Advancements in Treatment for Breast and Gynecologic Cancers
During a recent interview with State of the Summitt with OncLive on Women's Health, Gynecologic Oncology Program Chair Dr. Robert Wenham discussed the myriad of treatment advancements using antibody-drug conjugates (ADCs) in HER2-positive breast cancer and PARP inhibitors in ovarian cancer. These therapies have transformed the treatment approach and have made important strides in cervical and endometrial cancer.
"Things are improving in gynecologic cancers, and I’m very bullish that in my lifetime, we will continue to see patients live significantly longer. We may find a couple of these cancers that we can get rid of. I am hopeful that my career will be long enough to get to see that, and hopefully, the evolution of this will be fast enough," he said.
Antibody-Drug Conjugates (ADCs) clinical trials in ovarian cancer
Gynecologic oncologist Dr. Hye Sook Chon spoke about the role of ADCs in ovarian cancer and how these agents affect the treatment paradigm. ADCs are a very targeted therapy that goes to a specific cancer cell that overexpresses something that no other cells in the body do. There are a few clinical trials exploring ADCs in ovarian cancer. The goal is to study which combination of agents, such as anti-VEGF and immunotherapy, are going to be viable options. There are other drugs that are being explored that are ADCs, including tisotumab vedotin-tftv (Tivdak) in ovarian cancer, which is being explored both by itself and in various combinations.
"My hope is that we're going to find several of them are successful, and then we find patient populations that can be triaged based upon those markers. We would then have a therapeutic option for each patient who walks into the clinic, depending upon what their cancer expresses," she said.
PARP inhibitors in ovarian cancer
PARP inhibitors have completely changed the way molecular diagnostics and the way we treat cancer in general.
"We know that patients with BRCA mutations are the best responders to PARP inhibitors, and we know patients who are homologous recombination deficient [HRD], non-BRCA mutated are that second group. There are some response elements seen in the homologous recombination proficient group as well, though it is debatable about how much of a benefit is seen," said Dr. Jeannie Chern. "It is important to test ovarian cancer patients for biomarkers. If an oncologist is not used to doing genetic testing and counseling in this area, collaborate with a geneticist or an oncologist who has experience in this area."
Therapies for HER2-positive breast cancer
These different combinations of therapies result in improved outcomes with some of the ADC-type HER2 targets.
Advancement in surgery for ovarian cancer
"If you're going to debulk patients with ovarian cancer, you have to select patients appropriately. The ideal patients include those who have had a long treatment-free interval, those who have very few sites of disease, lack of carcinomatosis, good performance status, and had a good response to chemotherapy the first time," said gynecologic oncologist Dr. Mitchel Hoffman.
In summary, all these steps forward have been made because of research, which has kept the benchmark moving forward.
"I encourage any patient or any physician who may be wondering whether to refer a patient for a clinical trial, to do so. It is important to refer patients early with good performance status," said Dr. Wenham. "Don’t wait until you feel you’ve exhausted every option because sometimes this excludes patients from the opportunity to ever be involved in these novel trials, which are leading us forward."
Dr. Wenham said there are several opportunities for ADCs at Moffitt Cancer Center.
"We have some that are targeting FRα that are available at our institution. We're interested in some of the anti–PARP-resistance mechanisms using WEE1 and ATR inhibitors. We have a CAR T-cell therapy trial, which is a specific trial for our institution that is targeting the follicle-stimulating hormone receptor. The list goes on, but these things are great opportunities for patients to come in and be involved in what we think are going to be tomorrow’s treatments today," he said.
If you’d like to refer a patient to Moffitt, complete our online form or contact a physician liaison for assistance. As part of our efforts to shorten referral times as much as possible, online referrals are typically responded to within 24 - 48 hours.