2016 ASCO Annual Meeting Research Round Up – Gynecologic Cancers, with Jonathan S. Berek, MD, MMS

September 13, 2016
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In today’s podcast, Lineagotica Associate Editor Dr. Jonathan Berek discusses some of the research on gynecological cancers presented at the 2016 ASCO Annual Meeting. 



ASCO: You're listening to a podcast from Lineagotica. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world's leading professional organization for doctors who care for people with cancer.

In today's podcast Lineagotica Associate Editor Dr. Jonathan Berek discusses some of the research on gynecological cancers presented at the 2016 ASCO Annual Meeting. Dr. Berek is the Director of the Stanford Women's Cancer Center at Stanford University School of Medicine. The ASCO Annual Meeting is the premier educational and scientific event where physicians, researchers, and other healthcare professionals gather to discuss the latest in cancer care and treatment. This Lineagotica podcast helps put new research findings into context, and explains what they mean for patients. ASCO would like to thank Dr. Berek for summarizing this research.

Dr. Berek: Hello. This is Jonathan Berek. I'm the Director of the Stanford Women's Cancer Center, a part of the Stanford Comprehensive Cancer Institute at Stanford University. I'm going to talk to you briefly about some of the results of trials presented at the recent ASCO meeting in June. These relate to ovarian cancer. More recently, we have determined that most of ovarian cancer actually arises in the fallopian tube - the very end of the tube where the egg is collected after it's released from the ovary, and in which fertilization takes place. Somehow this is the area that's most vulnerable and where, particularly if women have mutations that they carry in their family - the most common of which are mutations in BRCA1 and 2 - they predispose to these lesions in the fallopian tube that are called high-grade serous carcinomas, the most common type of ovarian and fallopian tube and peritoneal cancer.

At the meeting at ASCO, we heard several presentations about ovarian, fallopian tube, and peritoneal cancer. The first was an analysis of a new drug called olaparib, which is what we call a PARP inhibitor. What that means is that it's a drug that inhibits a certain part of the DNA, which is very likely to be defective in women who have these germline mutations in BRCA1 or 2. That is mutations that they've inherited, that predispose them to these cancers. The drug actually targets the mistake that's created by this mutation. It can occur also in women who don't carry the mutation, but it's much more likely to occur in those who do. What this drug was shown to do is to prolong the overall survival of women who had been treated with various types of chemotherapy, mostly the chemotherapy that's standard for ovarian cancer: carboplatin and Taxol. And after they had responded to that, they were given what's called a maintenance therapy with olaparib, which is a pill that they'd take every day.

And the study is a follow-up to a large study, which had already demonstrated the effectiveness of this drug - olaparib. But now what we see is that in a maintenance regimen that is given after the upfront chemotherapy to try to keep people in remission, that women who took the drug as opposed to a placebo, actually lived longer than those women who did not have the drug. So this is very good news. This is a new class of drugs. We're going to be seeing other drugs that come to the market, I'm sure, this coming year, that will change how we treat ovarian and fallopian tube cancer. Probably most women, particularly those who have this particular mutation, but also other women who have the defect that's inside the tumors that are associated with these mutations, will be taking a drug like olaparib or other similar drugs after their primary chemotherapy. This is very good news because the pill is very well tolerated and obviously a benefit, because women don't have to go in to get a drug infusion and the toxicity is quite acceptable. Very good news.

Another couple of trials looked at intraperitoneal chemotherapy versus high dose chemotherapy, or with high dose chemotherapy. There is a study that showed that carboplatin - which is a less toxic and easier to take than cisplatin - can be given intraperitoneally, that is directly into the abdominal cavity, and it is better tolerated and associated with excellent treatment outcomes compared to the cisplatin. So the studies now are looking to see whether or not intraperitoneal carboplatin with what we call a dose-dense Taxol is better than or the same as intravenous carboplatin plus dose-dense paclitaxel. What that means in simple English is, can we gives the drugs more frequently, more intensively, and would that have an effect that's just as good as administering the drug directly into the peritoneal cavity? We have to await other studies, to determine whether that's going to be the case.

