Cork trial aims to treat ‘very sneaky cancer’ and increase life expectancy 

Cork trial aims to treat ‘very sneaky cancer’ and increase life expectancy 
Dr Dearbhaile Collins

A CORK woman became the first in the UK or Ireland to take part in a new ovarian cancer trial aimed at increasing the life expectancy of those with the illness.

The woman began the trial, which combines immunotherapy with chemotherapy, at Cork University Hospital (CUH) last week.

The worldwide trial will see 1,000 patients take part over a two-year period with the results expected to be published in 2022.

Currently, only around 30% of ovarian cancer patients live for five years after their diagnosis.

Irish chief investigator of this latest trial, Dr Dearbhaile Collins, hopes the trial will improve those odds. Dr Collins is an Irish-trained Medical Oncologist with specialty interest in gynaecological malignancies and lung cancer as well as other cancers. She spent two years as part of fellowship training at the Drug Development Unit at the Royal Marsden Hospital, London.

She is using this experience and training to start new cancer research and clinical trials in Cork so Irish patients can access promising new drugs.

“We had the first woman in the UK and Ireland signed up to the trial and she began her treatment at CUH on Friday,” Dr Collins told The Echo.

“She is super excited to be part of the trial. The trial will be opening up at other sites in Ireland and the UK,” she added. “We’re the first to get up and running.”

The trial which is open to patients who have been newly diagnosed with advanced ovarian cancer, will see a combination of chemotherapy and immunotherapy.

“The usual treatment for these patients has not changed in 20 years,” explained Dr Collins.

“I’m prescribing the same chemo to these patients that would’ve been subscribed 19 or 20 years ago so really we haven’t made any great impact in improving ovarian cancer survival and treatment.

“In this trial, patients will get the same chemo they would always receive but they will also get immunotherapy for the next two years,” she added.

“This basically gets your own immune system to attack the cancer and stop it from coming back.

“They will also get a tablet that is a very targeted treatment against ovarian cancer.”

The immunotherapy drug is known as Opdivo while Rubraca is the tablet prescribed.

“I will be offering this trial to all my patients in Cork that fit the criteria,” said Dr Collins.

“The hope is that it will stop their cancer coming back and improve their survival substantially.

“Instead of just 30% surviving for five years, we want to get up to 10 years,” she added.

“We would like to significantly improve the time that it takes for these cancers to come back.

“We know that the tablet alone, when it’s given to patients, that it can significantly help in preventing cancer coming back quickly.

“In the trials, it actually stopped it coming back for around the three, four and five-year mark.

“We hope that it will answer the question as to whether these treatments are better than just giving them what we currently do which is just chemo and then nothing.

“Immunotherapy doesn’t attack the cancer itself.

“It gets your immune system to attack it and we know from using it in lung cancer and melanoma that there are a proportion of patients who are surviving and who may be cured with this treatment. So that’s what we’re trying to do with ovarian cancer but it’s only at the trial stage at the moment.

“It’s fantastic that Ireland is involved and it is a huge coup for us that we are the first site open in Ireland and the UK that are offering this.”

Being able to access these new drugs for patients in Cork is hugely important, according to Dr Collins.

“Cork and Kerry has one of the highest levels of ovarian cancer in Ireland so being able to offer these brand new treatments is fantastic,” she explained.

“It’s giving people hope where before they may have had none. “Every patient that comes to Cork and Kerry with newly diagnosed ovarian cancer, I will consider for the trial,” she added.

“We would also accept referrals from elsewhere as we’re currently the only site open in the country.

“So if a patient was diagnosed elsewhere in the country and needed to get on a trial rather than waiting, we’re ready here.”

The average age of ovarian cancer patients is around 60 but Dr Collins said anyone can be impacted by it.

“The average patient is around 60 but we have seen ovarian cancers in their 20s and 80s/90s.

“It really does affect everyone but the majority would be in their 50s or 60s,” she added.

Unlike other cancers such as cervical, there is no vaccine for ovarian cancer, explained Dr Collins.

