In March 2021 the National Institute for Health and Care Excellence (NICE) announced a new maintenance treatment option for women with HRD positive advanced ovarian cancer in England. The Scottish Medicines Consortium (SMC) has today (13/12/2021) announced approval of this new maintenance treatment option for women with HRD positive advanced ovarian cancer in Scotland. This gives women in Scotland the same access to this drug combination approved for women in England in March 2021. The new treatment is a welcome addition to a growing number of targeted therapy options that will help women with advanced ovarian cancer live longer.
When this was approved primarily by NICE in spring 2021, Ovarian Cancer Action was one of several charities that contributed to the decision. We nominated a patient advocate to speak at the appraisal meeting to share their experience, to help the panel decide whether or not to approve these treatments. Elevating the voice of our community is vital to ensure decision-makers understand the impact new treatments options offer for women today and generations to come.
A combination of Avastin (bevacizumab) and Olaparib (Lynparza) has proven to be an effective maintenance treatment for women with advanced, high-grade epithelial ovarian, Fallopian tube or primary peritoneal cancer.
Maintenance treatments do not cure cancer, but they can prevent disease progression. The PAOLA-1 trial showed greater progression-free survival in women who received the combination of treatments, in comparison to those taking only Avastin. This means they had longer periods of time between further treatments where their cancer was stable.
The combi-treatment is now available to women who have experienced a complete or partial response after first-line platinum-based chemotherapy and Avastin, and their cancer is associated with HRD.
What is HRD?
HRD stands for homologous repair deficiency. This is what we call it when there is an error in one of the genes involved in repairing DNA. You may have heard of faulty BRCA1 or BRCA2 genes. They are just two of the genes involved in this DNA repair function, but there are many more.
Alterations in these genes can result in a higher risk of high-grade serous ovarian cancer, but also a better response to maintenance treatments, also known as PARP inhibitors. This treatment combination offers a new option for people who do not carry a BRCA mutation but are HRD positive.
HRD testing is performed on a sample of a tumour after surgery, at the same time and in a similar way to how tumour BRCA testing works currently. All women with non-mucinous high grade serous ovarian cancer should now be considered for HRD testing.
If you have just been diagnosed with high-grade serous ovarian cancer, you should ask your oncologist about HRD testing as part of your treatment pathway as it is in place from today. If you have previously been tested and found to not carry a faulty BRCA gene, then you can be retested for HRD. If you have a confirmed faulty BRCA gene (either through blood or tumour testing), you are classed as HRD positive so need no further testing to establish if you qualify for this treatment combination.
Campaigning for better access to treatments
Florence Wilks, a member of the Ovarian Cancer Action Research Network, shared her ovarian cancer experience with the panel to help them understand the impact making this new treatment available. Florence was diagnosed with advanced ovarian cancer in 2010 and told she had just 12-18 months to live. She spent two years going back and forth to her doctor with numerous symptoms before finally being diagnosed with stage 3c ovarian cancer. She’s since had four rounds of chemotherapy, two major surgeries, and has taken both Avastin and Olaparib. This March marks 11 years since her diagnosis. Access to personalised treatments over the last decade has enabled her to see her children grow up, continue to do the things she loves and treat every day as a gift.
Speaking in reaction to this news in March, Florence said: “This is such wonderful news, women with such a difficult diagnosis of advanced ovarian cancer need as many treatment options as possible to help combat the disease. I’ve been fortunate to be the patient representative on two NICE committees. Both experiences have been really positive. Ovarian Cancer Action help you with the process as do NICE itself. To provide first-hand knowledge of a specific condition and treatment is really important, and your individual patient perspective key in decision making. I have found that helping others in any way possible makes one's own journey more worthwhile.”
“Today’s decision demonstrates the power of patient advocacy. No one is better qualified to help NICE make informed decisions than women personally affected by ovarian cancer. We’re delighted we could help facilitate that and will continue to work alongside other charities to ensure all women have access to the best treatment and care available.”Cary Wakefield, Chief Executive of Ovarian Cancer Action (March 2021)
Dr Jonathan Krell, Consultant Medical Oncologist and Ovarian Cancer Action Researcher, tells us: “The decision by NICE to fund the combination of Olaparib with Bevacizumab as a maintenance treatment for women recently diagnosed with ovarian cancer who have responded well to chemotherapy and in whom tumour testing confirms the presence of certain molecular markers called HRD is very positive news. This will hopefully enable us to control ovarian cancer even more effectively for these women but will also allow us to test more women for the HRD markers which may help guide future treatment options as well if ever required.”
The treatment has been made available via the Cancer Drugs Fund. To find out if you are eligible, speak to your gynae-oncologist.
Every woman deserves access to the best possible treatment. Please help us to continue to campaign for better treatment access to help more women by donating today.