Future Outlook of the Ovarian Cancer Treatment Landscape
Leslie Randall, MD, MAS, offers closing thoughts on the future trajectory of ovarian cancer treatment.
Case: A 55-Year-Old Woman with BRCA-Mutated Ovarian Cancer
- A 55-year-old presents to her PCP for heartburn and abdominal pain that started approximately 2 years earlier.
- Imaging: Transvaginal US showed bilateral ovarian masses; CT reveals masses in adnexa, largest measuring 5.8 cm, with evidence of liver capsule and retroperitoneal lymph node involvement.
- Labs: CA125, 3600 U/mL
- Surgical intervention: She underwent hysterectomy, omentectomy, appendectomy, and debulking; residual disease was left on liver and diaphragm, approximately 2.2 cm
- Diagnosis: stage IIIc, high-grade serous ovarian cancer
- IHC testing: p53 (+)/ PAX 8 (+) /WTI and CK 7 (+)
- Germline testing: BRCA1 mutation
- Treatment: She received IV carboplatin/paclitaxel
- TRAEs: She experienced myelosuppression, most notably neutropenia (post cycle 3) that required postponement of next cycle
- Follow-up imaging: showed complete clinical remission after completion of chemotherapy; CA125, 30.5 U/mL
- Maintenance therapy with a PARPi was initiated.
- At week 3, her hemoglobin is 7.0 g/dL and she receives a transfusion
Transcript:
Leslie Randall, MD, MAS: There’s so much exciting development in ovarian cancer. The bevacizumab-PARP [inhibitor] maintenance was just a start. We’re learning [more about] potential prevention strategies for our [patients with] BRCA [mutations];we used to remove the ovaries at age 35, [but now] we’re…just looking at removing the fallopian tubes and allowing patients to go through a more natural menopause, and then removing the ovaries later, because at least half of these tumors actually start in the fallopian tube. That’s very exciting. That would [cause fewer adverse events] for patients going through menopause early.
Secondly, new targeted treatments. We saw at the most recent ASCO [American Society of Clinical Oncology] meeting a brand-new treatment that already has an accelerated approval in the United States for [patients with high folate receptor alpha expression]on mirvetuximab [soravtansine].We saw at ASCO the confirmatory trial [SORAYA (NCT04296890)] with an overall survival advantage for patients in the platinum-resistant setting, which we’ve not seen before. That’s exciting. We also saw data at ASCO [related to] other antibody-drug conjugates like mirvetuximab targeted to folate [receptor alpha] that work in the population that [has medium or low folate receptor alpha expression]. That requires more study, but that was exciting.
Additionally, [there are] other antibody-drug conjugates, such as upifitamab rilsodotin or UpRi, and these are moving from the platinum-resistant setting into the platinum-sensitive maintenance and eventually maybe even into the front line, just like we saw with the evolution of the PARP inhibitors. That’s exciting. We’re looking at novel ways of addressing immunotherapy for ovarian cancer. We know that checkpoint inhibitors don’t work that well or even at all for our patients, so we’re starting to look at more adoptive T-cell-type therapies that will engage the immune system in a different way for our ovarian cancer patients. It’s really exciting.
Transcript edited for clarity.
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