“It’s a very sneaky cancer in that 70% of patients who present with ovarian cancer present with cancer that has spread outside the ovaries; it could be in their abdomen causing fluid to build up, sometimes it’s in their lungs,” she said.

“It causes no symptoms until it has spread to that extent and is then incurable.

“It is almost uncommon to catch this cancer early because it just doesn’t cause symptoms,” she added.

“It is a silent killer and a huge issue.

“They haven’t been able to find anything that picks up ovarian cancer early.

“They tried doing ultrasound scans on patients and blood tests but none of these have been proven to pick up this cancer early.

“Researchers are currently looking for ways, maybe a blood test, to detect this cancer earlier because the sooner we catch cancer, the better chance we have to cure it.

“The majority of patients I’m seeing are incurable when I meet them.

“While I know I can get maybe half of them to survive maybe three to five years, that’s all I can get.

“That’s why these new trials are so essential and these new drugs are just critical.”

Despite the lack of an ability to detect ovarian cancer early, Dr Collins said that this is an innovative age of cancer research and treatments.

“We may be giving the same chemo that we did 20 years ago but the changes we’ve seen in ovarian cancer trials even in the past five years have been enormous,” she explained.

“So it’s a really exciting time to be an oncologist and to be treating cancer because we’re starting to see for the first time in a long time, real differences in all cancers.

“Immunotherapy has changed the way we treat many cancers but there are also these small tablet treatments that are different to chemo and that target cancers themselves,” she added.

“These are making huge headway and having a positive impact on people’s survival times.”

Around 20% of these cancers are actually inherited from parents, Dr Collins explained, in a Braca gene that can be passed on through males or females.

“That gene will increase massively a person’s chances of getting ovarian or breast cancer as a female but it also increases your chances of getting prostate cancer as a man.

“It affects everyone,” said Dr Collins.

“We currently don’t have the facilities to test for this gene because our genetic facilities in Crumlin is under-resourced and oversubscribed.

“We can’t identify these patients until a later stage in their treatment,” she added.

“Every patient in this new trial will be tested for the Braca gene.

“That’s important because we can get this extra information that will help inform the patients’ families about their risk of developing cancer.”

Dr Collins said that while it is very difficult to detect ovarian cancer early, there are two red flags that people can be on the lookout for.

“We always recommend that patients who are experiencing abdominal pain or abdominal swelling attend their GP.

“These are the two red flags and a GP should be able to pick up if there is fluid in the abdomen,” she added.

“Ideally, we would like to be able to pick it up before that develops but we just don’t have the ability at the moment.

“Hopefully, that will come about in the future with all of the research currently being conducted around it.

The Cancer Trials Cork unit are currently trying to raise funds for a state-of-the-art machine that can diagnose mutations within ovarian cancer itself and could lead to more treatments in the future.

The unit has currently raised half of the more than €100,000 needed and is hopeful that fundraising initiatives will see them reach their goal by 2020.

“We’d be then the only unit in Ireland with that resource which would be an incredibly helpful machine,” said Dr Collins.

“That will hopefully find new treatments for ovarian cancer moving forward.

“Our trials unit, Cancer Trials Cork, is really trying to push ahead and make more and more trials available in Cork because sometimes trials stay in Dublin and don’t make it down here,” she added.

“We’ve an excellent trial nurse Laura Sheehan who is pushing this as part of the Athena studies.”

Karen Fenton passed away from ovarian cancer in 2017, aged 43. 
Karen Fenton passed away from ovarian cancer in 2017, aged 43. 

The annual Karen Fenton Memorial Run will take place on Sunday, April 14, in Ballinora, and all proceeds will go towards Ovarian Cancer support and research, including this new equipment.

Karen Fenton passed away from Ovarian Cancer, on April 30, 2017, aged 43.

The annual Emer Casey Memorial 5k Road Race will take place in Youghal, tomorrow Thursday, April 4, at 8pm, with funds going towards research into ovarian cancer, its causes and treatments.

Ms Casey passed away from ovarian cancer on June 10, 2006, four days after her 28th birthday.

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