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Paradigms of Success in Ovarian Cancer

Panelists: Michael J. Birrer, MD, PhD, The University of Alabama at Birmingham; Robert L. Coleman, MD, FACOG, FACS, The University of Texas MD Anderson Cancer Center; Bradley J. Monk, MD, FACS, FACOG, The University of Arizona College of Medicine; Kathleen Moore, MD, The University of Oklahoma Health and Sciences Center; Shannon N. Westin, MD, MPH, The University of Texas MD Anderson Cancer Center
Published: Monday, Dec 02, 2019



Transcript:

Bradley J. Monk, MD, FACS, FACOG: We’ve had a robust discussion about ovarian cancer, beginning with the standard treatment: carboplatin-paclitaxel-BEV [bevacizumab] in BRCA-mutated patients. Olaparib is also showing that beyond BRCA—maybe in the HRD [homologous recombination deficiency] but also in the non-HRD in some studies, that there’s an opportunity for additional PARP inhibitor efficacy. I’d like to wrap up with a take-home message. I’m going to start with you, Rob. After you digest not only the frontline landscape but the recurrent landscape, what are you most compelled by as we move forward? Tell our audience what the key take-home message and compelling opportunities are.

Robert L. Coleman, MD, FACOG, FACS: In my opinion, I think the role of this new class of agent has now reached the pinnacle. We’ve moved it from…

Bradley J. Monk, MD, FACS, FACOG: PARP inhibitors.

Robert L. Coleman, MD, FACOG, FACS: PARP inhibitors—from the recurrent biomarker-selected, multiply pretreated patients all the way into the frontline discussion.

Bradley J. Monk, MD, FACS, FACOG: I love it.

Robert L. Coleman, MD, FACOG, FACS: We don’t have many of those. This is a unicorn moment, and I really feel that this solidifies its space...

Bradley J. Monk, MD, FACS, FACOG: When we bring drugs to market in late stages and then we do earlier lines of therapy, it went from really resistant, recurrent disease to platinum-sensitive maintenance to frontline maintenance. We do combinations, which are in with PAOLA, and then we go to other tumor types. As you know, olaparib is approved in breast cancer and will soon be approved in pancreatic and prostate cancers. Phase III–positive trials have been reported. It is short of a paradigm of success with the new class of agents, and thank you, for all of you. Shannon, what are you most compelled by?

Shannon N. Westin, MD, MPH: I think we’re getting better at selecting.

Bradley J. Monk, MD, FACS, FACOG: Yes, right?

Shannon N. Westin, MD, MPH: Although we’ve got all these positive data in all-comers, we are starting to see a little more differentiating and an ability to select the right drug or combination of drugs for our patients. We’re not quite there, but we’ve definitely made great strides.

Bradley J. Monk, MD, FACS, FACOG: With your help, and I’m very grateful. Thank you.

Shannon N. Westin, MD, MPH: Thank you.

Bradley J. Monk, MD, FACS, FACOG: Katie, go ahead.

Kathleen Moore, MD: I agree with Shannon. I think we’re turning ovarian cancer into a rarer and rarer disease with these subsets, which will help us do better, smaller, smarter trials to move things forward. I think this has been an exciting week, but it set a new floor for us.

Robert L. Coleman, MD, FACOG, FACS: Yes.

Kathleen Moore, MD: We still have a lot of room to go. For me, the most compelling thing is the work still to do for all these patients who are going to recur now—our 30 months, 27 months. As with PRIMA.

Robert L. Coleman, MD, FACOG, FACS: We’re in a new space, yeah.

Kathleen Moore, MD: It used to be 15 months. Now we’re at 30 months, but we’re still going to have these recurrences, and we need to be ready with active, science-driven combinations for them. This 1 down here is already doing a lot of those trials, so I think we have a lot of work to do. It’s an exciting time.

Bradley J. Monk, MD, FACS, FACOG: I like that you got the HRD-negative frontline patients where we have a lot of work to do, and you have all the PARP inhibitor failures.

Shannon N. Westin, MD, MPH: Yes.

Robert L. Coleman, MD, FACOG, FACS: That’s right. That’s where it’s going.

Bradley J. Monk, MD, FACS, FACOG: Thank you for that. Dr Birrer?

Michael J. Birrer, MD, PhD: I don’t have much to add. I would just remind people that it wasn’t long ago that, frankly, olaparib was abandoned.

Robert L. Coleman, MD, FACOG, FACS: It was in 2011, yes.

Michael J. Birrer, MD, PhD: The reasons I think it got back on are a lot of smart people in academics and advocates arguing, and the industry led us back to the right path. It’s all happening very fast. I do think the wave of the future is, at least in part, PARP inhibitor resistance. I’d love to think that all these ladies would be cured, but they’re not going to be. They’re going to come back. We need to know what to do with them.

Robert L. Coleman, MD, FACOG, FACS: What to do next.

