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Long Term Survivor Tumor Characterization Around 75 percent of patients diagnosed with ovarian cancer will experience a recurrence. With support from The Julie Fund, our team is working to advance promising research to characterize the tumors of long term ovarian cancer survivors. These efforts will help us understand why some cancers with certain mutations recur, why certain recurrent cancers stop responding to conventional therapies that once worked, and how to combat drug resistant cancers with the next generation of ovarian cancer therapies. Over the past year, funds from The Julie Fund were used to perform RNA sequencing on 300 ovarian cancer samples for this project.

Early Detection Efforts for Ovarian Cancer It is likely that the early detection of ovarian cancer will result in an improved outcome, since the treatment of early stage tumors (confined to the ovary) is quite effective. An effective early detection test requires not only a high sensitivity for the disease, but also a very high specificity to avoid over-diagnosis and needless surgery. Our team of physician scientists have been engaged in a multi-institution collaborative effort that will provide the foundation with a test for early detection of ovarian cancer. The goal of this study is to establish novel genomic (gene based) and proteomic (protein based) technologies to identify and detect very low levels of ovarian cancer specific biomarkers in patient specimens (blood and vaginal fluids). This project has a discovery and a validation phase. During the discovery phase, specific biomarkers are identified in patients with ovarian cancer at a single time point. This is possible thanks to our access to patients’ tissue through the Center for Gynecologic Oncology’s clinical research program. In the validation phase, these biomarkers will be tested for their change in time within the plasma of patients on a clinical trial that have eventually developed ovarian cancer. The latter is possible thanks to access to plasma of patients participating in the UKCTOCS study, which has enrolled 202,000 healthy women to monitor changes in their CA125 levels in plasma over time. Specifically, blood samples were collected from initially all healthy women every six months over the course of 10 years. Some of these women developed ovarian cancer and we can now look at their blood samples from the years leading up to their cancer diagnosis to see if we can detect specific proteins or DNA shed from cancer cells. During the past year we have made significant progress in the discovery phase of this project

1. We have identified a list of 50 proteins and related genes that have high potential to become effective biomarkers for ovarian cancer.

2. We have established a work process to collect vaginal fluids from women diagnosed with ovarian cancer at MGH to test whether these tissues can provide a more accurate source for an ovarian cancer screening test.

3. We have proved the capacity of a very novel sequencing technology to detect extremely low levels of mutated DNA shed from ovarian cancer in the vaginal fluids. The rationale for using vaginal fluids is that this tissue can be collected in a minimally invasive fashion (by carrying a small size vaginal tampon for a couple of hours or through a standard PAP smear) and contains proteins and DNA released from the fallopian tubes, i.e. the site that is currently believed to be the site of origin of ovarian cancer.

Overall, this collaboration between the Broad Institute, MGH, medical oncologists, and biostaticians has led to the development of an extremely innovative research project that aims to discover a biomarker’s “signature” (group of biomarkers combined together) for a very specific and highly sensitive screening program for ovarian cancer early detection. Much of this work is high risk and, as such, is not likely to be funded by the NIH. The monies provided by The Julie Fund have been critical for moving this research forward. In addition, new research avenues have been established to further validate the data derived from this project and to ensure the successful development of a functional screening test that can detect the very early stages of ovarian cancer progression, which will significantly improve survival of women affected by this disease.

Support for Patient Assistance In 2017, The Julie Fund also worked to ensure the best possible outcomes for all women being treated for ovarian cancer and other women’s cancers at the Mass General Cancer Center, regardless of financial situation, by providing vital patient assistance funding. Funding is provided for the additional non-medical expenses incurred by cancer patients and their families. These include transportation, food, childcare, meal delivery, rent, utilities, temporary housing, and, other exceptional expenses that are a result of cancer treatments. The following are some examples of how The Julie Fund made a difference in the lives of these women over the past year:

• L. is a 54-year-old patient with ovarian cancer. L. is in a very difficult financial situation; she currently has no income and is accumulating debt that far exceeds her savings. L. does have family but is reluctant to reach out to ask them for assistance. L. earned a good living prior to her diagnosis and her family perceives her as being wealthy, so asking them for money is out of the question. L. is worried that she will receive a notice telling her that her electricity would be shut off if she does not make a payment soon. To relieve some of the financial stress that L. is feeling The Julie Fund paid $1,200 to pay her bill.

• C. is a 51-year-old breast cancer patient. Prior to her treatment, C.’s only income was unemployment benefits, which were due to expire in a few months. C. was looking for a job but received news that her cancer had returned and she would likely need more treatment. In addition, C.’s mother was diagnosed with a terminal illness. C. wants to go back to work, but will not be able to until her condition improves. With the help of The Julie Fund we were able to pay C.’s $1,500 mortgage.

• M. is a 61-year-old ovarian cancer patient living on her own. M. lives simply, she has a low paying job with good insurance and mostly pays her bills on time. With a tight budget and increased costs dealing with her new diagnosis, M. was under incredible financial stress. With the help of The Julie Fund we were able to pay two months of rent ($2,400) for M.

Additionally, through the generous support of The Julie Fund, caregivers were able to provide financial assistance to 6 women during their treatment at the Vernon Cancer Center at NewtonWellesley Hospital in 2017. Five of these women were in treatment for breast cancer and one for ovarian cancer. Here are two examples of grateful patients.

• M. is a 67-year-old woman with ovarian cancer. She was working full-time when she was hospitalized for depression. Because of this she could only return to work part-time. Then, two months later, she was diagnosed with ovarian cancer. She was unable to work during her treatment and became increasingly concerned about meeting her monthly living expenses. The Julie Fund was able to provide $75 toward her phone bill. While this may be seen like a small gift to some, for M it was monumental – not only because it took such a weight off her financial worry, but also because she felt the support of a larger community.

• E. is a 48-year-old woman with breast cancer. She had to reduce her work schedule when she was diagnosed to complete surgery and chemotherapy. As a divorced mother of two, this reduced income just wasn’t enough to meet her regular bills. In order to help relieve this stress, The Julie Fund paid $175 to cover her heat bill during the winter. She was extremely grateful for this assistance.

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