Recent Advances in Cervical Cancer Treatment - Episode 15
Experts share their experience and thoughts on the use of tisotumab vedotin as the management of metastatic cervical cancer continues to evolve.
Bradley Monk, MD, FACOG, FACS: Have any of you utilized this agent [tisotumab vedotin]? Do you have experience with it? It’s very new.
Krishnansu S. Tewari, MD: Yes.
Premal H. Thaker, MD, MS: I have. On trial, they’re not required to see an ophthalmologist every cycle.
Krishnansu S. Tewari, MD: Right, only in the beginning.
Premal H. Thaker, MD, MS: Yes, in the beginning to document, and then I’m supposed to be the ophthalmologist and tell them if they have pink eye or not. It’s interesting that the FDA requires that.
Bradley Monk, MD, FACOG, FACS: Do you feel comfortable doing that, or do you think this will lessen the burden? You all belong to the most famous GYN [gynecologic] oncology centers in the world. When you are in a situation you are less familiar with, the burden is taken off the oncologist. But maybe not, maybe it’s a hassle. What do you think, Premal?
Premal H. Thaker, MD, MS: Most of it is conjunctivitis, so you can tell, and keratitis, which requires the ophthalmologic intensive examination, but it’s rare, 1% or 2%. It’s nice to have colleagues you can quickly refer them to, but it’s also good to not burden the patient, and when they come in they don’t have to make another appointment. I agree with you both ways, when I first started using this drug I was scared and apprehensive, but now that I’ve seen the mitigation strategy I understand it, similarly to how we were scared with BEV [bevacizumab]. I remember learning about antihypertensives, and asking how many can we give? What should we give? But we’ve gotten better, and we will continue to improve.
Bradley Monk, MD, FACOG, FACS: Bhavana, do you have experience?
Bhavana Pothuri, MD: Not yet.
Bradley Monk, MD, FACOG, FACS: Soon though, right?
Bhavana Pothuri, MD: Yes, I have a patient I’m going to put on it.
Bradley Monk, MD, FACOG, FACS: Warner, my patient is PD-L1 negative, so I can’t give her PEMBRO [pembrolizumab], to your point. But there are patients who are checkpoint inhibitor-naїve, PD-L1 positive, second line. You’ll have to decide whether to give her [pembrolizumab] and either balstilimab or cemiplimab, or if you should give her TV [tisotumab vedotin]. That means [tisotumab vedotin] is a third-line treatment or checkpoint is a third line. I can’t believe we’re talking about sequencing in cervical cancer. Tell us how you would decide to do second and third line with [tisotumab vedotin] versus checkpoint.
Warner K. Huh, MD, FACOG, FACS: That’s a tough question. I’m excited about this drug because it addresses the exact scenario that you’re describing. No one knows what the real-world experience will be for this drug, but I’m excited to use it in the setting that you described, in lieu of giving someone [pembrolizumab] or a checkpoint inhibitor, because the mechanism is different. The clinical data are truly impressive, that’s why I’m excited. I see many of these patients, and I’m disappointed by the lack of options I have for them.
Bradley Monk, MD, FACOG, FACS: Someone asked me that question, and I gave the same answer you did. Then an hour later I think, “Now, I know the answer.” Tell me if this resonates with you. You can give tisotumab vedotin and pembrolizumab together. The tisotumab vedotin label doesn’t say you can’t give it with [pembrolizumab], and [pembrolizumab] is easy to get. Bhavana, you said it, and you can give drug replacement. This was presented by Ignace Vergote [MD, PhD,] at ESMO [European Society for Medical Oncology], if you take the 14% for [pembrolizumab] and the 24% for [tisotumab vedotin], and add them together you get the high 30% range. Is it rational to combine them, or do you think I’m trying to be too creative? What do you think, Krish?
Krishnansu S. Tewari, MD: We need to use it as monotherapy first to be more comfortable with it.
Bradley Monk, MD, FACOG, FACS: What do you think, Warner? I’m a bit out there, I know.
Warner K. Huh, MD, FACOG, FACS: I love that you’re outside the box, but I agree with Krish, we have to gain familiarity with the drug first. That’s the rational way to do it, but I think what you’re proposing is truly fascinating.
Premal H. Thaker, MD, MS: At least we have data to support that, we are starting to see the data. I like your medicine island for our patients, but I don’t think our insurers do yet, so we must be in reality.
Bradley Monk, MD, FACOG, FACS: Bhavana says we should follow our paradigm and do earlier lines of therapy. We can replace the taxanes with tisotumab vedotin, they’re both antimitotic cytotoxics, so there’s an opportunity there.
Transcript edited for clarity.