Erika P. Hamilton, MD

Erika P. Hamilton, MD, director of the Breast Cancer and Gynecologic Research Program and principal investigator at Sarah Cannon Research Institute, discusses unmet needs in treatment options for patients with platinum-resistant ovarian cancer due to the difficulty of early discovery, and what treatment options may become viable in the future.

The lack of effective screening tests for ovarian cancer leads to late-stage diagnoses with fewer treatment options, according to Hamilton. Ovarian cancer screening is often not recommended due to the nonspecific symptoms of the disease, plus a high rate of false positives from a transvaginal ultrasound screening or serum cancer antigen 125 testing.

Patients that experience a relapse of ovarian cancer after standard-of-care treatment within 6 months are classified as platinum-resistant, so other therapies are required at this point. Hamilton says combinations of chemotherapy with antiangiogenesis drugs, including VEGF inhibitors such as bevacizumab (Avastin), are being investigated in this setting. PARP inhibitors and immunotherapy are currently available as well. She also anticipates success with antibody-drug conjugates, which target antigens that are highly expressed on the membrane surface of tumor cells, making them more effective at avoiding harm to non-cancerous tissues.

 Ovarian cancer is a difficult disease for a number of reasons. First, there's no good screening test for ovarian cancer, so oftentimes, when people get diagnosed with ovarian cancer, they present later lines: stage III, stage IV. Most patients respond quite well initially to carboplatin-type agents; Taxol [paclitaxel] and carboplatin combined is most often what we give up front. But unfortunately, a lot of patients—well over 50% of our patients—end up relapsing. Once patients relapse within 6 months of their most recent platinum-containing compound is when we deem them platinum-resistant, and this is probably the greatest unmet medical need—more drugs in this space.

There are a lot of drugs out there that we're looking at, certainly combinations like this with chemotherapy and antiangiogenesis drugs. We now have PARP inhibitors for ovarian cancer. We've looked at immunotherapy, although the results on that have been a bit mixed, and then another new class of drugs coming to ovarian cancer that we're probably going to see some successes in are the antibody-drug conjugates, where we have chemotherapy that's bound to an antibody to help target the cancer cell and leave some of the rest of the body alone.

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Erika P. Hamilton, MD, discusses unmet needs in treatment options for platinum-resistant ovarian cancer due to the challenges of screening, and what treatment options may become viable in the future.

New Options Upcoming for Treating Platinum-Resistant Ovarian Cancer

Erika P. Hamilton, MD, director of the breast cancer and gynecologic cancer research program at the Sarah Cannon Research Institute, discusses the rationale for exploring OP-1250 monotherapy in an open-label first-in-human multi center phase 1/2 study in adult patients with advanced and/or metastatic hormone receptor (HR)-positive, HER2-negative breast cancer.

OP-1250 is a novel therapy that is different to other agents, says Hamilton. It is a complete estrogen receptor (ER) antagonist with unique properties that shows promise for this particular patient population. OP-1250 has also demonstrated activity preclinically in both wild-type and ESR1 models, and it turns off both the AF1 and AF2 domain, says Hamilton.

Articles

Erika P. Hamilton, MD, discusses the rationale for exploring OP-1250 monotherapy in an open-label first-in-human multi center phase 1/2 study in adult patients with advanced and/or metastatic hormone receptor-positive, HER2-negative breast cancer.

Exploring the Rationale for OP-1250 in Advanced HR-Positive HER2-Negative Breast Cancer

Erika P. Hamilton, MD, director of the breast and gynecologic research program at Sarah Cannon Research Institute, discusses the results from a phase II study of abemaciclib (Verzenio) plus tamoxifen versus abemaciclib monotherapy in patients with HR-positive, HER2-negative advanced breast cancer.

The progression-free survival (PFS) range was 6.5 months to 9.1 months in this study and was not statistically significant across arms. Hamilton says the single-agent abemaciclib had equal activity in regard to PFS. Hamilton also noted the arm receiving 200 mg of abemaciclib had a response rate of 29% compared to 19% in the previous MONARCH trial.

Erika P. Hamilton, MD, discusses the results from a phase II study of abemaciclib plus tamoxifen versus abemaciclib monotherapy in patients with HR-positive, HER2-negative advanced breast cancer.

Findings With Abemaciclib Plus Tamoxifen in Advanced Breast Cancer

Hamilton says there are currently not very many "good" drugs for treating these metastases. She adds that the mainstay for treating these metastases is usually some form of radiation therapy, such as whole brain radiation.

Dr. Erika P. Hamilton on Difficulties of Treating Brain Metastases in Breast Cancer

Erika P. Hamilton , MD, associate director, Breast Cancer and Gynecologic Cancer Research Program, principal investigator, Sarah Cannon Research Institute, discusses the current treatment paradigm, and upcoming treatments, for HER2-positive breast cancer. She cites the approval of drugs like pertuzumab and T-DM1 over the years as a step in the right direction for treatment of HER2-positive breast cancer, and goes on to say that oncologists have more of an option in treatment now than ever before.

Hamilton says the biggest challenge oncologists face now is figuring out where to place these drugs in the treatment paradigm. She says as T-DM1 and pertuzumab are used more in the neoadjuvant or adjuvant space, the metastatic sequence may be up in the air more.

Erika P. Hamilton, MD, discusses the current treatment paradigm, and upcoming treatments, for HER2-positive breast cancer.

Dr. Erika P. Hamilton on the Shifting Treatment Paradigm in HER2-Positive Breast Cancer

Erika P. Hamilton, MD, associate director, Breast Cancer and Gynecologic Cancer Research Program, principal investigator, Sarah Cannon Research Institute, on ONT-380 for HER2-positive breast cancer and the treatment's ability to cross the blood-brain barrier. Hamilton says the reason ONT-380's ability to cross that barrier is important is because patients with HER2-positive breast cancer have a predilection to develop brain metastases.

She added that ONT-380 was proven to be effective when combined with capecitabine (Xeloda) and trastuzumab (Herceptin), though sometimes a combination of all three proved most useful. ONT-380 is a HER2-specific inhibitor and showed promising results when tested in patients with HER2-positive breast cancer who had previously received trastuzumab and T-DM1.

Erika P. Hamilton, MD, on ONT-380 for HER2-positive breast cancer and the treatment&#39;s ability to cross the blood-brain barrier.