Treating Ovarian Cancer With Immunotherapy & Checkpoint Inhibitors
Receiving an ovarian cancer diagnosis can be devastating. If you or a loved one has recently been diagnosed with this disease, you’re likely trying to find out everything you can about how to treat ovarian cancer and what options are available. You’ll be glad to know that there’s an emerging treatment method for ovarian cancer that’s showing plenty of promise: immunotherapy.
Traditional approaches can certainly still be effective in treating ovarian cancer, including chemotherapy and surgery (such as unilateral salpingo-oophorectomies, bilateral salpingo-oophorectomies, hysterectomies, lymph node dissections, omentectomies and cytoreductive/debulking procedures). However, immunotherapy offers patients and their physicians a new realm of possibilities for treatment—particularly in cases where ovarian cancer is diagnosed in an advanced stage.
What is immunotherapy?
Immunotherapy involves harnessing components of a patient’s immune system with the goal of fighting off certain diseases, including various types of cancer. Unlike many other forms of cancer treatment, immunotherapy doesn’t involve any direct interaction with malignant tumors. Instead, physicians use immunotherapy to strengthen a patient’s immune system so that it has a better chance of fighting off the cancer on its own. In some instances, immunotherapy might involve boosting a patient’s overall immune system; in other cases, it may involve teaching the immune system how to recognize and attack specific cancer cells.
What are immune checkpoint inhibitors?
An immune checkpoint inhibitor is a form of immunotherapy. A person’s immune system contains checkpoints that are tasked with the responsibility of distinguishing between healthy cells and harmful foreign ones. Once these checkpoints detect the presence of foreign cells, the immune system springs into action to attack the foreign cells, leaving the healthy ones alone.
Sometimes, when cancer invades a person’s body, it can prevent the checkpoints from performing their job. Certain cancer cells emit proteins that essentially fool the checkpoints into thinking that they’re healthy cells, and when this happens, the cancer can continue spreading throughout the body undetected. Immune checkpoint inhibitors stop this from occurring. By blocking the cancer proteins from interacting with the checkpoints, the inhibitors allow the immune system to correctly identify and destroy cancer before it can spread any further.
What about monoclonal antibodies?
Certain variations of monoclonal antibody (MAB) therapy are considered a form of immunotherapy. This treatment works by introducing antibodies that recognize and seek out certain types of proteins on cells—some are developed to find proteins on cancer cells, while others locate proteins on immune system cells.
The specific function of a monoclonal antibody drug will depend on what type of protein is being targeted. In general, these drugs fight cancer by stimulating the immune system, often by “marking” cancer cells so the immune system can locate them easier or by drawing immune T-cells closer to the cancer and encouraging a more potent immune response.
What is Bevacizumab (Avastin®)?
Avastin is a type of monoclonal antibody that is approved for late-stage ovarian cancer patients as maintenance treatment and recurrent ovarian cancer patients who previously received one or two rounds of chemotherapy. Avastin has been also considered for use in conjunction with other forms of immunotherapy.
What types of immunotherapy drugs are used to treat ovarian cancer?
The role of immunotherapy has not been established yet, but ambitious research initiatives are steadily diversifying treatment options for ovarian cancer patients. Currently, there are three FDA-approved immunotherapy drugs that have shown to be effective against ovarian cancer, with several more on the horizon:
A type of immunomodulator, Keytruda is a checkpoint inhibitor that modifies the behavior of the immune system to help immune cells more easily recognize cancer cells. Keytruda is usually administered intravenously (through an IV in the arm) around once every three weeks.
Immunomodulator Jemperli is another checkpoint inhibitor that was originally used to treat endometrial cancer. It’s approved to treat select types of advanced-stage tumors located in the ovaries, colon and other areas of the body.
As previously mentioned, Avastin is a type of monoclonal antibody that is approved for late-stage ovarian cancer patients who have previously received one or two rounds of chemotherapy. It’s often used to treat recurrent ovarian cancer, which refers to cancer that returns after a disease-free period of at least six months.
Other types of immunotherapy drugs for ovarian cancer include Durvalumab, Avelumab and Nivolumab.
Possible side effects of immunotherapy
As is the case with virtually all types of cancer treatment, immunotherapy comes with a risk of side effects. The most common side effects tend to be mild and may include:
- Itching and skin rash
- Loss of appetite
- Joint pain
The following side effects can also occur, although they are much less common:
- Fever and chills
- Difficulty breathing
- A flushed complexion
- An autoimmune reaction (this is rare)
What are PARP inhibitors?
Poly ADP-ribose polymerase (PARP) inhibitors are a form of targeted therapy, a type of cancer treatment that uses special drugs to identify and disable the inner workings of cancer cells while minimizing disruption to normal, healthy cells. Evidence points to notably improved outcomes for ovarian cancer patients when PARP inhibitors are used in conjunction with immunotherapy. Two PARP inhibitors that are commonly used to treat ovarian cancer are niraparib (Zejula), an FDA-approved, once-daily pill that’s also cleared for women with fallopian tube cancer, and Olaprib, a drug that may be reccommend for women with late-stage or recurrent ovarian cancer.
PARP inhibitors are viewed as a promising treatment that may slow the progression of ovarian cancer while prolonging the period between remission and recurrence. (In fact, PARP inhibitors are often referred to as an ovarian maintenance treatment). This is significant, as more than 80% of ovarian cancer patients experience recurrent disease after initially achieving remission.
Ovarian cancer immunotherapy at Moffitt Cancer Center
The Gynecologic Oncology Program at Moffitt Cancer Center is pleased to offer immunotherapy for ovarian cancer and is an active participant in immunotherapy trials involving checkpoint inhibitors, vaccine therapy and cellular therapy. We were also among the first institutions in the world to give patients access to PARP inhibitors through clinical trials for women with recurrent ovarian cancer. What’s more, Moffitt is involved in clinical trials focusing on extracted immune T-cells that have been engineered to recognize other specific cancer proteins.
Moffitt’s bold research efforts are evidenced by our status as Florida’s only National Cancer Institute-designated Comprehensive Cancer Center, along with our survival rates that are up to four times higher than national averages. By combining the latest breakthroughs in ovarian cancer treatment with multispecialty expertise and unrivaled clinical experience, our team is able to achieve more positive outcomes and better quality of life for our patients.
For the best outcomes, choose Moffitt first. We encourage you to contact Moffitt at 1-888-663-3488 if you’re interested in learning more about immunotherapy for ovarian cancer, our other progressive treatment approaches or our latest ovarian cancer clinical trials. You may also request an appointment by submitting a new patient registration form online. No referrals are needed to visit Moffitt.
Medically reviewed by Hye Sook Chon, MD, gynecologic oncologist, Gynecologic Oncology Program