Knowledge Is Power: Understanding Your Cancer to Help Inform Treatment
Ethel and Dr Lewin have received compensation for their participation.
Know Your Cancer
While it’s easy to put different types of cancers under one umbrella, the reality is, no two cancers (and no two people living with cancer) are the same.
That’s why getting tested for both inherited mutations and biomarkers can help us understand the unique characteristics of each type of cancer, guiding us and our healthcare team to make informed decisions about our care.1 For Maryland-based Ethel, understanding her genetic mutations has been able to help better inform her treatment journey through advanced ovarian cancer.
Ethel is an avid volunteer and participant at her local synagogue, and her involvement is not only a big part of her life, but it also played a role in a major health change. In 2017, after experiencing intense pelvic pain, Ethel learned that she had Stage 3 ovarian cancer. Having learned about BRCA mutations at her synagogue, she decided to get tested and learned she had inherited the mutation.
Inherited mutations are identified through genetic testing and passed down from parent to child.2 For example, mutations in the BRCA1 and BRCA2 genes increase the risk of certain cancers, including breast, ovarian, prostate and pancreatic cancers.3 In fact, approximately 15% of ovarian cancers are thought to be caused by inherited (germline) BRCA mutations.4 On the other hand, unlike inherited mutations passed down from generation to generation, biomarkers are indicators of cancer that convey unique aspects of a tumor’s behavior, development and progression — all important factors that can greatly impact treatment decisions.5
Advances in precision medicine, a highly individualized way of implementing health care that considers both the genetic makeup, biomarker profile, and lifestyle of an individual, means we no longer need a “one-size-fits-all” approach to treating cancer. Now, our ability to target specific biomarkers and genetic mutations has allowed physicians to address the complexities of certain subtypes of cancer and make informed decisions about treatment.5
“Fewer than one in five individuals with a history of breast cancer or ovarian cancer have undergone genetic testing, but we now have therapeutic options for women with certain mutations.6 It’s critical for women to know their BRCA status early and do tumor testing if they have cancer,” shared Dr Sharyn Lewin, Director of Gynecologic Oncology at Holy Name. “We have learned so much about personalized medicine that women are able to advocate for themselves to ensure they’re receiving all of the information possible to inform their course of treatment.”
When a person is diagnosed with cancer, genetic testing can provide information that may improve patient care and enable access to certain types of targeted therapies.1 This information may help family members too as they can gain knowledge about their own risk of developing the disease by understanding the heritability of a certain cancer.1 Genetic testing can let someone with ovarian cancer know whether they possess an inherited mutation in one of the BRCA genes, which can influence the patient’s decisions about care.1
Beyond knowing she is Ashkenazi Jewish, a risk factor for ovarian cancer, Ethel’s knowledge of her family history was limited. “After learning about my BRCA2 mutation, my oncologist recommended my daughter get tested. We learned that she also has the BRCA2 mutation,” Ethel shared. “We thought it was important to have all of our family members get tested because I have a granddaughter now and we want to be prepared.”
The Importance of Biomarkers in Cancer Treatment
While genetic testing is a critical part of informing a treatment journey, other tests may also be recommended by a doctor to provide important information about a person’s disease. Biomarker testing looks for genes, proteins, and other substances that provide useful information about how a specific type of cancer behaves.
For example, biomarker testing for a trait known as homologous recombination deficiency (HRD) can provide important information after an ovarian cancer diagnosis. HRD impacts how well DNA can be repaired and may be the root cause of the cancer. BRCA mutations are part of the HRD “family” of mutations. About half of the people living with advanced ovarian cancer have tumors that test positive for HRD, which can help guide treatment decisions and determine if a woman may be eligible for certain targeted treatment options. 7
Armed with information about their genetic makeup and tumor characteristics, patients can work with their care teams to make informed decisions about treatment, which may include options such as PARP inhibition therapy. PARP is a protein that repairs DNA damage in cells so they can survive. In cancer cells, you want to stop this repair so they can’t survive. LYNPARZA® (olaparib) is an oral targeted PARP inhibition therapy for certain types of cancers and helps to kill cancer cells by preventing PARP from repairing them.8 PARP is also found in healthy cells, so LYNPARZA may affect them too.9
LYNPARZA is indicated for the maintenance treatment of adult patients with BRCA-mutated advanced ovarian cancer who are in complete or partial response to first-line platinum-based chemotherapy. Select patients for therapy based on an FDA-approved companion diagnostic for LYNPARZA. LYNPARZA is also indicated for the maintenance treatment of HRD+ advanced ovarian cancer, in combination with bevacizumab, after the cancer has responded to first-line platinum-based chemotherapy. Select patients for therapy based on an FDA-approved companion diagnostic for LYNPARZA.9
After achieving a complete response from chemotherapy, Ethel started taking LYNPARZA as a maintenance therapy. Once beginning LYNPARZA, Ethel was able to complete her treatment regimen after two years. Because of her BRCA2 mutation, Ethel continues to see an oncologist every six months since she is at risk for other cancers.
