Q&A With Ovarian Cancer Physician Scientist Kevin Elias, MD

A summer job in a medical lab laid the groundwork for Kevin Elias, MD, to forge a career as a physician scientist focused on the research and treatment of gynecologic cancers.

Dr. Elias joined Cleveland Clinic in November 2024 as the Lilli and Seth Harris Endowed Chair for Ovarian Cancer Research.

“I directed a laboratory for almost 10 years at Brigham and Women's Hospital that was focused mostly on early detection and prevention of gynecologic cancers,” says Dr. Elias. “Cleveland Clinic approached me because they were interested in building up their research program, and two areas of priority are cancer and women's health. That's the intersection of where I practice. It was clear from talking to leadership and visiting that they were making a substantial investment in that.”

Dr. Elias has appointments in both Cleveland Clinic’s Obstetrics & Gynecology Institute and the Department of Biomedical Engineering at the Lerner Research Institute. “We are focused on developing new tools, both for science and clinical application,” he says.

In this Q and A with Consult QD, Dr. Elias describes his research and clinical work with ovarian cancer and gestational trophoblastic disease.

How did you become interested in gynecologic cancers?
When I was a teenager, I was looking for a summer job before college and I got a job working in a lab in Chicago, where my family lived at the time. It just so happened that it was with a gynecologic oncologist. He didn't really have any money to pay a summer student, so we worked out a deal that if I could help him with getting some experiments done in the laboratory, I could join him in the operating room to get some experience understanding what life as a surgeon was like. The most memorable surgeries tended to be surgeries related to ovarian cancer.

What was important to you about that experience?
There are some people who go into gynecologic oncology because they enjoy doing really big surgeries. The procedures we do tend to be very long and complicated. This is particularly true for ovarian cancer, which often tends to have spread pretty diffusely by the time of diagnosis. So some people go into it for that reason.

For me, it was actually the exact opposite experience. I couldn’t believe that in this era, the best we had to offer patients was very disfiguring, difficult surgeries. I thought that clearly there must be a better way to do this.

The irony is that 30 years later, I'm still doing those surgeries I was seeing as an early college student. The field still desperately needs advances. But I've come to focus on the idea of making ovarian cancer a disease that's not only more survivable but more survivable with better quality of life, which has to center on early detection and prevention.

Advances in ovarian cancer

What progress has been made in the field since you were a college student?

What has changed quite a bit over that time is our understanding of the biology of the disease. We now know that somewhere between one in three and one in four ovarian cancers have a genetic component to them. And identifying who might have a genetic predisposition for ovarian cancer is an opportunity to dramatically prevent deaths from disease. If you identify that someone is at risk, and they undergo preventive surgery, their risk of dying from ovarian cancer goes down by 90%.

The other thing we know is that most ovarian cancers are no longer actually ovarian cancers. We used to think that all these cancers arose as cysts in the ovary. We now know that probably 75% to 80% of them arise from the fallopian tubes. And that has been a paradigm shift in the field, in terms of early detection and prevention strategies. Increasingly, we recognize that for many women, removing just their fallopian tubes will dramatically reduce their risk from ovarian cancer without the negative consequences of removing the ovary. We can get the cancer-protection benefits of removing the fallopian tube without the risk of premature menopause.

Tell us about the focuses of your laboratory work.

We have three major areas of focus. One is specifically developing better tools for early detection and prediction of ovarian cancer. And that research has been based mostly around combining new techniques for identifying blood-based biomarkers. We look at a family of molecules called micro RNAs and how they can be used for predicting specific diseases. We combine that with a type of artificial intelligence called neural network analysis. We've been working in that field for about 10 years.

We use those tools to look at blood samples to both diagnose ovarian cancer for people who may be asymptomatic and, increasingly, to predict people who otherwise wouldn't know they're at risk for ovarian cancer.

The second part of my lab focuses on understanding the biology of ovarian cancer. We do a lot of basic science looking at how different types of cells within the fallopian tube and the ovary interact with one another. How do these cancers arise in the first place? Are there opportunities for prevention that could come from that?

The third part of my lab is a little bit different. When I finished my clinical training, I did postdoctoral work at MIT in chemical engineering, focusing specifically on nanotechnology. There we are developing nanoparticles for delivering novel therapies for ovarian cancer and also developing new tools potentially for things like diagnosis.

What are some benchmarks you have your eye on that will help push things forward?

There have been a number of early detection and cancer screening trials that I've been wanting to bring to Cleveland Clinic and open. Getting those first trials open is one of the first benchmarks, and I'm hoping that's going to be within the next weeks or months. I want both for patients and industry collaborators to think of Cleveland Clinic as a place to go.

I'm also working with other investigators to create a network of collaborators who have similar interests when it comes to ovarian cancer and early detection in general. It's really nice being based at Lerner and being able to interact with other principal investigators and talk about science. I think it promotes a lot of collaboration, which is great. Creating interest groups around gynecologic cancers creates an opportunity to bring people who might be from other fields to apply their expertise to solving the problems that I treat clinically.

Expertise in trophoblasts

What should we know about the clinical side of your work?

One of my clinical areas of expertise is enhanced recovery after surgery (ERAS), which is about getting patients through the surgical process with the least perturbation to the normal physiology as possible so that patients recover and get back to normal life as quickly as possible. I'm the president of ERAS USA, a society that spans across all surgical specialties.

I am also an expert in cancers of the placenta, known as trophoblastic tumors. They only occur in women who have at some point been pregnant. They can either occur immediately following a pregnancy or years after the last pregnancy. They tend to occur in younger women.

What's important to know about trophoblastic tumors is that they are almost 100% fatal if not treated properly and almost 100% curable if treated properly. There are very, very few cancers that have such a wide dichotomy as far as outcome.

Trophoblastic tumors are pretty rare; there are probably only a couple thousand cases nationally every year. Of the more severe ones, where risk of mortality is potentially higher, there are probably no more than a couple hundred cases every year. It's a field I've been working in for a long time, and we're setting up a reference center here in Cleveland. The number one risk factor for dying from one of these diseases is not being treated at a reference center. It's more important than the stage of disease and the age of the patient.

Are these tumors as difficult to identify as ovarian cancer is?

No. They're fairly easy to identify — if you think to diagnose them. That's the problem, because they're a rare tumor. We can usually diagnose them essentially with a pregnancy test, but you have to understand the clinical scenario. Anybody who has unexplained bleeding following a pregnancy, or any young woman who presents with some sort of metastatic cancer and they don't know what type it is, checking a pregnancy test is the easiest way to understand that this could be a trophoblastic tumor, because they're very aggressive tumors. They can spread to anywhere in the body. I've seen them everywhere from people's retinas to their fingernails. But they're highly curable, even when patients have advanced-stage disease. It's just a matter of knowing what you’re looking for.