Jonathan Ledermann, MD, professor of medical oncology, UCL Cancer Institute, London, United Kingdom, discusses the treatment landscape for patients with rare gynecologic cancers.

There is evidence supporting the use of chemotherapy and hormone therapy for the management of rare epithelial cancer, although new concepts for clinical trials are being developed globally. Since these are rare tumors, it is important to work collaboratively on a global scale for the investigation of hormone therapy as an initial therapy for low-grade serous cancers, says Ledermann.

According to Ledermann, there are difficulties in treating clear cell cancer since chemotherapy does not work well. Clinicians are still using chemotherapy, but there is little evidence of benefit. However, there are some genomics and molecular changes that are being picked up in these tumors, which may provide potential targets for novel therapies.

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Dr. Ledermann on the Treatment Landscape for Rare Gynecologic Cancers

Jonathan Ledermann, MD, professor of medical oncology, UCL Cancer Institute, London, United Kingdom, discusses patient selection in the treatment of patients with ovarian cancer.

It is important to delineate which patients benefit from BRCA-targeting agents. This is not only to keep costs down, but to ensure that the patients receiving the drug will derive the most benefit, Ledermann says.

Dr. Ledermann Discusses Patient Selection in Ovarian Cancer

Rare tumors are the hardest ones to treat because less is understood about their biology and the current drugs are not as active in these tumors, explains Ledermann.  

Jonathan Ledermann, MD, professor of medical oncology, UCL Cancer Institute, London, United Kingdom, discusses systemic treatment for patients with rare gynecologic tumors.

Dr. Ledermann on Systemic Treatment for Rare Gynecologic Tumors

Jonathan Ledermann, MD, professor of medical oncology, UCL Cancer Institute, London, United Kingdom, discusses rucaparib (Rubraca) maintenance in ovarian cancer.

The ARIEL3 trial is currently looking at maintenance therapy with rucaparib by giving patients chemotherapy, and then maintaining the response and freedom from progression by using a PARP inhibitor. Rucaparib is licensed in the United States for the treatment of 

ARIEL3 is the third randomized trial in this setting.

Dr. Ledermann on Rucaparib Maintenance in Ovarian Cancer

Jonathan Ledermann, MD, professor of medical oncology, UCL Cancer Institute, London, United Kingdom, discusses the results of the ARIEL3 trial in ovarian cancer.

Results of ARIEL3 showed that there was a significant improvement in progression-free survival with maintenance rucaparib in the 

-mutant population, the homologous recombination deficient (HRD) cohort, and the all-comers cohort.

Jonathan Ledermann, MD, professor of medical oncology, UCL Cancer Institute, London, United Kingdom, discusses the results of the ARIEL3 trial in ovarian cancer.
 

Dr. Ledermann on the Results of the ARIEL3 Trial in Ovarian Cancer

Jonathan Ledermann, MD, professor of medical oncology, UCL Cancer Institute, London, United Kingdom, discusses the phase III results of the ARIEL3 trial in ovarian cancer during the 2017 ESMO Congress.

This trial included patients with ovarian cancer who did and do not harbor a 

 mutation, Ledermann explains. The design of the trial was to explore the investigator-assessed progression-free survival (PFS) with maintenance rucaparib (Rubraca) first in patients with 

 mutations, then in patients who had homologous recombination deficiency-defined disease as an increase in loss of heterozygosity (LOSS) through a Foundation Medicine assay, and then the intention-to-treat population, which was all-comers.

Results showed that rucaparib led to a significant improvement in PFS across all groups. The biggest activity was observed in patients with 

 mutations, but there was also significant benefit seen in those who were LOH positive. Moreover, there were also improvements in PFS in LOH-negative, 

 wild-type patients with maintenance rucaparib, he adds.

Dr. Ledermann on Phase III ARIEL3 Results in Ovarian Cancer

Jonathan Ledermann, BSc, MD, FRCP, Professor of Medical Oncology in the UCL Cancer Institute, University College London, discusses health-related quality of life during olaparib maintenance therapy in patients with platinum-sensitive relapsed serous ovarian cancer and a BRCA mutation.

Ledermann explains that olaparib is a PARP inhibitor, which is an active group of drugs in patients with ovarian cancer. This agent is particularly active if the patient has platinum-sensitive disease and especially in those that carry a BRCA mutation.

The Study19 Trial was conducted to examine the activity of olaparib in patients who had platinum-sensitive relapsed serous ovarian cancer, Ledermann says. The patients in the trial had a BRCA mutation or had high-grade serous cancer but no mutation. The study showed that there was a highly significant improvement in the progression-free survival in both the patients with the BRCA mutation and the wild-type patients but the greatest benefit was seen in those with the mutation, Ledermann says. â€‹

Jonathan Ledermann, MD

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