Spotlight on Ovarian Cancer Treatment
Ovarian cancer develops in the ovaries – two glands on each side of the uterus, in the pelvis, which are part of the female reproductive system.
As for many other cancers, advances in the search for new treatments are largely in the field of immunotherapy.
Immune-based drugs and therapies work by boosting the immune system’s ability to selectively attack and destroy cancer cells, minimizing damage to healthy tissue. For this reason, they are also often referred to as targeted treatments.
A number of immunotherapies are currently under study, which promise to improve both quality of life and health outcomes for women with the condition. They include exciting novel drugs such as monoclonal antibodies and checkpoint inhibitors, as well as cancer vaccines and adoptive cell transfer procedures.
Following is an overview of the most promising among these therapies. Some are not yet routinely available, but suitable patients may be able to receive them as part of a clinical trial.
The monoclonal antibody bevacizumab is already used for advanced ovarian cancer, usually in combination with standard chemotherapy. It works by interfering with the ability of cancer cells to develop a blood supply, which they need to grow.
An international team of scientists recently analysed the results of randomised controlled trials conducted to date on the efficacy of bevacizumab in various types of solid tumours, including ovarian cancer.
The analysis confirmed that the immunotherapy drug can significantly increase progression free survival (the time, during or after treatment, in which the cancer does not get worse) as well as overall survival.
Bevacizumab is presently not available on the NHS, following a recommendation by the National Institute for Health and Care Excellence (NICE), which does not consider the treatment cost effective.
Also known as immune modulators, checkpoint inhibitors can either activate or block molecules found on the surface of certain immune cells. This enables the latter to recognise and attack cancer cells that would otherwise remain ‘invisible’ to the immune system.
Data surrounding the efficacy of checkpoint inhibitors in the treatment of ovarian cancer are only just emerging. However, the findings of several clinical studies, including completed and ongoing trials, are encouraging.
For example, the checkpoint inhibitor nivolumab has been found effective in women with a form of the condition that does not respond to chemotherapy, achieving progression-free survival of 3.5 months and overall survival of 20 months.
The efficacy and safety of nivolumab in ovarian cancer (in combination with the cancer drug epacadostat) is now being evaluated in a new clinical trial.
Other checkpoint inhibitors under study include pembrolizumab and durvalumab, both of which are being evaluated for the treatment of recurrent ovarian cancer. These trials are all enrolling participants.
Adoptive cell transfer
Adoptive cell transfer (ACT) is another potentially revolutionary new treatment avenue for ovarian cancer.
It is a form of personalised therapy in which white blood cells are taken from the patient, made more powerful against the cancer through genetic or other changes, and then returned to the patient.
Data published to date suggest that this approach has modest but promising effects on both progression free survival and overall survival.
Researchers report in the Journal of Ovarian Research that the advantage over other cancer therapies is that “each tumour has different biological and molecular features, and immunotherapies based on the use of autologous cells [taken from the patient] have potential of high specificity, not achievable with chemotherapy.”
Encouraging results have been reported also for an experimental immunotherapy vaccine called gemogenovatucel-T, whose efficacy is being evaluated in a phase III trial of women with advanced ovarian cancer that tends to grow and spread quickly.
In an earlier study, whose results appear in the journal Gynecologic Oncology, the vaccine prolonged recurrence free survival from about 16 months to about 27 months, on average.
Gemogenovatucel-T had been administered to women with advanced ovarian cancer, following conventional treatment with surgery and chemotherapy.
The findings are of particular significance, because in patients with this type of cancer who achieve complete response the disease tends to return, and there is no available maintenance therapy for them.
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Expanding treatment options for patients with ovarian cancer
“Standard treatment for ovarian cancer is currently limited to surgery followed by chemotherapy, usually with carboplatin alone or in combination with paclitaxel. While generally successful, this approach is often followed by relapse, and only 35 per cent of affected women live ten or more years,” notes Jonathan Furst, CEO at Alivia Swiss Health.
“Novel therapies under development have the potential to greatly expand treatment options for women with the condition, and improve upon the benefits offered by available therapies, as a result of being more targeted and effective.”
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