General information on the disease, diagnosis and therapy of cancer of the ovary
(ovarian carcinoma)

Diagnosis
At the beginning, cancer of the ovary does not cause any complaints; diagnoses in the early stages are therefore usually random findings. To date, there is no reliable method for early detection of cancer of the ovary. Therefore, the disease has very often already spread at the time of diagnosis.
Ovarian carcinomas can grow into surrounding tissue and destroy it. Additionally, the tumour can deposit metastases, which spread in the abdominal cavity and the lymph nodes especially and form new tumours there. Ovarian carcinoma most commonly attacks the peritoneum and the intestines. However, cancer cells can also spread to distant parts of the body via the lymph system and the bloodstream.
If cancer of the ovary is suspected, the doctor will first ask the patient in detail about her medical history. To clarify the diagnosis, a gynaecological examination in association with an ultrasound scan of the ovaries and the abdominal cavity is then performed. The tumour marker CA 125 in the blood is usually also determined. Elevated tumour-marker values are not a definite sign of cancer, however, as they can also be raised in non-malignant changes. In the individual case, further imaging procedures such as computer tomography (CT) or magnetic resonance imaging are also conducted for more accurate clarification of the findings. But cancer of the ovary can only be established with absolute certainty by surgery (laparotomy) and the removal of tissue samples for microscopic examination (biopsy).

Prognosis
The course of the disease depends primarily on the stage at which it is discovered. In the early Stage I, more than 80 % of patients can be cured. The chances of recovery in the advanced stages are best if all visible tumour tissue can be removed by surgery. In the advanced stages, a relapse – a so-called recurrence – occurs in many patients, even after initially successful treatment. The tumour grows again and must be re-treated. Further treatment is dictated by various factors, for example how long ago the first treatment was, or how the tumour has receded after first treatment.

Surgery
The first step in the therapy of ovarian carcinoma is as complete as possible surgical removal of the tumour tissue. The less residual tumour remains, the better the further prognosis. Typical steps of surgery are removal of the uterus (hysterectomy), the ovaries and fallopian tubes (salpingoophorectomy and adnectomy), the peritoneal fold (omentectomy) and the lymph nodes (lymphadenectomy). These are also examined for tumour cells. This is crucial for further treatment. It is not unusual for parts of the intestines to have to be removed as well after being attacked by cancer.
A drug treatment (chemotherapy) is almost always required following surgery.

Chemotherapy
The aim of chemotherapy is to eradicate any tumour cells that might remain in the body. Chemotherapy is given over a certain period, usually about five months. It takes place in cycles, i.e. in several treatment segments between which there are always long recovery periods.
Today, the combination of two medicines, a platinum derivative (carboplatin) and a taxane (paclitaxel) is regarded as the standard for chemotherapy following surgery (first-line chemotherapy) for almost all patients. Although many patients are tumour-free after surgery and chemotherapy, the danger is not yet past. For many patients suffer a relapse, a so-called recurrence. Depending on the time at which the relapse occurs, new therapeutic measures such as surgery or chemotherapy are necessary. Which measures are taken in the individual case depends on various factors: Which complaints should be eliminated? How did the patient tolerate the first treatment? How did she respond to it? How long was the interval between the end of the first treatment and the relapse? Once these questions have been answered, discussion with the patient can take place as to whether new surgery followed by chemotherapy or repeated chemotherapy alone might be indicated. The choice of medicines is also dictated by this.
In recent years, attempts have been made in clinical studies to improve the situation that, after completion of primary treatment (surgery and chemotherapy), a large number of patients are first tumour-free clinically and according to imaging, but the majority of them then suffer a relapse after all. For instance, prolonging chemotherapy or additional treatment with more than two different medicines has been tested. Unfortunately, in as far as results are available, it has not been possible to show an increase in effectiveness.

New approaches
A completely new therapeutic approach is vaccination with the Abagovomab antibody to be administered immediately following chemotherapy in order to prevent relapse. The potential of the Abagovomab vaccine, still in clinical development, is based on its capacity to activate the immune system in women so that it can recognise and attack tumour cells that display the CA 125 protein, typical of ovarian cancer. This new approach may lead to hope that the body’s immune system will combat any remaining individual tumour cells, thus preventing the disease’s recurrence. Based on this hypothesis, and on the results of the initial immunology pilot studies, the MIMOSA clinical trial was initiated to confirm Abagovomab’s potential in delaying or preventing relapses.

The right clinic
It is particularly important that patients are cured at a clinic that has adequate experience in treating ovarian tumours. During surgery an experienced doctor is able to judge which surgical steps and measures are necessary for the specific case and which will be the best therapy after surgery. The centres selected for the clinical trial of the Abagovomab vaccine (MIMOSA trial) are listed here.

For further information please visit www.clinicaltrials.gov