Personalized Treatment Revolutionizes Ovarian Cancer Care in Israel

Ovarian cancer, a significant and challenging gynecological malignancy, is diagnosed in hundreds of Israeli women annually. While less common than breast cancer, it often presents at advanced stages, complicating treatment. Early symptoms like abdominal bloating, early fullness, pain, bowel habit changes, and fatigue are nonspecific and can be attributed to other conditions. Key risk factors include advanced age, family history, and genetic mutations like BRCA.

Over the past decade, the approach to ovarian cancer has shifted dramatically from a one-size-fits-all treatment to a personalized strategy based on the tumor's unique biological signature. Previously, most patients received similar surgery and chemotherapy regimens. Now, advancements allow for understanding the tumor's molecular profile, including genetic and biological characteristics, to tailor treatments. "We understand that ovarian cancer is not one disease, but a group of diseases with different biological characteristics," explained Dr. Emad Matanes, Director of the Gynecologic Oncology Unit at Rambam Health Care Campus. "Personalized medicine in ovarian cancer is based on understanding the tumor's molecular profile, its genetic and biological signature."

Central to this personalized approach are tests identifying BRCA mutations (BRCA1 and BRCA2) and homologous recombination deficiency (HRD). BRCA genes normally help repair DNA damage, and mutations increase cancer risk. HRD describes a broader inability of cells to repair DNA breaks, even without BRCA mutations. These tests provide a detailed tumor "identity card," revealing genetic mutations, HRD status, and active biological pathways. This information guides treatment decisions, potentially leading to more precise, effective therapies with fewer side effects. "For one patient, we will recommend a certain treatment, and for another, a different treatment, even if ostensibly it's the same disease," Dr. Matanes noted.

A prime example of this progress is the use of PARP inhibitors, a targeted therapy that exploits a weakness in cancer cells with DNA repair defects. By blocking an additional repair mechanism in cells with BRCA mutations or HRD, these drugs cause an accumulation of damage, leading to cancer cell death through a process called "synthetic lethality." This approach is less harmful to healthy cells.

Even for advanced-stage ovarian cancer, personalized medicine has improved survival rates and quality of life. The ability to match biological treatments to tumor characteristics, use maintenance therapies like PARP inhibitors, and predict treatment response is changing the disease's course. While not a cure, these advancements offer longer, better lives for many patients.

Despite medical progress, challenges remain in ensuring equitable access to information and advanced treatments, particularly in the Arab community in Israel. Dr. Matanes emphasized the importance of raising awareness, providing clear and culturally appropriate information, and encouraging women to seek medical attention for persistent symptoms. He stressed that understanding genetic and molecular tests like BRCA and HRD and discussing their implications with healthcare teams is crucial for patients to fully benefit from personalized medicine.