Bradley J. Monk, MD, FACS, FACOG: Well, thank you. It’s been a robust discussion. I’m very grateful. On behalf of our panel, we thank you for joining us, and we hope you found this Peer Exchange discussion to be useful and informative. Please join us again. Thank you, and so long for now.

Transcript Edited for Clarity

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Transcript:

Bradley J. Monk, MD, FACS, FACOG: We’ve had a robust discussion about ovarian cancer, beginning with the standard treatment: carboplatin-paclitaxel-BEV [bevacizumab] in BRCA-mutated patients. Olaparib is also showing that beyond BRCA—maybe in the HRD [homologous recombination deficiency] but also in the non-HRD in some studies, that there’s an opportunity for additional PARP inhibitor efficacy. I’d like to wrap up with a take-home message. I’m going to start with you, Rob. After you digest not only the frontline landscape but the recurrent landscape, what are you most compelled by as we move forward? Tell our audience what the key take-home message and compelling opportunities are.

Robert L. Coleman, MD, FACOG, FACS: In my opinion, I think the role of this new class of agent has now reached the pinnacle. We’ve moved it from…

Bradley J. Monk, MD, FACS, FACOG: PARP inhibitors.

Robert L. Coleman, MD, FACOG, FACS: PARP inhibitors—from the recurrent biomarker-selected, multiply pretreated patients all the way into the frontline discussion.

Bradley J. Monk, MD, FACS, FACOG: I love it.

Robert L. Coleman, MD, FACOG, FACS: We don’t have many of those. This is a unicorn moment, and I really feel that this solidifies its space...

Bradley J. Monk, MD, FACS, FACOG: When we bring drugs to market in late stages and then we do earlier lines of therapy, it went from really resistant, recurrent disease to platinum-sensitive maintenance to frontline maintenance. We do combinations, which are in with PAOLA, and then we go to other tumor types. As you know, olaparib is approved in breast cancer and will soon be approved in pancreatic and prostate cancers. Phase III–positive trials have been reported. It is short of a paradigm of success with the new class of agents, and thank you, for all of you. Shannon, what are you most compelled by?

Shannon N. Westin, MD, MPH: I think we’re getting better at selecting.

Bradley J. Monk, MD, FACS, FACOG: Yes, right?

Shannon N. Westin, MD, MPH: Although we’ve got all these positive data in all-comers, we are starting to see a little more differentiating and an ability to select the right drug or combination of drugs for our patients. We’re not quite there, but we’ve definitely made great strides.

Bradley J. Monk, MD, FACS, FACOG: With your help, and I’m very grateful. Thank you.

Shannon N. Westin, MD, MPH: Thank you.

Bradley J. Monk, MD, FACS, FACOG: Katie, go ahead.

Kathleen Moore, MD: I agree with Shannon. I think we’re turning ovarian cancer into a rarer and rarer disease with these subsets, which will help us do better, smaller, smarter trials to move things forward. I think this has been an exciting week, but it set a new floor for us.

Robert L. Coleman, MD, FACOG, FACS: Yes.

Kathleen Moore, MD: We still have a lot of room to go. For me, the most compelling thing is the work still to do for all these patients who are going to recur now—our 30 months, 27 months. As with PRIMA.

Robert L. Coleman, MD, FACOG, FACS: We’re in a new space, yeah.

Kathleen Moore, MD: It used to be 15 months. Now we’re at 30 months, but we’re still going to have these recurrences, and we need to be ready with active, science-driven combinations for them. This 1 down here is already doing a lot of those trials, so I think we have a lot of work to do. It’s an exciting time.

Bradley J. Monk, MD, FACS, FACOG: I like that you got the HRD-negative frontline patients where we have a lot of work to do, and you have all the PARP inhibitor failures.

Shannon N. Westin, MD, MPH: Yes.

Robert L. Coleman, MD, FACOG, FACS: That’s right. That’s where it’s going.

Bradley J. Monk, MD, FACS, FACOG: Thank you for that. Dr Birrer?

Michael J. Birrer, MD, PhD: I don’t have much to add. I would just remind people that it wasn’t long ago that, frankly, olaparib was abandoned.

Robert L. Coleman, MD, FACOG, FACS: It was in 2011, yes.

Michael J. Birrer, MD, PhD: The reasons I think it got back on are a lot of smart people in academics and advocates arguing, and the industry led us back to the right path. It’s all happening very fast. I do think the wave of the future is, at least in part, PARP inhibitor resistance. I’d love to think that all these ladies would be cured, but they’re not going to be. They’re going to come back. We need to know what to do with them.

Robert L. Coleman, MD, FACOG, FACS: What to do next.

Bradley J. Monk, MD, FACS, FACOG: Well, thank you. It’s been a robust discussion. I’m very grateful. On behalf of our panel, we thank you for joining us, and we hope you found this Peer Exchange discussion to be useful and informative. Please join us again. Thank you, and so long for now.

Transcript Edited for Clarity
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