LYNPARZA is associated with serious, potentially fatal, side effects including bone marrow problems called Myelodysplastic Syndrome (MDS) or Acute Myeloid Leukemia (AML), lung problems (pneumonitis), and blood clots (venous thromboembolic events). The most common side effects of LYNPARZA are: nausea or vomiting, tiredness or weakness, cough, low red blood cell counts, low white blood cell counts, diarrhea, shortness of breath, loss of appetite, dizziness, headache, indigestion or heartburn, changes in the way food tastes, low platelet counts. These are not all of the possible side effects of LYNPARZA. Please see additional Important Safety Information below.
Indications for certain mutations or biomarkers can help determine where a patient is on their treatment journey and further inform if and when to start LYNPARZA. The better we understand the cancer, the greater chance we have to maximize patient outcomes.
Our goal as physicians is to keep women with advanced ovarian cancer in remission for as long as possible.
Our goal as physicians is to keep women with advanced ovarian cancer in remission for as long as possible.
Dr Lewin commented, “Our goal as physicians is to keep women with advanced ovarian cancer in remission for as long as possible. Treatment with PARP inhibitors such as LYNPARZA as a monotherapy for BRCAm advanced ovarian cancer or a combination of LYNPARZA plus bevacizumab for women with HRD-positive advanced ovarian cancer has allowed us to reach women using personalized medicines that are meant to target the specific behaviors of their tumor type to optimize care.”
So, What Comes Next?
Understanding our familial risk and the unique makeup of cancer tumors provides crucial information to help us make informed decisions about cancer treatment. With a biomarker-driven approach to treating cancer, it is the hope that patient care teams can work to potentially enhance treatment plans with targeted therapies, treat patients more effectively, and ultimately, improve outcomes.9
Since completing her treatment with surgery, chemotherapy, and LYNPARZA, Ethel and her husband are enjoying their first grandchild, traveling, and exercising, and she is excited to continue her volunteer activities at her synagogue. “I’ve become much more grateful and thankful after experiencing all the support from my family and friends all the way from chemotherapy up until I finished taking LYNPARZA.”
Visit www.LYNPARZA.com to learn more and talk to your doctor about genetic and biomarker testing after a cancer diagnosis.
IMPORTANT SAFETY INFORMATION
LYNPARZA may cause serious side effects, including:
Bone marrow problems called Myelodysplastic Syndrome (MDS) or Acute Myeloid Leukemia (AML). Some people who have ovarian cancer or breast cancer and who have received previous treatment with chemotherapy, radiotherapy, or certain other medicines for their cancer have developed MDS or AML during treatment with LYNPARZA. MDS or AML may lead to death. If you develop MDS or AML, your healthcare provider will stop treatment with LYNPARZA.
Symptoms of low blood cell counts are common during treatment with LYNPARZA, but can be a sign of serious bone marrow problems, including MDS or AML. Symptoms may include weakness, weight loss, fever, frequent infections, blood in urine or stool, shortness of breath, feeling very tired, bruising or bleeding more easily.
Your healthcare provider will do blood tests to check your blood cell counts:
- before treatment with LYNPARZA
- every month during treatment with LYNPARZA
- weekly if you have low blood cell counts that last a long time. Your healthcare provider may stop treatment with LYNPARZA until your blood cell counts improve
Lung problems (pneumonitis). Tell your healthcare provider if you have any new or worsening symptoms of lung problems, including shortness of breath, fever, cough, or wheezing. Your healthcare provider may do a chest x-ray if you have any of these symptoms. Your healthcare provider may temporarily or completely stop treatment if you develop pneumonitis. Pneumonitis may lead to death.
