After 30 years of stagnation, new hope emerges for ovarian cancer treatment

After three decades of stagnant treatment outcomes, a breakthrough has been achieved in ovarian cancer treatment.

“Unfortunately, there has been no significant improvement in treatment outcomes for ovarian cancer over the past 30 years. However, in the last decade, clinical trials using new drugs have shown promising results, marking a turning point,” said Professor Jung Sang-geun of the Gynecologic Oncology Center at CHA University Bundang Medical Center on the YouTube channel with the same name as the hospital.

According to Statistics Korea, the five-year survival rate for ovarian cancer was only 65.9 percent in 2021. There are reasons for the poor treatment outcomes for ovarian cancer.

“Ovarian cancer is often diagnosed at an advanced stage, making it a cancer that requires repeated treatments due to its tendency to recur and metastasize, to the point where it is referred to as a cancer that cannot be cured with a single treatment,” Professor Jung said.

Unlike other cancers, ovarian cancer is treated with surgery even in advanced stages. The first step in ovarian cancer treatment is surgery, specifically a procedure called debulking surgery, which involves removing as much of the cancerous tissue as possible from the patient's body.

“Tumor debulking surgery is a procedure that aims to minimize the amount of cancer remaining in the body by removing as much of the cancer as possible from areas where it has spread but can still be surgically removed,” Jung said, explaining the reason for the procedure. “The fact that minimizing residual tumors in the abdominal cavity during the initial surgery leads to better outcomes is an established principle in gynecologic oncology.”

It is known that good outcomes can be expected when all visible ovarian cancer is removed or left smaller than 1 centimeter. For this reason, the surgical scope for ovarian cancer is broader than for other cancers.

“To achieve a good prognosis, the basic procedure includes total hysterectomy, bilateral oophorectomy, salpingo-oophorectomy, and lymphadenectomy. If the cancer has spread, surgery is performed to remove as much of the affected tissue as possible, including parts of the peritoneum, diaphragm, liver, spleen, colon, small intestine, and mesentery,” Professor Jung said. “Such surgeries can take four to five hours, or even up to eight hours or more.”

The surgery is performed in collaboration with obstetricians, surgeons, urologists, and other specialists.

“When residual tumors are minimized, the effectiveness of chemotherapy is maximized, so even though the process is lengthy and challenging for both patients and medical staff, we strive to perform it diligently,” he said. “Following tumor-reduction surgery, chemotherapy is administered to eliminate any remaining cancer cells. In rare cases where surgical removal is difficult based on imaging tests, neoadjuvant chemotherapy is administered first before attempting surgery.”

After surgery, most patients undergo chemotherapy.

“Chemotherapy plays a crucial role in eliminating remaining cancer cells and reducing the risk of recurrence. In ovarian cancer treatment, postoperative chemotherapy is as important as surgery itself,” Jung explained. “The goal is to improve treatment outcomes by removing any microscopic residual lesions after surgery to prevent recurrence.”

Ovarian cancer chemotherapy typically involves a combination of carboplatin and paclitaxel, which are platinum-based cytotoxic anticancer drugs that have been traditionally used for over 20 years.

“Even if most ovarian cancers are detected at stage 3 or higher, when they have spread throughout the abdominal cavity, aggressive tumor debulking surgery followed by chemotherapy can result in a response rate of over 80 percent of patients, with some achieving complete remission.”

Despite such a high response rate to initial chemotherapy, there are reasons why the overall treatment outcomes for ovarian cancer remain low.

“The problem is that over 80 percent of patients experience recurrence after initial treatment,” Professor Jung said.

Whether recurrence occurs within six months or a year is critically important. Recurrence within six months is considered platinum-resistant, leading to very poor treatment outcomes, he added, emphasizing the need for introducing new drugs.