We recently traveled to Pittsburgh, Pennsylvania for an OncLive®
State of the Science Summit™ on Ovarian Cancer. At the meeting, faculty from the University of Pittsburgh Medical Center who highlighted the many advances made with PARP inhibitors, the importance of molecular testing, considerations for the frontline treatment of newly diagnosed disease as well as the best options for neoadjuvant therapy. Faculty also shed light on exciting immunotherapy combinations under exploration and shared key updates in the treatment of recurrent disease.
First, we spoke with the chair of the meeting, Alexander Olawaiye, MD, director of the Gynecologic Research Program, and assistant professor of gynecologic oncology at the University of Pittsburgh and Magee-Womens Hospital, University of Pittsburgh Medical Center Hillman Cancer Center. Olawaiye told us that by blocking PARP, a key enzyme involved in DNA damage repair, researchers have been able to induce synthetic lethality, which has resulted in dramatic clinical responses for patients with platinum-sensitive ovarian cancer. In our interview, Olawaiye walked us through the trials that led to the FDA approvals of various PARP inhibitors
, such as olaparib, niraparib, and rucaparib as maintenance therapy in platinum-sensitive disease.
Afterward, Lan G. Coffman, MD, PhD, sat down with us to discuss frontline maintenance therapy in advanced ovarian cancer. In our interview, Coffman, an assistant professor at UPMC Hillman Cancer Center, stressed that everyone should be aware of the impressive progression-free survival benefit that has been seen with frontline maintenance PARP inhibition
. Although OS data are not yet available, this approach is available for use in patients with BRCA
mutations, both germline and somatic, she added. Listen on to hear more about some of the pivotal trials supporting the use of this approach and the unanswered questions that need to be addressed with future research.
Next, we sat down with John Comerci, Jr, MD, who told us that the emergence of PARP inhibitors in the treatment of patients with ovarian cancer has led to prolonged survival benefit without sacrificing quality of life. In fact, according to Comerci, an associate professor in the Department of Obstetrics, Gynecology, & Reproductive Sciences, and vice chair, Women’s Health Line Specialty Services and Referral Physician Relations, at the University of Pittsburgh Medical Center, said that the introduction of these agents to the treatment paradigm is the most significant advance that has been made in nearly 3 decades. Despite this progress, several questions still exist with regard to surgery, neoadjuvant chemotherapy, and immunotherapy, he added. In our interview, Comerci broke down the advances made in the treatment of ovarian cancer
in recent years as well as remaining challenges.
PARP inhibitors can also be helpful therapeutic tools in prolonging time between chemotherapy treatments in patients with ovarian cancer who are in their third line of therapy or beyond, added Terry L. Evans, MD. However, more information is needed to understand in whom these agents will be most beneficial and who should receive them in combination with other drugs, said Evans, a clinical assistant professor at the University of Pittsburgh School of Medicine and medical director of the UPMC Hillman Cancer Center. In our interview, Evans delves into the use of PARP inhibitors in ovarian cancer treatment
and provides insight into how they are poised to fit in the paradigm.
In order to create more personalized treatment approaches in ovarian cancer, all patients should receive somatic and germline testing upon diagnosis, provided that insurance covers the cost, Sarah E. Taylor, MD, told us when she stopped by. She stressed that this testing can have huge implications not only for patients, but for their families as well. Somatic testing can help guide therapeutic interventions for patients, said Taylor, an obstetrician-gynecologist and oncologist at the Magee Gynecologic Cancer Program at UPMC Hillman Cancer Center. Listen on to hear Taylor discuss the role of somatic and germline testing in ovarian cancer
and how it’s being used to provide more individualized treatment to patients.
When it comes to newly diagnosed advanced ovarian cancer, a patient’s fitness should be established prior to considering intraperitoneal chemotherapy or dose-dense chemotherapy, said Jessica L. Berger, MD, as both strategies carry more toxicity than that of a standard weekly intravenous approach. If medically fit enough, the decision to pursue one of these approaches could be based on whether the patient underwent an optimal or suboptimal cytoreduction, she added. In our interview, Berger, a gynecologic oncologist at the UPMC Hillman Cancer Center, walked us through the available therapeutic approaches for patients with newly diagnosed advanced ovarian cancer
Afterward, Michelle M. Boisen, MD, stopped by to discuss the role of neoadjuvant chemotherapy in advanced ovarian cancer. Notably, the phase III SCORPION trial compared neoadjuvant chemotherapy followed by surgery and adjuvant therapy versus upfront surgery and adjuvant surgery in patients with advanced disease. Findings of a survival analysis from the trial demonstrated that the PFS in patients who underwent primary debulking therapy compared with neoadjuvant chemotherapy was 15 months versus 14 months. Furthermore, median OS was 41 months in the primary debulking arm versus not reached in the neoadjuvant therapy arm. In our interview, Boisen, an assistant professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Pittsburgh Medical Center, discussed some of the key trials evaluating neoadjuvant chemotherapy in ovarian cancer
One of the hot topics of the evening focused on immunotherapy in ovarian cancer
. To discuss the research surrounding checkpoint inhibitors in combination with PARP inhibitors, other immunotherapies, and chemotherapy, was Brian Orr, MD, an assistant professor in the Department of Obstetrics, Gynecology, & Reproductive Services at the University of Pittsburgh Medical Center. In our interview, Orr walked us through the challenges faced with immunotherapy in ovarian cancer and pointed to early promising data with combination regimens.
We closed out the evening with Madeleine B. Courtney Brooks, MD, MPH, who told us that although chemotherapy is the foundation of treatment for patients with recurrent ovarian cancer
, conversations on the potential for secondary debulking and the use of bevacizumab may also be warranted in this space. In our discussion, Brooks, a gynecologic oncologist at the University of Pittsburgh Medical Center, provided insight into the role of chemotherapy and secondary debulking in patients with recurrent disease, and shed light on how bevacizumab is being used in this space.
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