Bradley J. Monk, MD, FACOG, FACS, professor, director of the Division of Gynecologic Oncology at Creighton University School of Medicine at St. Joseph’s Hospital and Medical Center in Phoenix, Arizona, highlights promising abstracts in gynecologic malignancies presented at the 2019 ASCO Annual Meeting.
One of the most important studies to come out of the 2019 ASCO Annual Meeting in gynecologic oncology is the SOLO-3 trial. In the phase III trial, olaparib (Lynparza) demonstrated a statistically significant reduction in the risk of progression or death compared with chemotherapy in patients with platinum-sensitive, relapsed, germline BRCA1/2-mutated ovarian cancer who received at least 2 prior lines of chemotherapy. These results remove any doubt that olaparib does not fare as well against chemotherapy in this setting, says Monk.
As more targeted therapies emerge, investigators are hoping to lessen the need for chemotherapy. Such rationale served as the basis for the phase II trial of niraparib (Zejula) and bevacizumab (Avastin) in patients with platinum-sensitive recurrent disease. Treatment with the doublet resulted in a median progression-free survival of 11.9 months compared with 5.5 months with niraparib alone. Notably, these results are comparable to what is seen with chemotherapy alone, says Monk. Furthermore, the combination seemed to be most active in patients without BRCA mutations.
Physicians are eagerly awaiting data from the 2019 ESMO Congress, where results from the phase III PRIMA and PAOLA-1 trials are expected to read out. These trials are attempting to expand the activity of PARP inhibitors to patients who do not harbor BRCA mutations, explains Monk.
Regarding other gynecologic cancers, pembrolizumab (Keytruda) is FDA approved for use in both endometrial and cervical cancers. However, despite these approvals, patients are not being cured, says Monk. Here too, combinations may prove useful. The ongoing phase III CALLA trial is investigating the combination of chemotherapy, durvalumab (Imfinzi), and radiation therapy in these patients with locally advanced disease in an effort to try to increase the cure rate.