Introduction
Ovarian cancer is the most common among gynecological tumors in Western countries and is the fifth cause of leading death in gynecological malignancies. Genetic factors and environmental factors are responsible for causing ovarian cancer. The risk of ovarian cancer is increased in patients with breast cancer genes (BRCA1 or BRCA2) mutation. BRCA1 or BRCA2 are genes located in the long arm of chromosome 17. These genes are referred to as caretaker genes as they repair the deoxyribonucleoside acid (DNA). Various imaging techniques and biopsies help in diagnosing the tumor extent. Ovarian cancer can be treated by platinum-based chemotherapy and radical surgery. But it is seen that standard management is not effective for advanced stages of ovarian cancer.
According to studies, 70 percent of advanced stages of ovarian cancer cases recur within five years, along with drug resistance in patients. The recurrence of ovarian cancer emphasizes the need for new treatment strategies and the introduction of Ricaprib for ovarian cancer. Poly-ADP-ribose polymerase (PARP) inhibitors play an important role in treating ovarian cancer caused by genetic alteration. The role of PARP inhibitors (Rucaparib) is approved by the Food and Drug Administration (FDA) as a maintenance therapy for relapsed ovarian cases.
What Is Ovarian Cancer?
Ovarian cancer is a disease in which a group of abnormally growing cells in the ovary divides rapidly, having the potential to invade other body parts. The group of cell mass (tumor) can invade and spread (metastases) to other body organs. Ovarian cancer is the eighth most common cancer among women. Ovarian cancer progress to its advanced stage (second or third) due to lack of diagnosis, making it the fifth leading cause of cancer-related death. Most ovarian cancers (90 percent) are epithelial in origin. Few cases of ovarian cancer (7 percent) have a positive family history.
Advanced stages of ovarian cancer due to BRCA1 genetic alteration grant homologous recombination (HR) defect. This alteration of the BRCA1 gene results in loss of HR-mediated DNA damage repair. These events also lead to genomic loss of heterozygosity (a phenomenon in which gene duplication or loss occurs).
What Is Rucaparib?
Rucaprib is an oral drug used as chemotherapy for ovarian cancer. Rucaprib is a PARP1, PARP2, and PARP3 inhibitor approved by the Food and Drug Administration (FDA) on April 6, 2018, as chemotherapy for BRCA-mutated ovarian cancer. PARP1, PARP2, and PARP3 repair damaged DNA in cancer cells. PARP enzymes are unable to repair DNA in the absence of a functional BRCA1 gene. Therefore, PARP inhibitors work as anti-neoplastic. Recently, three PARP inhibitors have been approved, namely: Olaparib, Rucaparib, and Niraparib. PARP inhibitors are suggested in HR-deficient tumors. Rucaprib is used as maintenance therapy after chemotherapy for patients with recurrent ovarian cancer.
What Are the Causes of Ovarian Cancer?
The majority of cancer does not occur due to only a single factor. It results from the complex interaction between genetic factors and exposure to environmental carcinogens (a substance that promotes cancer formation). Genetic and environmental factors play an important role in causing ovarian cancer. Ovarian cancer is caused due to mutation of the BRCA1 or BRCA2 gene. BRCA1 or BRCA2 are genes located in the long arm of chromosome 17. These genes are referred to as caretaker genes as they repair the deoxyribonucleoside acid (DNA).
Older age, family history, and ovarian stimulation all increase the risk of ovarian cancer. On the other hand, suppressed ovulation, pregnancy, prolonged breastfeeding, and contraceptive pill have all been shown to reduce the risk of ovarian cancer.
What Are the Symptoms of Ovarian Cancer?
The patient is asymptomatic in the early stages of ovarian cancer, and symptom appears in the advanced stages of ovarian cancer.
The following are the symptoms of ovarian cancer
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Vague abdominal discomfort.
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Abdominal swelling.
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Vaginal discomfort.
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Low back pain.
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Altered bowel habits (such as constipation).
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Weight loss.
How Is Ovarian Cancer Diagnosed?
The patient history, physical examination, and imaging techniques diagnose women with ovarian cancer.
The patient with ovarian cancer can be diagnosed in the following ways:
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Patient History - The patient’s full history provides information about family history or habits such as smoking or occupational exposure to infection.
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Physical Examination - The palpation of viscera can be done on a physical examination. The abdominal or mass swelling is palpable as omental cake.
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Blood Test - The serum level of tumor marker CA-125 is measured with the help of a blood test.
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Ultrasound - Ultrasound can be performed to define the extent and location of the tumor.
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Computed Tomography (CT scan) - This imaging technique allows us to obtain high-resolution images of organs. It helps to define the course, location, staging, and extent of tumors.
How Is Ovarian Cancer Treated?
The early stage of ovarian cancer is treated by surgery followed by chemotherapy. Chemotherapy with Carboplatin and Paclitaxel is the treatment of choice. Surgery treats ovarian cancer through the removal of a tumor. Treatment can include Platinum or Paclitaxel combined with Topotecan or Liposomal Doxorubicin as a combination therapy.
What Is the Role of Rucaparib in Ovarian Cancer?
The Food and Drug Administration (FDA) approved Rucaprib as a maintenance treatment in patients who responded to platinum-based therapy. Rucaprib treats patients with BRCA-mutated ovarian cancer. The exact time for administering Rucaprib is not known. The trials are going on to establish the use of Rucaprib with immunotherapies as a combination therapy.
According to studies, all women who respond to platinum therapy and receive Rucaprib live approximately one year without disease progression. The role of Rucaprib in patients with HRD tumors has shown up to 1.5 years progression-free survival rate. The accepted dose of Rucaprib is 600 mg orally twice daily. The common side effects of Rucaprib are nausea, vomiting, fatigue, anemia, and altered bowel habits such as constipation. Therefore, Rucaprib is effective with fewer side effects.
Conclusion
Rucaprib is a new therapeutic option used as maintenance therapy in ovarian cancer with few side effects. Rucaprib has been proven effective by clinical trials to be used as treatment therapy and maintenance therapy in recurrent ovarian cancer cases. The future trials of Rucaprib may show a positive result to be used as the first line of treatment in BRCA1 or BRCA2 mutated ovarian cancer. Researchers have expanded the use of Rucaprib with immunotherapies (combination therapy) for HRD tumors. Rucaprib prolonged lifespan in women with ovarian cancer without disease progression.
