Ovarian cancer is often known as the ‘silent killer’ because its symptoms can be mistaken for other less harmful conditions, or simply put down to changes in the body due to ageing. This means around 7 in 10 cases are diagnosed at a late stage, by which time the cancer has often spread or is difficult to cure.
There are different types of ovarian cancer, with High Grade Serous Ovarian Cancer (HGSOC) being the most common and accounting for 70% of cases. Despite improvements in treatment over the past few decades, prognosis for HGSOC is still poor, with only 41% of patients surviving beyond 5 years.
Professor Charlie Gourley of the University of Edinburgh explains how a precision medicine project being carried out by the Stratified Medicine Scotland Innovation Centre could potentially help improve the outlook for patients.
“The trouble with ovarian cancer is that, because it’s in the abdomen, by the time a patient becomes aware of the symptoms it has often already spread,” explains Charlie. “Current treatment options are usually surgery followed by chemotherapy, and the disease normally responds very well to chemo initially. The problem is that even if you can successfully remove the tumour and kill most of the cancer cells with chemotherapy, you can’t usually kill them all – there will still be some left in the body. This is why ovarian cancer so often re-occurs, and it unfortunately often doesn’t respond so well to chemo the second time around.”
Charlie is currently chief investigator on a project involving the Stratified Medicine Scotland Innovation Centre, the Universities of Edinburgh and Glasgow, and NHS Lothian, Greater Glasgow & Clyde, Tayside, Grampian and Highland. The project aims to discover how genetic mutations in HGSOC tumours affect the way they respond to treatment. This has exciting possibilities for improving patient outcomes.
“There are some really effective new drugs for the treatment of ovarian cancer, called PARP inhibitors, which work well for women with certain genetic mutations in their tumours – about 20% of all HGSOC patients have these. Our project involves sequencing the DNA from the tumours of ladies with HGSOC from around Scotland, in order to show which genes are driving the growth of the tumour,” explains Charlie. “We hope that this will allow us to identify more patients who are likely to benefit from PARP inhibitors as well as other patients who may require different or additional strategies. It would be great news if more patients could benefit from these drugs.”
SMSIC’s role in the project was to fund the first stage, bring the project team together and carry out some of the initial sequencing in their laboratory. Since the project began, it has gained the interest of drug companies, resulting in extra investment which has allowed Charlie to expand the study beyond its original scope and carry out more sophisticated sequencing of the whole genome.
“SMSIC has been the glue that has held the collaboration together,” says Charlie. “We would not have got the secondary funding if it had not been for SMSIC – that only came about because we could show we had an effective project team already in place here in Scotland.
“Ultimately, if this project shows that sequencing DNA will allow us to make better decisions when it comes to treatment of HGSOC, we would like this to become standard practice for every single HGSOC patient. If we can give the right drugs to the right patient at the right time, this will also be more cost effective for the NHS than using a trial-and-error approach which can often result in a patient trying several types of treatment which have little or no effect, whilst often resulting in unpleasant side effects.
“We’ve had some exciting findings from the project and are currently carrying out further investigations to confirm the importance of these findings. It’s early days but I am feeling hopeful!”