Managing Treatment Decisions for Ovarian Cancer - Episode 10

Unmet Needs in Ovarian Cancer

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Angeles Alvarez Secord, MD: We made great progress in ovarian cancer for the past 3 years. We’ve seen approvals for 3 different PARP inhibitors across different indications. We have approvals for bevacizumab and the recurrent ovarian cancer setting in platinum-resistant disease and platinum-sensitive disease. Who knows, we may have approval for frontline bevacizumab in the United States, which already exists in Europe but we’re waiting here.

Michelle Berke: That’s exciting.

Angeles Alvarez Secord, MD: And then there is this other drug we haven’t even talked about, which is pembrolizumab, which is one of the immunotherapy drugs. That’s approved for women with gynecologic cancer who have microsatellite instability in their cancers or deficient mismatch repair protein expression. So, we haven’t even touched that whole area at all. That has all happened in the last 3 years. But there are still some unmet needs. So, I think it’s really important that we don’t get complacent. I’m just looking at you and your whole history and what you’ve gone through, and I hope that this drug works for a long, long time and gets rid of your cancer completely.

Michelle Berke: I hope so.

Angeles Alvarez Secord, MD: But you know, there are still patients who need more. And so, we need to work to be smarter on who we deliver these drugs to, using biomarkers to identify the patients most likely to benefit, those patients who need PARP inhibitors, and combinations with other drugs and what drugs you pair that with. And there’s always the future. We need to continue to work hard to understand these cancers completely and find the drugs that are best going to target them. Another really important unmet need, though, is prevention, and make sure that we can wipe this disease off the face of the earth. That would be fantastic.

Michelle Berke: Early detection.

Angeles Alvarez Secord, MD: Right. You had mentioned how you knew you had a BRCA1 mutation. Your sisters, or your daughters, got tested and they’re negative.

Michelle Berke: They’re both negative.

Angeles Alvarez Secord, MD: But you have a sister, don’t you?

Michelle Berke: I have 2 sisters, yes. They haven’t gotten tested yet.

Angeles Alvarez Secord, MD: Yes. So, an unmet need is, how can we implement the system better so that when somebody tests positive, we can make it easier for all their family to get tested? They don’t have to go to all these different locations to request a test and instead just do one-stop shopping for all so that we can determine if they have the mutation or not. If they have the mutation, there are surgeries that you can do to prevent these cancers or even treatments you can take for prevention, too. And now that we know that some of these cancers are coming in from the fallopian tubes, the ovary is just a poor innocent bystander, how many women are going to benefit from having their fallopian tubes removed as a prevention strategy? Those are all really important questions that we need to answer still.

Michelle Berke: Yes.

Angeles Alvarez Secord, MD: From your perspective as a patient, and you have me as your audience, and other doctors out there, what would you tell them?

Michelle Berke: I would definitely say that doctors need to have their patients tested. I’m one of these patients where I look at statistics before I base my decision on what I take and recommendations. So, from a physician’s standpoint, for them to sit down and talk to the patients and let them know.

Angeles Alvarez Secord, MD: OK, share that information.

Michelle Berke: Yes, let them know that there are options out there for you.

Angeles Alvarez Secord, MD: And really dive into the details so you can handle that as a patient.

Michelle Berke: Yes.

Transcript Edited for Clarity