Dr. Leslie Randall doesn’t settle. When she was a medical student at University of Louisville School of Medicine, Louisville, Ky., she witnessed firsthand that fewer effective treatments were available to women with gynecological cancers, such as ovarian and cervical cancer. She wanted to do something about it.
When she became a physician, she saw that some treatments didn’t meaningfully extend the lives of women with cancers. She decided to address the problem. And today, as a UC Irvine Health gynecological oncologist, she continues to challenge the status quo—asking whether treatments are really as good as people say they are and conducting studies to obtain the maximum benefit from various therapies.
“What called me to a career in gynecological oncology was the unmet need,” says Randall. “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 colleagues are doing better. She has expertise in all of the treatments that comprise state-of-the-art gynecological cancer care, including the latest surgical techniques for removing cancer.
For example, UC Irvine Health patients may be candidates for robot-assisted surgery—a procedure that involves smaller incisions and less trauma and blood loss. Patients typically recover faster and have fewer complications. Reproductive-age women may also be candidates for surgeries that aim to remove the cancer while preserving fertility.
One of Randall’s specialty areas is ovarian cancer. Each year more than 22,280 women in the United States are diagnosed with the disease. Many are diagnosed with advanced disease because ovarian cancer often produces no symptoms or only vague symptoms. But, she insists, many more women could live longer if they received the most advanced therapies at a high-volume cancer facility like the Chao Family Comprehensive Cancer Center.
“The actual mortality of ovarian cancer has declined, partly due to improved therapies. But it’s also due to preventive care.”
Randall and her colleagues have long championed cytoreduction, or debulking, surgery for women with advanced ovarian cancer. This surgery involves removing as much of the cancer as possible before, or sometimes after, administering chemotherapy. Doctors then turn to therapies to try to kill any microscopic cancer cells that remain behind such as intraperitoneal therapy (IP), which involves pumping chemotherapy medications directly into the abdomen to bathe the tissues and destroy residual cancer cells.
Another newer procedure is called hyperthermic intraperitoneal chemotherapy (HIPEC). In this procedure, immediately after removing tumors doctors infuse the abdominal cavity with heated high-dose chemotherapy.
“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 that’s not all. Randall is enthusiastic about emerging treatments, such as use of a biological therapy, Avastin, for women with ovarian cancer that 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 Avastin may be beneficial for most 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 UC Irvine Health’s services for women with gynecological cancers impressed Randall since she walked through the doors 11 years 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. [Former chief] Dr. Philip DiSaia was a leader, both nationally and internationally, in pushing forward the gynecological oncology agenda.”
One of her goals today is challenging and testing claims that surround high-tech treatments and pushing for research to better utilize existing technology. For example, she wants to know if 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 true,” she says.
She spends part of her time treating patients and part of her time conducting research and 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.”