As researchers and clinicians in the Susan F. Smith Center for Women’s Cancers at Dana-Farber continue studying the benefits of a two-drug combination in slowing progression of recurrent ovarian cancer, one patient is as a beacon of hope for her caregivers – and for others facing the disease.
Betsy Brauser, treated with standard chemotherapy near her Florida home after an initial ovarian cancer diagnosis in 2009, came to Dana-Farber a year later when new tumors were found in her pelvic area. A biopsy confirmed the cancer had returned in an inoperable form. Brauser and her husband, Michael, were given two options: another try at standard chemotherapy, or enroll in a new clinical trial comparing the drugs cediranib and olaparib (both in pill form), versus olaparib alone.
For the Brausers, it was an easy choice. The trial was a great unknown, but what they did know was that recurrent ovarian cancer is usually resistant to standard treatment. They had four adult sons, one of whom was engaged, and were looking forward to the years ahead, with weddings and grandchildren. A clinical trial offered them the best opportunity to look toward the future.
“It’s nerve-racking and scary to join a trial, but everybody at Dana-Farber was so supportive and helpful,” says Brauser of her treatment team, led by Ursula Matulonis, MD, interim director of the Susan F. Smith Center. “I was willing to live with the potential side effects to help myself and other patients down the road.”
The trial’s leaders felt confident about its potential based on the two drugs involved. Cediranib is an angiogenesis inhibitor that prevents tumors from forming new blood vessels that help them grow and spread. Olaparib is part of a class of agents known as PARP inhibitors that was then starting to show promise in tumors that had trouble repairing damaged DNA.
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“The combination of olaparib and cediranib has shown significant promise in the fight against ovarian cancer,” says Matulonis, senior author of the trial, which she has led since April 2011 with colleague and senior author Joyce Liu, MD, MPH. “It has been wonderful and very encouraging to see first-hand women like Betsy directly benefiting from this combination and our research here at Dana-Farber.”
Because it was an oral-based trial, Brauser could continue living in Florida with her family and taking the drugs twice daily. Although she initially flew to Boston weekly for checkups at Dana-Farber, she soon only had to come once a month.
When side effects like hypertension, stomach trouble, and a hoarse voice set in, she emailed or called Stephanie Morrissey, RN, OCN, the nurse overseeing the trial, for support. “Betsy always had such a great attitude,” says Morrissey. “We worked through the side effects together. She is a fabulous patient who has inspired all of us and is invested in helping herself and hopefully helping others.”
The combination, it turns out, has been life-saving. Brauser has been on the trial for more than six years, and her cancer has not worsened. The study has since been expanded to many more women with recurrent ovarian cancer as a phase 2 trial, the report of which was ranked as the most influential publication of 2014 in breast, gynecologic, and obstetric disorders by the Columbia Hospital for Women Research Foundation.
“The results of these trials have suggested that oral combinations could be a vital part of how to combat ovarian cancer,” says Liu, director of clinical research for Gynecologic Oncology at the Susan F. Smith Center. “We have now opened two large NCI-sponsored trials that will examine how the combination of cediranib and olaparib compares to standard chemotherapy as a treatment for the disease.”
Brauser still doesn’t know what her future holds, but her recent past now includes two sons’ weddings – with a third in November. Then there is her first grandchild, Nathaniel, who lives around the corner from his Florida grandparents. Brauser will help him celebrate his third birthday in August.
“It’s been a wonderful five years,” she says, “but I never take it for granted.”