By Jodi Helmer
When Heidi E. Godoy, D.O., gynecologic oncologist, sees new ovarian cancer patients for the first time, she starts preparing them for the likelihood their cancer will return.
Dr. Heidi E. Godoy, gynecologic oncologist
For those unfamiliar with the disease, Godoys early focus on recurrence may seem premature. But she believes that being upfront about the realities of ovarian cancer is as important as discussing the initial treatment, which is typically surgery followed by platinum-based chemotherapy.
Ovarian cancer is difficult to diagnose, increasing the odds that it wont be discovered until it reaches an advanced stage. And in 85% of late-stage ovarian cancer cases, the disease recurs, according to research published in the International Journal of Surgical Oncology.1
One of the first conversations I have with patients outlines the relapse that often happens with ovarian cancer, said Godoy, who works in private practice in New York State and is affiliated with several hospitals there. I dont want it to be a surprise if the cancer returns.
Godoy also makes it a point to reassure women living with ovarian cancer that she will be with them throughout their cancer journey. Gynecologic oncologists, she explained, generally provide complete care, from diagnosis to surgery, for cancers affecting the ovaries, uterus, cervix, vulva and vagina. Holistic care is one of the reasons she pursued the subspecialty.
When I was going through medical school, I wanted a subspecialty that provided a lot of continuity of care, Godoy recalled. In gynecologic oncology, you develop such personalized, deep relationships with your patients.
Expert, Empathetic Care
For women living with ovarian cancer, receiving treatment from a gynecologic oncologist can simplify care and provide a sense of familiarity with their treatment teams. Research published in Frontiers In Oncology2 in 2015 shows that the highly-trained medical professionals also provide positive clinical outcomes.
Gynecologic oncologists perform complex procedures such as surgical debulkinga tumor-removal procedure that often affects other organsto remove the entire tumor and improve the prognosis. They are among the only specialists that perform surgical debulking, Godoy said. While surgery and chemotherapy are well-known components of treatment plans, maintenance therapies have become meaningful options for doctors in recent years.
Ovarian cancer patients who have a response to platinum-based chemotherapy in the recurrent setting are candidates for PARP inhibitors, one of those being niraparib or ZEJULA, Godoy explained.
Those candidatespatients who recur after a first-line treatment and receive a second line of platinum-based chemotherapyreally need to have that conversation about starting maintenance therapy, she continued.
The current approach of watch-and-wait, where we take them off their chemotherapy or their cytotoxic therapy and just watch and wait to see if the cancer returns, is no longer the only option, Godoy said. Maintenance therapy has changed the paradigm of watching and waiting to see if the cancer returns.
ZEJULA, made by the pharmaceutical company GSK, is a prescription medicine used for the maintenance treatment of adults with ovarian cancer, fallopian tube cancer or primary peritoneal cancer, when the cancer comes back. ZEJULA is used after the cancer has responded (complete or partial response) to treatment with platinum-based chemotherapy. It can also be used for treatment of adults with advanced ovarian cancer, fallopian tube cancer or primary peritoneal cancer who have been treated with three or more prior types of chemotherapy and who have tumors with a certain BRCA gene mutation, or a positive laboratory test, and whose cancer was in response to treatment with platinum-based chemotherapy, and who have progressed more than six months after the last treatment. For treatment in the late-line setting, your healthcare provider will perform a test to make sure that ZEJULA is right for you.
ZEJULA has serious risks such as bone marrow problems called MDS or a type of blood cancer called AML. Low blood cell counts are common. Tell your doctor about any weakness, tiredness, infections, fever, shortness of breath, blood in urine or stool, bruising, bleeding or weight loss. High blood pressure is common and can become serious. Nausea and constipation are also common.
Benefiting From More Recent Treatment Options
The idea of maintenance therapy to treat ovarian cancer is not new, Godoy said. Until recently, however, only intravenous forms of maintenance therapy were available, which required women to receive the treatment in clinics.
More recent treatment options for ovarian cancer include oral medications, like ZEJULA, which give women the ability to take it at home. ZEJULA is taken once a day.
Women living with ovarian cancer are often surprised to learn that maintenance therapies exist, she added. For the newly diagnosed, Godoy offered important advice.
If you have ovarian cancer, ask your OB/GYN to make a referral to a gynecologic oncologist and have a meeting with them to discuss your care, she said. Learn more about current treatments, including maintenance therapy, and be your own best advocate.
Jodi Helmer writes about health, science and innovation.
Important Safety Information
ZEJULA may cause serious side effects, including:
Bone marrow problems called Myelodysplastic Syndrome (MDS) or a type of blood cancer called Acute Myeloid Leukemia (AML). Some people who have ovarian cancer and who have received previous treatment with chemotherapy or certain other medicines for their cancer have developed MDS or AML during treatment with ZEJULA. MDS or AML may lead to death.
Symptoms of low blood cell counts (low red blood cells, low white blood cells, and low platelets) are common during treatment with ZEJULA. They can be a sign of serious bone marrow problems, including MDS or AML. These symptoms may include the following:
Your doctor will do blood tests to check your blood cell counts before treatment with ZEJULA. You will be tested weekly for the first month of treatment with ZEJULA, monthly for the next 11 months of treatment, and from time to time afterward.
High blood pressure is common during treatment with ZEJULA, and it can become serious. Your doctor will check your blood pressure and heart rate at least weekly for the first two months, then monthly for the first year, and as needed thereafter during your treatment with ZEJULA.
Before starting to take ZEJULA, tell your doctor about all of your medical conditions, including if you:
Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
The most common side effects of ZEJULA include the following:
o Heart not beating regularly
o Pain in the stomach area
o Mouth sores
o Indigestion or heartburn
o Dry mouth
o Loss of appetite
o Urinary tract infection
o Shortness of breath
o Changes in liver function or other blood tests
o Pain in your joints, muscles, and back
o Change in the way food tastes
o Trouble sleeping
o Sore throat
o Changes in the amount or color of your urine
If you have certain side effects, then your doctor may change your dose of ZEJULA, temporarily stop, or permanently stop treatment with ZEJULA.
These are not all the possible side effects of ZEJULA. For more information, ask your doctor or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
For full prescribing information visit http://www.ZEJULA.com/prescribing-information.
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