Blood clots (venous thromboembolic events). Some people may develop a blood clot in a deep vein, usually in the leg (venous thrombosis) or a clot in the lungs (pulmonary embolism), which may be severe or lead to death. Tell your healthcare provider right away if you have any symptoms such as pain or swelling in an extremity, shortness of breath, chest pain, breathing that is more rapid than normal (tachypnea), or heart beats faster than normal (tachycardia). Your healthcare provider will monitor you for these symptoms and may prescribe blood thinner medicine.
Before taking LYNPARZA, tell your healthcare provider about all of your medical conditions, including if you:
- have lung or breathing problems
- have kidney problems
- are pregnant, become pregnant, or plan to become pregnant. LYNPARZA can harm your unborn baby and may cause loss of pregnancy (miscarriage)
- If you are able to become pregnant, your healthcare provider may do a pregnancy test before you start treatment with LYNPARZA
- Females who are able to become pregnant should use effective birth control (contraception) during treatment with LYNPARZA and for 6 months after the last dose of LYNPARZA. Talk to your healthcare provider about birth control methods that may be right for you. Tell your healthcare provider right away if you become pregnant or think you might be pregnant following treatment with LYNPARZA
- Males with female partners who are pregnant or able to become pregnant should use effective birth control (contraception) during treatment with LYNPARZA and for 3 months after the last dose of LYNPARZA
- Do not donate sperm during treatment with LYNPARZA and for 3 months after your final dose
- are breastfeeding or plan to breastfeed. It is not known if LYNPARZA passes into your breast milk. Do not breastfeed during treatment with LYNPARZA and for 1 month after receiving the last dose of LYNPARZA. Talk to your healthcare provider about the best way to feed your baby during this time
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Taking LYNPARZA and certain other medicines may affect how LYNPARZA works and may cause side effects.
How should I take LYNPARZA?
- Take LYNPARZA tablets exactly as your healthcare provider tells you
- Do not change your dose or stop taking LYNPARZA unless your healthcare provider tells you to. Your healthcare provider may temporarily stop treatment with LYNPARZA or change your dose of LYNPARZA if you experience side effects
- Your healthcare provider will decide how long you stay on treatment
- Do not take more than 4 LYNPARZA tablets in 1 day. If you have any questions about LYNPARZA, talk to your healthcare provider or pharmacist
- Take LYNPARZA by mouth 2 times a day
- Each dose should be taken about 12 hours apart
- Swallow LYNPARZA tablets whole. Do not chew, crush, dissolve, or divide the tablets
- Take LYNPARZA with or without food
- If you are taking LYNPARZA for early breast cancer and you have hormone receptor-positive disease, you should continue to take hormonal therapy during your treatment with LYNPARZA
- If you are taking LYNPARZA for prostate cancer and you are receiving gonadotropin-releasing hormone (GnRH) analog therapy, you should continue with this treatment during your treatment with LYNPARZA unless you have had a surgery to lower the amount of testosterone in your body (surgical castration)
- If you miss a dose of LYNPARZA, take your next dose at your usual scheduled time. Do not take an extra dose to make up for a missed dose
- If you take too much LYNPARZA, call your healthcare provider or go to the nearest hospital emergency room right away
What should I avoid while taking LYNPARZA?
Avoid grapefruit, grapefruit juice, Seville oranges, and Seville orange juice during treatment with LYNPARZA since they may increase the level of LYNPARZA in your blood.
LYNPARZA may cause serious side effects (see above). The most common side effects of LYNPARZA are:
- nausea or vomiting. Tell your healthcare provider if you get nausea or vomiting. Your healthcare provider may prescribe medicines to treat these symptoms
- tiredness or weakness
- low red blood cell counts
- loss of appetite
- changes in the way food tastes
- low white blood cell counts
- shortness of breath
- indigestion or heartburn
- low platelet counts
These are not all the possible side effects of LYNPARZA. Call your healthcare provider for medical advice about side effects.
You may report side effects related to AstraZeneca products by clicking here. If you prefer to report these to the FDA, either visit www.FDA.gov/medwatch or call 1-800-FDA-1088.
WHAT IS LYNPARZA?
