Twenty years ago, Kian Behbakht, MD started researching ovarian cancer at a time when there was not much hope for women diagnosed with the disease. Here he talks about how growing awareness for the condition has brought new resources that have helped drive the pace of discovery.
Behbakht: Without a doubt, collaborators and infrastructure. When I first arrived in 2002, my lab was near Heide Ford’s (CU Cancer Center’s Associate Director of Basic Research) and I knew she was looking at various genes in breast cancer. We started working on developing drugs similarly targeting genes in ovarian cancer. Andrew Thorburn (Professor of Pharmacology) joined us in studying a gene called SIX1, which is active in embryonic development in making cells grow while at the same time stopping the cells from dying. Cancer cells sometimes reactivate this embryonic pathway to drive their own growth and survival. For the past 15 years, our group has worked to find treatments based on this.
C3: Has the approach to treating ovarian cancer changed over the years?
Behbakht: Recently the way we approach it has changed dramatically. It used to be “take no prisoners.” Remove everything. Today we have a more thoughtful, methodical approach. We do a laparoscopy, take samples, look around. If we cannot remove the tumor completely, we give three cycles of chemotherapy and come back when we have a better chance of a successful surgery. This approach also helps us eliminate unnecessary biopsies and interventions.
C3: Has research changed along with treatment?
Behbakht: The paradigm shift in the way we treat ovarian cancer gives us the unique opportunity to study the tumor and its environment before and after chemotherapy. Until recently, our approach had been static – we would gather information through genomic testing and maybe immune analysis to plan treatment but we wouldn’t have the opportunity to revisit the biology of patients’ tumors after treatment. We have just gotten funding to gather dynamic data, before chemo and after three cycles of chemo, from a starting group of 10 patients to see what we can learn. This sort of data is not available in ovarian cancer and this is a unique opportunity to study the before and after in a patient setting. What we find may have implica-tions in the way we think about treating other types of cancer.
C3: When did ovarian cancer patients start to live longer?
Behbakht: There has been some progress over the previous decade, but only in the past two years have we seen major developments. Targeted therapies and new uses of chemotherapy have dramatically improved treatment options, helping to push median survival past five years. We want to continue building on that to allow women and their families more time for important future life events, for example another wedding or another grandchild. Every year that we get a few more percentage points in overall survival is another year of progress toward making this a chronic disease women can live with.
Behbakht: A major challenge in ovarian cancer diagnosis is the fact that medical technology doesn’t allow us to survey the abdominal cavity repeatedly without surgery. The moment technol-ogy allows the detection of circulating tumor cells or some sort of scan that can detect changes from the outside, screening could help us catch this cancer sooner.
C3: What challenges do you think lie ahead for ovarian cancer research?
Behbakht: National collaborative grants put me where I am today and the exciting advances of the last two years are a result of the research invest-ment 20 years ago. However, if the current funding environment continues, we risk losing steam and the ability to move forward for the next 20 years. Because much of what we learn from ovarian cancer research is applicable to other cancers, lack of funding for research into this cancer type could affect our inroads against the disease as a whole. That is a sobering thought.