DRIVE Study Highlights Effective Non-Surgical Treatment Options for Vulvar Cancer Patients
Vulvar cancer is a rare malignancy, accounting for approximately 6% of cancers affecting female reproductive organs, according to the American Cancer Society. The disease cancer affects the vulva, the external female genitalia, including the labia, opening of the vagina and clitoris. While the exact cause of vulvar cancer is still under investigation, researchers have identified several risk factors including advanced age, human papillomavirus (HPV) infection and precancerous conditions of the vulva or cervix.
Vulvar cancer primarily affects women over 55, and these patients find their treatment options quite limited compared to the available treatment of other cancers. Surgery is the standard first line treatment, but significant proportion of patients present with either extensive disease that precludes upfront resection or are medically unfit for surgery. The options available for patients who aren’t candidates for surgery are limited.
“Our understanding of radiation and chemotherapy for patients who aren’t candidates for surgery has evolved significantly. Previously, treatment involved radiating large areas, which led to significant toxicity,” said Anupam Rishi, MD, a radiation oncologist at Moffitt Cancer Center. “Today, with advances in radiation oncology like image-guided and intensity-modulated radiation therapy (IMRT), we can precisely target the areas affected by cancer, delivering higher doses more safely. This approach minimizes exposure to healthy tissues, such as the bladder, rectum and skin, allowing patients to tolerate treatment much better.”
Rishi is currently leading the DRIVE study, a multi-institutional collaborative research initiative focused on vulvar cancer patients treated with high-dose IMRT. The research team is evaluating treatment response and outcome, how well patients followed their treatment plans, side effects and the pattern of failure. Their results were presented at the American Society for Radiation Oncology Annual Meeting.
“With IMRT, we found that patients could safely tolerate higher doses of radiation, from 64 to 66 Gray units, which is an effective dose for controlling tumors. Remarkably, we observed complete response rate of 74%, indicating the disease completely disappeared following treatment,” Rishi explained.
The team discovered that nearly 91.4% of patients in the study successfully completed their planned treatment. This marks a significant improvement compared to older treatment technique, where only about 70% of patients completed treatment. According to Rishi, those who had to stop treatment was largely due to higher toxicity.
The overall survival rate was also promising, with a median survival of 63 months, 87.3% of patients surviving at the two-year mark and 73% at five years.
“This research highlights the effectiveness of non-surgical treatments, allowing patients to manage their tumors through radiation and chemotherapy alone. Many of these patients may not require further treatment or surgery in the future, although surgery remains an option if needed later,” he said. “Traditional surgeries can be disfiguring, leaving patients with significant physical changes that can impact their self-esteem and psychological well-being, especially for younger patients who lead active sexual lifestyles. This study offers an important alternative for those seeking to avoid the potential consequences of surgery.”
While this treatment offers an alternative for patients who prefer to avoid surgery, Rishi advises that patients consult with their care team to ensure it is the right choice for them.
