle factors that might differ between short-term and long-term survivors.

“With ovarian cancer, it’s so important to have the correct operation and access to clinical trials,” says Dr. Krishnansu S. Tewari, a UCI Health gynecological oncologist and director of research in gynecologic oncology.  “At centers like UCI Health, we have surgical teams, multidisciplinary teams that include liver and thoracic surgeons, who do whatever we can to remove all of the cancer. UCI Health physicians really have dedicated a lot of our time to the science of surgery and these diseases.”

Leading-edge treatment for cervical cancer

These doctors have a history of excellence to live up to, established by the Division of Gynecologic Oncology’s founding director Dr. Philip J. Di Saia, a nationally respected expert. Others in the division include Dr. Ramez N. Eskander, Dr. Kristine R. Penner and Dr. Michael Krychman. Of 35 large, national clinical trials that inform the body of evidence on treatment gynecological cancers, 31 of them involved contributions from UCI Health investigators.

Eskander recently became the third member of the UC Irvine gynecologic oncology faculty to receive the Society of Gynecologic Oncology’s Presidential  Award in the past four years. The honor  recognizes the most outstanding oral plenary presentation at the society’s annual meeting.

In 2012 Bristow was recognized for his research on racial and economic disparities in access to ovarian cancer care and survival. Tewari was recognized in 2013 for his findings that avastin combined with chemotherapy prolongs survival in advanced cervical cancer.

Lorena Medina, 39, benefited from the very treatment Tewari helped pioneer. The Corona woman was diagnosed  advanced cervical cancer in 2012 and has had several relapses despite surgery, radiation therapy and chemotherapy. She consulted with Tewari, who recommended avastin therapy after she relapsed a second time and the cancer spread to her lungs.

But the doctor Medina was seeing at another hospital recommended only chemotherapy. After Medina’s cancer returned a third time, she was able to switch her insurance so she could receive care from Tewari, who put her on chemotherapy and avastin.

“Dr. Tewari was so positive,” says Medina, who has two young children and is now in remission. “He told me, ‘You’re going to get through this.’ He believed in the clinical trial, and I believed in him.”

Caring for the whole patient

Treatment of early-stage cervical cancers also has seen progress. Women with early-stage cancers can undergo a robot-assisted surgery to remove the cervix and uterus. This minimally invasive operation carries fewer risks of complications and speeds recovery time. “Many patients get treated too aggressively even for small cancers,” Tewari notes.

UCI Health surgeons are also among only a handful of specialists nationwide who offer a procedure for cervical cancer treatment, called a trachelectomy, that preserves a woman’s fertility. Only the cervix and a small part of the uterus are removed. Although infertility is sometimes an inevitable result of cancer treatment, patients can be referred to oncofertility specialists to discuss their options prior to treatment.

“We want to offer fertility preservation whenever possible,” Tewari says. “Trachelectomy is such a complicated operation that only a few centers offer it.”

UCI Health also offers robot-assisted surgery for uterine cancer. This approach limits surgical complications and pain, and patients can proceed to chemotherapy with no delays.

UCI Health physicians and nurses focus on the patient’s well-being, not just the cancer, Bristow says. Patients have access to Ann’s Clinic, funded by the Queen of Hearts Foundation, which offers genetic testing and support for ovarian cancer patients to improve their quality of life.

“That is the essence of that holistic approach,” Bristow says. “When patients come to see us, we’re not just looking up lab values and plugging in medication dosages. We’re asking how they are coping, is their support network functioning or not functioning? What is their exercise regimen, their dietary habits? We talk about overall wellness and management of complications, about menopausal symptoms and sexual health. We’re treating the whole person.”

Learn more about gynecologic oncology treatments and research at ucirvinehealth.org/gyncancer.

— UCI Health Marketing & Communications
Featured in UCI Health Live Well Magazine Fall 2016