Dr. Monk on Platinum Ineligibility and Emerging ADCs in Ovarian Cancer

Bradley J. Monk, MD, FACS, FACOG, professor, Division of Gynecologic Oncology, Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine at St. Joseph’s Hospital, medical director, Gynecologic Program, US Oncology Research Network, co-director, GOG Partners, discusses the role platinum-based chemotherapy in recurrent ovarian cancer, plus emerging antibody-drug conjugates in the space.

Since the majority of patients with ovarian cancer eventually recur, determining if they are eligible for platinum-based chemotherapy is vital, even in patients who might have been historically considered to have platinum-resistant recurrent ovarian cancer, Monk says. Patients are no longer described as platinum resistant; instead, they platinum ineligible, and emerging evidence that platinum doublets are better than single agents, Monk adds. Moreover, if a patient is not a candidate for platinum-based chemotherapy, then the most active non-platinum agents to consider are weekly paclitaxel or bevacizumab (Avastin), though if a PARP inhibitor was used in the beginning of therapy, bevacizumab is the preferred option, Monk adds.

Although there is not a bevacizumab/PARP inhibitor combination approved in for the treatment of patients who have recurred, bevacizumab can be utilized multiple times, Monk continues. Importantly, it is necessary to be aware of the risk of gastrointestinal perforation with multiple lines of therapy and understand the risk factors, Monk says.

All patients who recur becoming platinum ineligible over time and eventually die of their disease, creating the highest unmet medical need in ovarian cancer, Monk explains. However, ADCs remain some of the most promising agents emerging in ovarian cancer, as multiple clinical trials have shown the benefit of these agents, Monk adds. Agents such as mirvetuximab soravtansine (IMGN853), upifitamab rilsodotin (XMT-1536), and others have shown promise, and they remain under evaluation, Monk says.

Another unique factor includes ovarian clear cell carcinomas harboring an ARID1A mutation, which is also being studied, Monk adds. Oncologists continue to observe the time to recurrence in platinum eligibility, plus the number of lines of therapy and molecular signatures, Monk concludes.

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