LYNPARZA is a prescription medicine used to treat adults who have:
- advanced ovarian cancer, fallopian tube cancer, or primary peritoneal cancer with a certain type of inherited (germline) or acquired (somatic) abnormal BRCA gene. LYNPARZA is used alone as maintenance treatment after the cancer has responded to your first treatment with platinum-based chemotherapy. Your healthcare provider will perform a test to make sure that LYNPARZA is right for you
- advanced ovarian cancer, fallopian tube cancer, or primary peritoneal cancer with a certain type of abnormal BRCA gene or a positive laboratory tumor test for genomic instability called HRD. LYNPARZA is used in combination with another anti-cancer medicine, bevacizumab, as maintenance treatment after the cancer has responded to your first treatment with platinum-based chemotherapy. Your healthcare provider will perform a test to make sure that LYNPARZA is right for you
- ovarian cancer, fallopian tube cancer, or primary peritoneal cancer, as maintenance treatment, when the cancer has come back. LYNPARZA is used after the cancer has responded to treatment with platinum-based chemotherapy
- human epidermal growth factor receptor 2 (HER2)-negative early breast cancer with a certain type of inherited (germline) abnormal BRCA gene. LYNPARZA is given after surgery (treatment after surgery is called adjuvant therapy). You should have received chemotherapy medicines before or after surgery to remove the tumor. Your healthcare provider will perform a test to make sure that LYNPARZA is right for you
- a certain type of abnormal inherited BRCA gene, human epidermal growth factor receptor 2 (HER2)-negative breast cancer that has spread to other parts of the body (metastatic). You should have received chemotherapy medicines, either before or after your cancer has spread. If you have hormone receptor (HR)-positive disease, you should have been treated with hormonal therapy. Your healthcare provider will perform a test to make sure that LYNPARZA is right for you
- metastatic pancreatic cancer with a certain type of abnormal inherited BRCA gene. LYNPARZA is used as a maintenance treatment after your cancer has not progressed on at least 16 weeks of treatment with platinum-based chemotherapy. Your healthcare provider will perform a test to make sure LYNPARZA is right for you
- prostate cancer with certain inherited or acquired abnormal genes called homologous recombination repair (HRR genes). LYNPARZA is used when the cancer has spread to other parts of the body (metastatic), and no longer responds to a medical or surgical treatment that lowers testosterone, and has progressed after treatment with enzalutamide or abiraterone. Your healthcare provider will perform a test to make sure LYNPARZA is right for you
It is not known if LYNPARZA is safe and effective in children.
Please see complete Prescribing Information, including Medication Guide.
US-68837 Last Updated 11/22
- American Cancer Society. Tests for Ovarian Cancer. Available at https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed November 2022
- American Cancer Society. What Causes Ovarian Cancer? Available at https://www.cancer.org/cancer/ovarian-cancer/causes-risks-prevention/what-causes.html. Accessed November 2022
- Petrucelli N, Daly MB, Pal T. BRCA1– and BRCA2-Associated Hereditary Breast and Ovarian Cancer. In: Adam MP, Everman DB, Mirzaa GM, et al., eds. GeneReviews®. Seattle (WA): University of Washington, Seattle; September 4, 1998.
- Zheng Q, Ying Q, Ren Z, et al. First-degree family history of prostate cancer is associated the risk of breast cancer and ovarian cancer. Medicine (Baltimore). 2021;100(4):e23816. doi:10.1097/MD.0000000000023816
- National Cancer Institute. Biomarker Testing for Ovarian Cancer Treatment. Available at https://www.cancer.gov/about-cancer/treatment/types/biomarker-testing-cancer-treatment. Accessed November 2022.
- Childers CP, Childers KK, Maggard-Gibbons M, Macinko J. National Estimates of Genetic Testing in Women With a History of Breast or Ovarian Cancer [published correction appears in J Clin Oncol. 2018 Feb 1;36(4):432]. J Clin Oncol. 2017;35(34):3800-3806. doi:10.1200/JCO.2017.73.6314
- Konstantinopoulos PA, Ceccaldi R, Shapiro GI, D’Andrea AD. Homologous Recombination Deficiency: Exploiting the Fundamental Vulnerability of Ovarian Cancer. Cancer Discov. 2015;5(11):1137-1154. doi:10.1158/2159-8290.CD-15-0714
- Rose M, Burgess JT, O’Byrne K, Richard DJ, Bolderson E. PARP Inhibitors: Clinical Relevance, Mechanisms of Action and Tumor Resistance. Front Cell Dev Biol. 2020;8:564601. Published 2020 Sep 9. doi:10.3389/fcell.2020.564601
- LYNPARZA® (olaparib) [prescribing information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2022.
- Moore K, Colombo N, Scambia G, et al. Maintenance Olaparib in Patients with Newly Diagnosed Advanced Ovarian Cancer. N Engl J Med. 2018;379(26):2495-2505. doi:10.1056/NEJMoa1810858