A 63-Year-Old Woman With Recurrent Ovarian Cancer - Episode 6

Looking to the Future of Ovarian Cancer Treatment

An expert in ovarian cancer considers the future of ovarian cancer treatment, the use of PARP inhibitors and overcoming PARP resistance, and the emerging treatments options.

Erin Crane, MD: I think the future of treatment for ovarian cancer is really exciting. For a long time, the treatment options available to us were pretty stagnant. The PARP inhibitor explosion has offered so much hope for us as physicians and for our patients. We are extending progression-free survival, and we think we may even be curing some patients who were placed on it in the frontline setting, especially patients in the SOLO-1 study. Future studies will look at how we can exploit these PARP inhibitors even more. How can we overcome PARP resistance? We need to see how combining them with other treatments, for example, in the PAOLA trial with bevacizumab, to see how we can extend progression-free survival. Immunotherapy in ovarian cancer, especially with PD-1 and PD-L1 inhibitors, has quite frankly been a little disappointing.

We have not seen some of the same responses that have been seen in the melanoma realm or for our patients with endometrial cancer. For a subset of patients with MSI [microsatellite instability]-high tumors or high tumor mutational burden, immunotherapy can offer them a benefit. Of course, there are also trials out there looking at how to combine immunotherapy with other drugs to treat ovarian cancer and make treatment more effective. In some of the ovarian cancer vaccine trials, which provide a different way of looking at immunotherapy,

at least the preliminary results have been very exciting. I am looking forward to more clinical trials coming out addressing that. In regard to unmet needs, we need better screening for these patients. It is terrible that we are diagnosing the majority of these patients at stage III or IV of their disease. 

Even though we are helping our patients live longer, it is still very hard to cure their disease. That speaks to the fact that we need a better way to find these diseases at an early stage when they are curable. When we treat patients with HRD [homologous recombination deficiency]-negative cancers or with platinum-resistant cancers, we know that those cancers are much more difficult to treat; at that point, patients have a worse prognosis. It is difficult to find therapeutics that help those patients. Things like antibody-drug conjugates or other targeted therapies hold a lot of promise, and trials are ongoing.

This transcript was edited for clarity.

Case: A 63-Year-Old Woman With Recurrent Ovarian Cancer

Initial Presentation

  • A 63-year-old female presented with early satiety and abdominal discomfort
  • PMH: unremarkable, postmenopausal; no known family history of cancer
  • PE: left lower quadrant tenderness on palpation
  • ECOG PS 1

Clinical work-up

  • Pelvic exam with transvaginal ultrasound showed a left ovarian mass
  • Transvaginal U/S showed a left ovarian mass
  • Chest/abdomen/pelvis CT with contrast confirmed a left adnexal 4.4-cm mass with paraaortic lymph node involvement and ascites
  • Paracentesis (1000 cc) cytology confirmed high-grade epithelial ovarian cancer
  • Germline molecular testing: HRD+, BRCA1/2-
  • CA-125, 370 U/mL
  • Diagnosis: Stage III, high-grade epithelial ovarian cancer

Treatment

  • Patient underwent TAH/BSO, lymph node dissection, with optimal debulking; R0
    • Paclitaxel/carboplatin q3 weeks for 6 cycles; CA-125 decreased; PR
  • At 7-month post treatment follow-up imaging showed progression of disease
    • Paclitaxel/carboplatin + bevacizumab was initiated q3 weeks for 6 cycles
  • At 14-months CA-125 had increased
    • Cisplatin/gemcitabine was initiated, PR
    • Initiated niraparib maintenance