Ovarian Cancer: Evolving Concepts Around Systemic Therapy - Episode 18

Systemic Management of Ovarian Cancer: Closing Thoughts

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Bradley J. Monk, MD: I want to thank all 4 of you for a very rich and informative discussion. Before we conclude I’d like to get your final thoughts, including what you’re the most excited about moving forward, and any pearls that you think we discussed. Tom Krivak, I’m going to have you go next, then Sharyn Lewin, Dr Herzog, and Katie Moore. Tom Krivak, what are you excited about, and what pearls do you think were brought out today?

Thomas C. Krivak, MD:I’m excited about the trials that you all talked about, specifically the first trial upfront. I think that Katie changed the standard of care with SOLO1 (NCT01844986), as well as GOG-0218 (NCT00262847). Now we’re looking at different combinations in upfront settings because we wanted to get the PFS [progression-free survival] to be the longest upfront. I’m really excited about ATHENA (NCT03522246) and that the HR [hormone receptor] proficient group is about 40 to 50% of the population. It’s going to be exciting to see what FIRST (NCT03602859) is going to bring about in that subgroup of the HR proficient subgroup. I completely agree that for patients with recurrent ovarian cancer, the first thing that we need to do is look at our clinical trials to see what they’re qualified for. We have probably 3 or 4 competing trials open, and it’s about selecting patients for these trials because we’re not going to get the answers unless we do that. I think there are a lot of options for all these patients, and a clinical trial is tremendously important. I work at Allegheny Health Network in Pittsburgh, Pennsylvania, which is kind of a community-based center that has residents. But we’re very passionate about clinical trials because we know that’s going to change the standard of care and move that needle to improve the quality and longevity of life for women with ovarian cancer.

Bradley J. Monk, MD: Thank you, Tom Krivak, for being with us. I know you’re a big-time enroller and a great author. You like to write and teach, and you’re known for your clinical expertise, so thank you for that. Sharyn, go ahead. Pearls, summary.

Sharyn N. Lewin, MD:Pearls and summary. I agree with everything Tom said. I will highlight again the importance of germline testing all patients when they’re diagnosed, and I believe in HRD [homologous recombination deficiency] testing. We see a lot of these trials where women have an upfront cytoreduction, are completely cytoreduced, and even do best. I think we shouldn’t forget the role of surgery for these women who are newly diagnosed, as well, and with clinical trials we still have a lot of important questions to answer.

Bradley J. Monk, MD:Thank you, Sharyn, it’s been good seeing your face and hearing your comments. Go ahead, Tom Herzog.

Thomas J. Herzog, MD:So, Brad, thank you. It’s always, harder to be fourth, but it looks like I’m third, so it’s still a little bit difficult. I agree with everything that’s been said. It’s important to figure out how we’re going to use all the new toys that we now have available. While some people let subgroup analysis guide that, you can only rely on that so far, but it is helpful. We want the science to really take us the rest of the way. Which of these subgroups really benefit from these different combinations?

I do think it is about combinations, and what I’m most excited about is really starting with Katie’s SOLO1, and now extending and looking at the opportunity to do combinations with bevacizumab and PARPs, and so forth. Can we cure more women with frontline ovarian cancer? And that’s the most exciting thing that I’ve thought about in decades in working in this disease. Thank you for having me today.

Bradley J. Monk, MD: Thanks, Tom, and go ahead, Katie. I wanted to thank you for your leadership within the Society of Gynecologic Oncology. Even though it was virtual, it was still the best meeting. We would have enjoyed going to Toronto, but we certainly enjoyed the virtual opportunity, and with your leadership, you were able to pivot quickly to this virtual opportunity. I’m glad that we could be together virtually today, but I’m going to give you the last word. Tell us sort of what the future holds in your mind and what you’ve been most excited about.

Kathleen N. Moore, MD:Thanks, Brad, and thank you again for having me. The first thing I want to point out is you all kindly keep referring to SOLO1 and QUADRA (NCT02354586) as my studies, but these were all big team-based efforts, and many times international efforts, with many dedicated investigators. I was just fortunate enough to lead. Clinical research is a team-based effort, and we have to keep that in mind and keep moving forward. With ESMO [European Society for Medical Oncology], we’ll see the new indications that are to be decided any day now, and that will set the new floor for ovarian cancer patients. This is where we are now, and we have to build off of that, and there are very exciting opportunities.

Even though I don’t love the HRD biomarker, it definitely has made us think differently about populations of patients, especially the group of patients who are truly proficient in homologous recombination function. We need to study that group and be science-driven in how we design studies to help them live longer and better, which is going to be the next big challenge that we need to undertake. It may not be PARP inhibitors; rather, it may be something else or it may be a combination, figuring out, is it CCNE1? How do we target that group of patients?

That’s what I’m interested in, and we’re already designing studies for that population, and I’m excited to be involved in those. I’m anxious to see what the FDA indications are and I’m excited to have expanded options for women with ovarian cancer in the front line. I do hope it translates to a higher percentage of the cure fraction. The patients in SOLO1 are doing so well that we will not have that answer for a long time, and that’s a good problem to have. PRIMA and PAOLA are much higher-risk populations, so we may get signals from there earlier, and that’s important. It’s an exciting time, but we have to pivot our focus a little bit and really start looking at smaller groups of women within the ovarian cancer diagnosis to make big improvements. It’s going to be hard to do even in the HRD group, and we’re identifying all the subgroups–8 rare tumors– that we have to study differently.

Bradley J. Monk, MD: I want to thank all 4 of you, Tom Krivak, Tom Herzog, Sharyn Lewin, and Katie Moore. Thank you for your friendship. Thank you for what you do for your patients and how you teach us, based on the clinical trials and your personal experience, how to take care of our patients. I hope the audience found this interesting and informative. I look forward to the next time that we’re together, and so long for now.

Transcript edited for clarity.