Ovarian Cancer Clinical Trials

What is Ovarian Cancer?

Ovarian cancer is a type of cancer that starts in or near the ovaries, fallopian tubes, or primary peritoneum (the lining of the8 abdomen). Most ovarian cancer cases begin in the thin surface layer of the ovary, called the epithelium. Because of its complex origin, ovarian cancer disease can present in different forms and with varying symptoms.

Common types of ovarian cancer include:

1. High-grade serous carcinoma (HGSC): The most common subtype. It often starts at the end of the fallopian tube, then involves the ovary and nearby areas. It tends to grow and spread quickly.
2. High-grade endometroid carcinoma (HGEC): A less common subtype whose cells look similar to the cells that line the uterus (endometrium). Like HGSC, it grows and spreads faster than low-grade tumors.

While these epithelial cancers make up the majority of ovarian malignancies, there are also rare forms of ovarian cancer:

1.  Ovarian Granulosa Cell Tumor: This subtype originates from the granulosa cells, which are involved in egg and hormone production within the ovaries. These tumors are typically low-grade, tend to grow slowly, and may produce estrogen, leading to hormonal symptoms such as abnormal uterine bleeding or breast tenderness. Understanding the full spectrum of ovarian cancer tumors is key for proper diagnosis and treatment.

Signs and Symptoms of Ovarian Cancer

Recognizing the signs of ovarian cancer early can improve outcomes and help identify the disease before it spreads. The symptoms of ovarian cancer can be vague, which makes early detection challenging. However, there are several warning signs that should not be ignored:

• Abnormal Uterine Bleeding: Irregular menstrual cycles or bleeding after menopause, often one of the earliest signs of an ovarian cancer.
• Abdominal Pain or Distension: As a tumor grows, it can cause discomfort or visible swelling.
• Urinary urgency or frequency: As the tumor grows, it can press on the bladder, generating a sudden or frequent need to urinate.
• Fatigue: Ongoing tiredness or low energy that doesn’t improve with rest.
• Hormonal effects (in some subtypes): Certain ovarian tumors, like granulosa cell tumors, may produce hormones, especially estrogen, which can lead to specific symptoms such as endometrial thickening or changes in the menstrual cycle.

If you are wondering how to detect ovarian cancer, regular gynecological checkups, pelvic imaging, and tumor marker testing are recommended for individuals at risk.

 Staging in Ovarian Cancer:

 Staging describes how far the cancer has spread and helps guide treatment. The FIGO system is the most commonly used and considers: the extent of the primary tumor, spread to nearby lymph nodes, and spread to distant sites.

• Stage I: Cancer is limited to one or both ovaries or fallopian tubes.
• Stage II: Cancer has spread from the ovaries/fallopian tubes to other pelvic organs (such as the uterus, bladder, or rectum).
• Stage III: Cancer involves the lining of the abdomen (peritoneum) or nearby lymph nodes; it can also be on the surface of the liver or spleen.
• Stage IV: Cancer has spread to organs outside the abdomen (for example, fluid around the lungs or disease inside the liver).

Each stage has different implications for the ovarian cancer prognosis and ovarian cancer survival rate. For instance, stage 4 ovarian cancer require more intensive treatments. Clinical trials are continuously improving outcomes and offering tailored treatment options for ovarian cancer—including rarer forms like granulosa cell tumors—at all these stages.

Ovarian Cancer Treatment Options

Treatment depends on the cancer’s type and stage, whether it has spread, biomarker results (such as a BRCA mutation), your overall health, and—when relevant—your fertility preferences. Common ovarian cancer treatments include:

1. Surgery: When possible, surgery is the first step to remove the cancer. This usually includes removing the ovaries and fallopian tubes (and often the uterus) plus any visible cancer in the abdomen (“debulking”). For localized tumors, ovarian cancer surgery can sometimes be curative.
2.  Chemotherapy: Medicines that kill cancer cells or stop them from growing. The choice of drugs depends on the individual case, with regimens often including agents used in other ovarian cancers. Chemotherapy can be given after surgery (adjuvant), before surgery to shrink tumors (neoadjuvant), as the main treatment, or for symptom relief (palliative).
3.  Maintenance therapy: If surgery and chemotherapy work well, medicines may help delay the cancer’s return. Options include PARP inhibitors (especially helpful if the tumor has a BRCA mutation) and sometimes anti-VEGF therapy (bevacizumab).
4.  Radiation therapy: Not a main treatment for ovarian cancer but can help relieve symptoms (for example, pain or bleeding) in specific areas.
5. Target therapy: treatments that target specific mutations or molecular markers such as BRCA ovarian cancer pathways or DNA repair deficiencies. These drugs aim to slow growth while limiting damage to healthy cells.
6. Immunotherapy: Helps the immune system recognize and attack cancer cells. It may be used for tumors with certain biomarkers (such as MSI-H/dMMR)
7. Hormone (endocrine) therapy: Given the hormone-sensitive nature of these tumors, hormone therapy (e.g. aromatase inhibitors or luteinizing hormone-releasing hormone agonists) may be used to block estrogen production and slow tumor growth.

Ovarian cancer treatment is highly personalized, reflecting the tumor’s characteristics, the patient’s situation, and evolving research in the field. Emerging treatments and clinical trials exploring new chemotherapy regimens, targeted therapies, and immunotherapies offer additional hope for those affected.

Next-Generation Sequencing (NGS) is vital in linking patients with specific genetic mutations in their cancers to clinical trials for targeted treatments. This approach, part of personalized medicine, increases the effectiveness and success rates of these trials by ensuring patients receive therapies most likely to work for their particular cancer type.

Ovarian cancer, like many other types of cancer, can be associated with various genetic changes. These changes can affect oncogenes, tumor suppressor genes, and genes that are involved in DNA repair. Here are some of the key genes and genetic changes often associated with ovarian cancer:

1.  BRCA1/2 mutation (germline or tumor) / HRD-positive: BRCA1/2 help repair broken DNA. When they’re mutated (or the repair system is deficient/“HRD”), cancer cells rely on backup repair. PARP inhibitors block that backup, causing cancer cells to die.
2. Folate receptor-α (FRα) high: Many epithelial ovarian cancers have high levels of this folate-binding protein on the cell surface. Antibody-drug conjugates (such us Mirvetuximab soravtansine) binds FRα and releases a chemo payload that kills cancer cells.
3. MSI-H /dMMR (Microsatellite instability-high / Defective mismatch repair): Faulty DNA “spell-check” leads to many mutations, making tumors look more foreign to the immune system. Immune check-point inhibitors (e.g. pembrolizumab) lift immune brakes so T cells can attack the cancer.
4. NTRK gene fusion: mutations in NTRK gene allows growth and survival of cancer cells. TRK inhibitos (e.g. entrectinib) target this mutation and turn it off.
5. RET fusion: alterations in RET gene, can lead to increased cell growth and survival.
6. BRAF V600E: mutations in BRAF gene contribute to uncontrolled cell division and tumor growth.
7. FOXL2: A hallmark mutation of ovarian granulosa cell tumors, useful for diagnosis and treatment decisions.

Ovarian Cancer clinical trials play a crucial role in advancing the treatment options by evaluating the safety and efficacy of new therapies, surgical techniques, and diagnostic tools. Researchers design these trials to find more effective and less toxic treatments, improve quality of life, and increase ovarian cancer survival rates.

By joining a clinical trial, patients may access treatments that represent the future of ovarian cancer care.

• Access to New Treatments: Participants can access cutting-edge treatments that are not available outside the clinical trial setting.
• Contribution to Research: By participating in clinical trials, individuals contribute to medical research that could improve cancer treatment for future patients.
• Close Monitoring: Participants in clinical trials receive intense medical monitoring related to their treatment and overall health.

Massive Bio provides a fast and free way to find clinical trials for ovarian cancer, tailored to each patient’s tumor type, biomarkers, and location. Whether you have early-stage disease or stage 4 ovarian cancer, our system can match you with appropriate studies to support your treatment journey.