So the standard treatments now are giving people carboplatin and paclitaxel as a primary treatment for fallopian tube and ovarian cancer of the high-grade serous type that we've mentioned. And the question now is how to give that. Should we give it every third week, which is the standard, or should we give it every week, which is considered the dose dense? And should the platinum compound - the carboplatin - be given intravenously or into the abdomen directly, so-called intraperitoneal route. Future trials will determine that. In our own setting, we tend to use the dose-dense regimen of carboplatin and paclitaxel intravenously while this is still being determined.

Another trial that was presented is from the United Kingdom, the so-called UKCTOCS trial, which is a screening trial for ovarian cancer. This is a very large study that's been going on for a number of years, that's looked at a couple hundred thousand women in a randomized trial, comparing routine surveillance in women while they're coming in for their mammogram screening, to getting a transvaginal ultrasound versus a blood CA-125 test every six months. So far, what this study has shown is that this screening is feasible and there have been some detections of early tumors. It's unclear still whether or not this is leading to a detection of tumors such that it reduces the mortality from the disease. So we still don't know at this point whether screening for ovarian cancer in the general population actually will improve the early detection and the mortality from the disease. So we have to await further studies, further evaluation of this trial, to determine that. So at present, we do not recommend screening women in the general population using ultrasound and CA-125 to try to detect ovarian and fallopian tube cancer early. It's still unresolved issue.

Another study that was presented at the ASCO meeting, was a quality of life study - a very large if not the largest study looking at the quality of life in women with recurrent ovarian cancer. And there were almost 1,000 women in this international study. I had the privilege of being one of the participants in this study as an author. What was found was that one could look at what we call global health status and the physical function of patients and the various symptoms that one has in the abdomen, gastrointestinal symptoms, and that through careful analysis and questionnaires, could determine that these levels of function actually predicted overall survival and were independent predictors of survival. That is that they, in fact, were able to sort out groups of patients that were more likely to live longer given the same type of chemotherapy. It also predicts which women are more likely to discontinue chemotherapy earlier. So this is an important study because it does give us a good idea of what kind of women, based on their symptoms and their quality of life, actually are more likely to do well with chemotherapy for ovarian and fallopian tube cancer.

I should mention just quickly a couple of other studies, which are in endometrial cancer and in what we call low-grade serous carcinoma of the ovary. Both of these types of tumors when they have spread are very difficult to treat, because they tend not to respond to the kind of chemotherapy that we just talked about for ovarian and fallopian tube cancer. And these were hormonal therapies with a variety of different hormone treatments, and some of these drugs actually are very well tolerated and have been shown as presented to result in responses and improved outcome, and what we call progression-free survival advantage - that is, the time when the disease might come back. Women benefited by taking these hormonal drugs for their metastatic endometrial cancer or for their low-grade serous carcinoma of the ovary.

So in summary, we have studies that are now showing some new treatments in ovarian cancer and related tumors. We've confirmed, so far, that drugs that are what we call PARP inhibitors are a benefit to patients and can improve overall survival. We've shown that quality of life types of measurements can improve our ability to determine how people will do on various types of chemotherapy. We've shown that carboplatin can be substituted for cisplatin in intraperitoneal chemotherapy for primary treatment, and that when the dose dense regimen is given with Taxol, this may be as good as the intraperitoneal route, but we're waiting for further data. Thank you very much for your attention.

ASCO: Thank you, Dr. Berek. To learn more about the science presented at the 2016 ASCO annual meeting, visit lineagotica.info/ASCOannualmeeting. If you have questions about whether new research may affect your care, be sure to talk with your doctor.

Lineagotica is supported by the Conquer Cancer Foundation, which is working to create a world free from the fear of cancer by funding breakthrough research, sharing knowledge with physicians and patients worldwide, and supporting initiatives to ensure that all people have access to high quality cancer care. Thank you for listening to this Lineagotica podcast.