Leslie M. Randall, MD, associate professor, Division of Gynecologic Oncology, UC Irvine Health, discusses emerging treatment strategies for patients with cervical cancer.

The current management of patients with locally advanced cervical cancer is chemoradiation—this has been the standard of care for 20 years. Ongoing research is looking to improve this paradigm by bringing immunotherapy into the mix, Randall says.

In the metastatic setting, immunotherapy is being studied in several different ways. One approach is looking at cellular-based therapy through tumor infiltrating lymphocytes. Noncellular therapies on the rise include PD-1/PD-L1 and CTLA-4 inhibitors, as well as antibody-drug conjugates. Moreover, PARP inhibitors, which have transformed the ovarian cancer space, are also being studied in combination with immunotherapy and PIK3CA inhibition in cervical cancer, Randall says.

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Leslie M. Randall, MD, associate professor, Division of Gynecologic Oncology, UC Irvine Health, discusses emerging treatment strategies in the treatment of patients with cervical cancer.

Dr. Randall on Emerging Treatment Strategies in Cervical Cancer

Leslie M. Randall, MD, associate professor, Division of Gynecologic Oncology, UC Irvine Health, discusses next steps with PARP inhibitors in the treatment of patients with gynecologic malignancies.

PARP inhibition has been one of the most significant developments made in the treatment of gynecologic cancers in recent years, earning 3 FDA approvals for the maintenance treatment of patients with recurrent ovarian cancer who are in complete or partial response to platinum-based chemotherapy. While these oral agents have shown encouraging benefit, patients are still developing resistance, with most patients having to stop therapy due to progressive disease.

Aside from extending the reach of PARP inhibitors beyond ovarian cancer, the most exciting research moving forward is developing combination therapies to overcome PARP resistance, Randall says. There is intriguing ongoing work looking at combining PARP inhibitors with immunotherapy or with PIK3CA inhibition, which is particularly important in the treatment of cervical cancer.

Dr. Randall on Next Steps With PARP Inhibitors in Gynecologic Malignancies

Leslie M. Randall, MD, associate professor of Gynecology/ Oncology, University of California Irvine, discusses the importance of early BRCA testing for patients with ovarian cancer.  

 testing is very important for several reasons, the most of which is identifying patients who have specific tumor biology, said Randall. Patients with 

 mutations tend to be more platinum-sensitive than patients who don't have those mutations. They're also eligible for different clinical trials than patients who don't have those mutations.

In addition to that, identifying the patients who are BRCA mutated now, will help determine their treatment line for PARP inhibitor therapy later on, as well as identify those whose family members should be tested for genetic mutations.  

Dr. Leslie M. Randall on Early BRCA Testing in Ovarian Cancer

Leslie M. Randall, MD, associate professor of Gynecology/ Oncology, University of California Irvine, discusses evidence supporting the use of 

 testing for patients with ovarian cancer.

A strong consensus has been reached in the oncology community that 

 testing should be performed, although it is not conducted as often as it should be, Randall explains. The level of evidence to support 

 testing is a level "B," according to the United States Preventive Services Task Force guidelines.

Randall says that, currently, the prevalence of 

 mutations in ovarian cancer is approximately 20%.

Leslie M. Randall, MD, associate professor of Gynecology/ Oncology, University of California Irvine, discusses evidence supporting the use of BRCA testing for patients with ovarian cancer.

Leslie M. Randall, MD

Articles

Dr. Randall on Emerging Treatment Strategies in Cervical Cancer

Dr. Randall on Next Steps With PARP Inhibitors in Gynecologic Malignancies

Dr. Leslie M. Randall on Early BRCA Testing in Ovarian Cancer

Dr. Leslie Randall Discusses Evidence Supporting BRCA Testing in Ovarian Cancer