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Raising the bar for ovarian cancer

January 22, 2019 | UCI Health
uci health ovarian cancer physician leslie randall

When she was a medical student at University of Louisville School of Medicine, Louisville, Ky., Dr. Leslie M. Randall witnessed firsthand that few effective treatments were available to women with gynecological cancers, such as ovarian and cervical cancer. She wanted to do something about it.

When Randall became a physician, she saw that few treatments meaningfully extended the lives of women with cancers. She became determined to address the problem.

Now she is a gynecological oncologist at UCI Health, which is ranked No. 20 for excellence in gynecology by U.S. News & World Report. And she continues to challenge the status quo — questioning whether standard treatments are really effective and conducting studies to improve the maximum benefits of various therapies.

“What called me to a career in gynecological oncology was the unmet need,” Randall says. “I loved OB-GYN as a medical student, but I saw the greatest unmet need in cancer treatment. I’m pretty intolerant of giving treatments that don’t meaningfully prolong life. I think we can do better.”

Advances in surgery and medical therapies

Randall and her UCI Health colleagues are leaders in gynecologic cancer care, conducting leading-edge clinical trials that test new treatments and drug therapies. She’s an expert in all treatments that comprise state-of-the-art gynecological cancer care, including the latest surgical techniques for removing cancer.

For example, UCI Health patients may be candidates for robot-assisted surgery — a procedure that involves smaller incisions, with less trauma and blood loss. Patients typically recover faster and have fewer complications. Reproductive-age women may also be candidates for surgery that aims to preserve fertility while removing the cancer.

Ovarian cancer is one of Randall’s specialties. Each year more than 22,000 U.S. women are diagnosed with the disease. Although it represents only 3 percent of all cancers in women, it causes more deaths than any other cancer of the female reproductive system — about 14,000 annually. That’s because the disease produces no or only vague symptoms until it has reached an advanced stage, when it is far more difficult to treat.

Survival is higher at high-volume cancer centers

But Randall insists that many more women could live longer if they were treated at a high-volume cancer facility such as UC Irvine Chao Family Comprehensive Cancer Center, where experienced gynecologic oncologists provide access to the most advanced therapies and surgical treatments.

She and her colleagues have long championed cytoreduction, or debulking, surgery for women with advanced ovarian cancer. This involves removing as much of the cancer as possible before, or sometimes after, administering chemotherapy.

Doctors also try to kill any microscopic cancer cells that remain behind with procedures such as hyperthermic intraperitoneal therapy (HIPEC). In this procedure, immediately after removing tumors, doctors infuse the abdominal cavity with heated high-dose chemotherapy to destroy residual cancer cells.

“It makes intuitive sense that if you treat the cancer in a specific location, you may have a better anti-cancer effect,” Randall notes. “We’ve had three clinical trials of showing a benefit of giving chemo in this way.”

Embracing emerging therapies and genetic testing

Randall also is enthusiastic about emerging treatments, such as use of a biological therapy, Avastin®, for women whose ovarian cancer has become resistant to traditional chemotherapy.

Avastin is an anti-angiogenesis medication, meaning that it interferes with the growth of blood vessels that nourish tumors and prompt them to grow. Randall is among a group of researchers studying whether the drug may be beneficial for more women with advanced ovarian cancer.

She also advocates genetic testing of tumors to assess whether targeted therapies — drugs that hone in on a particular genetic abnormality — can increase the chances of survival.

“The actual mortality of ovarian cancer has declined, partly due to improved therapies. But it’s also due to preventive care,” she says.

“We recommend all women with ovarian cancer of a certain type be tested for BRCA mutations and sometimes for other mutations. It’s important for patients and their family members. For patients, gene testing can drive treatment decisions and inform prognosis. The secondary effect is it can drive testing in their relatives, who can then consider preventive options.”

Integrating treatment and research

The comprehensive nature of UCI Health’s services for women with gynecological cancers impressed Randall when she walked through the doors more than a decade ago.

“I came to this program as a fellow. UC Irvine is one of the premier clinical trial centers in the world in gynecological cancer. Our then chief, Dr. Philip DiSaia, was a leader, both nationally and internationally, in pushing forward the gynecological oncology agenda.”

One of Randall’s goals today is challenging and testing claims that surround high-tech treatments and pushing for research to better use existing technology. For example, she is studying whether HIPEC may be better using different types of chemotherapy.

“My reason for studying technology is that some centers are advertising treatments as the next great thing, but they don’t have enough data to say that’s really true,” she says.

Randall spends part of her time treating patients and part of her time conducting research. She can’t imagine it any other way.

“The greatest satisfaction I have is working in research programs that make clinical programs better. The more we integrate our programs, the more progress we can make.”

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