Rucaparib

img_0947Picture shows my surgeon Dr Chetty with me at a recent doctor-patient symposium

For those of you who are wondering what’s happening, I’m still waiting for a clear way forward.

I was disqualified from joining the trabectedin trial on account of having had too much prior chemotherapy. The conditions specified no more than 2 prior lines of treatment, but I’ve already had chemo 3 times.

When I first heard of trabectedin, I was told it is derived from a sea sponge and I was very excited because of my own contribution to this work years’ ago. One of my best jobs ever was diving on the reef collecting sponges to send to the National Cancer Institute in the US. My samples were screened for potential use as cancer medicines. It turns out trabectedin comes from a Caribbean tunicate, not a sponge, and now it is synthesised from fermented bacteria, to spare the natural populations.

This little story is so you can imagine how keen I was to be included in the clinical trial, and how disappointed I am to be ruled out. Boo hoo! I wanted to try that sea squirt medicine!

By lucky timing, my specialist heard last week that a trial for a different new drug is just now opening up to recruit women like me, veterans having had 3 or more chemotherapy treatments. This one is called rucaparib, it’s taken as tablets, and I think there’s about a 25% chance it might be helpful in my case.

There are many different types of ovarian cancer resulting from a variety of mutations – that’s why it is so difficult to treat. Cancer research is slowly sifting through the genetics of different types with a goal of finding a specific effective treatment for each individual.

One way to understand cancer is that damaged cells accumulate to form a tumour – cells with mutated DNA that should never have been repaired. Therefore scientists have been searching for ways to stop cancer cell repair. PARP is a repair enzyme, and recuparib is a PARP inhibitor, that stops the repair process, so those cells with horrible mutations will break down and be cleared away naturally.

Two of the ways known for repairing damaged cells are homologous recombination (HR) and PARP. There’s no point taking a PARP inhibitor if HR is functional. Fifty percent of patients are HR deficient and then a PARP inhibitor may be helpful. So I will have a tumour biopsy for genetic testing, hoping to find out that the mutations evident in my cancer tissue are of the HR deficit type.

The recuparib trial is being conducted at a different hospital (RBWH) so I will be going there for a while. I have met the doctor who will be looking after me because one of his patients is my friend and last year I went with her to an appointment when she needed a support person and note-taker. He seems to be another of these dedicated and highly respected oncologists working hard to save us.

Although it is not a huge chance for recuparib to work for me, it is worth a try because it could give me months or years with the disease under control and give my body a rest from toxic chemotherapy. Rucaparib is a targeted therapy, as also is trabectedin and farletuzumab (the trial drug I was on a couple of years’ ago). This means they directly control cancer cells, so it is a relatively mild treatment. In comparison, chemo is the “sledge hammer” approach, killing all fast-growing cells, healthy ones as well as cancer.

I don’t have dates or a timetable yet and there will be a waiting period for the biopsy results to come back from the US. I am hoping and hoping that I qualify this time! If not, then I will have chemotherapy with caelyx.

I have been very preoccupied with all this – reading, learning, hoping, grieving, coming to terms with each new possibility. I’m ok though. Thanks to you all for thinking of me and sending kind wishes! 🙂

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10 thoughts on “Rucaparib”

  1. Hi Alison. Sorry you didn't get into the trabectedin trial. It would have been very satisfying to be able to benefit from your own earlier work. Pretty disappointing. I hope the recuparib works really well for you. Best of luck. Love, Carmel

  2. HI Alison. Interesting to read about the different trials, great to know there are newer and safer treatments. I do hope recuparib will work well for you and save you needing anything more toxic. Hope you have biopsy and get results quickly. The waiting game must be difficult. Love the photo of you and the surgeon, he looks lovely. So nice to be treated by dedicated people. Lots of love

  3. Although disappointing to hear your news re the trabectedin trial, glad you've shared the challenges you have faced, and news of recuparib trial is a hopeful possible alternative. Fingers crossed you get accepted. Keep smiling. xx

  4. Hi Ali, sorry about drug no 1 but delighted you could be on the other trial. Anything to give you a break from chemo. My friend Hilary, I mentioned she too has ovarian cancer, has got over the worst of her op and is waiting to hear when the chemo starts. The prognosis is far better than they all feared and she is hopeful. The sad side effect is that the mesh inserted after a hernia operation two years ago had to be removed as the cancer had welded it to her liver and one r other bits so she now has a smaller liver and one or two other bits missing – which she can deal with – but without the mesh she has been told that lifting, digging and strenuous exercise is out. Not that she is in the mood/has the ability to indulge at the moment but I understand her frustration with regard to the garden. lke us she is a keen horticulturalist!. Take care an the very best for the treatment love from us to you al Jane

  5. Wow! You make my head spin – but so glad there are positive moves and perhaps choices. As always you are an inspiration to us with our treatment – knowing that we never give up. Love & hugs

  6. Thank you as always for the information. Heard about a new success on RN last week …some drug that was originally developed to target oesphargical? cancer + a T53? gene has now been found to work in ovarian as well as any cancer with that particular gene. Wonder if your drug is it? big hugs, darling. Glad you ok, glad you have your family around you. xxx

  7. Boohoo. Definitely got fingers and toes crossed for the next hopeful treatment. I'm glad they treat you with such care and that the relationships with the medical staff seem so caring and supportive too.

  8. BTW, I was going through the big trunk of my health notes, and I found the ovarian cancer and eggs article. 2002. Queensland Institute of Medical Research Dr David Purdie and Uni of QLD senior lecturer in epidemiology Sandi Pirozzo found women who ate more than two eggs a week were 80% more likely to develop ovarian cancer. Published in Cancer Epidemiology Biomarkers and Prevention Oct 2002. Based on dietary reports from about 1600 women, including 800 with ovarian cancer. Close to the largest study ever done. A few earlier research papers had shown the link between egg consumption and ovarian cancer but hadn't followed it up. He said the link is about as bad as smoking when it comes to getting ovarian cancer. The only dietary risk factor with a stronger link to the disease was high daily intakes of saturated fats. One unproven theory was that chemicals such as DDT could have been unwittingly passed up the food chain.

  9. Thanks everyone!! xxx I love reading your comments and receiving your kind wishes. Regarding egg intake and the risk of ovarian cancer, here is an update – Anne followed up with QIMR recently to ask about this and received the following reply: ~10 years ago there were a few papers that suggested eating eggs might increase risk of ovarian cancer but more recent studies did not see an association and it was speculated that in the past levels of chemicals in eggs were higher than they are now and this *might* have been the problem. The most recent studies do not see an association. So we think it's ok to eat eggs now, even if DDT or something in the eggs decades ago may have been a problem.

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