Dr. Matulonis on the Current Treatment Landscape of Recurrent Ovarian Cancers

Ursula A. Matulonis, MD, physician, chief, Division of Gynecologic Oncology, Dana-Farber Cancer Institute, Brock-Wilson Family chair, professor of Medicine, Harvard Medical School, discusses the current treatment landscape of recurrent ovarian cancer.

There is considerable overlap in the treatment paradigms for patients with newly diagnosed ovarian cancer and recurrent ovarian cancer, Matulonis says. Though some patients may develop platinum-resistant ovarian cancer, defined as progression within 6 months of their last treatment with platinum-based chemotherapy, it is possible to utilize platinum again if there was a response, Matulonis explains.

When treating a patient who could respond to platinum-based chemotherapy, options include a carboplatin doublet with or without bevacizumab (Avastin), Matulonis continues. Typical doublets with bevacizumab may include carboplatin/paclitaxel or carboplatin/gemcitabine, Matulonis explains.

Regarding PARP inhibitors, the phase 3 SOLO2 (NCT01874353), NOVA (NCT01847274), and AERIAL3 (NCT01968213) trials all demonstrated progression-free survival benefits in patients with ovarian cancer who responded to platinum-based chemotherapy before receiving a PARP inhibitor as maintenance, Matulonis says. When considering the use of a PARP inhibitor, patients can be classified as BRCA-mutated, homologous recombination deficient/BRCA wild-type, and homologous recombination proficient/BRCA wild-type, though patients in the latter category tend to have the least benefit from PARP inhibitors, Matulonis explains.

FDA approvals for this patient population have been seen mainly with PARP inhibitors in different spots within patient treatment, including niraparib (Zejula), olaparib (Lynparza), and rucaparib (Rubraca), Matulonis continues. Additionally, bevacizumab can be utilized up-front, in platinum sensitive-recurrence, and then platinum-resistant recurrence, Matulonis explains.

One of the newer medications in the space is mirvetuximab soravtansine, an antibody-drug conjugate that has shown promising efficacy in heavily pretreated patients with folate receptor alpha–high, platinum-resistant ovarian cancer, Matulonis says. The agent is currently under review by the FDA for accelerated approval, Matulonis emphasizes.

Aromatase inhibitors are being examined in women with low-grade serous ovarian cancer. These cancers have shown to not be consistently chemotherapy sensitive, but they are usually estrogen receptor–positive and hormonally sensitive, Matulonis explains. An ongoing phase 3 trial (NCT04095364) trial is investigating the aromatase inhibitor, letrozole (Femara), with or without carboplatin plus paclitaxel, in patients with stage II-IV low-grade serous ovarian cancer, Matulonis concludes.

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