Dr. Powell on Tumor Mutational Burden in Ovarian Cancer

Matthew Powell, MD, associate professor, Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University School of Medicine, discusses tumor mutational burden (TMB) in ovarian cancer.

A compilation of several trials across various tumor types suggested that TMB may be a good predictor of response, says Powell. Though it is being investigated in ovarian cancer, Powell adds that it is not yet ready for clinical application in the malignancy.

The biggest application of TMB has been in lung cancer. In June 2018, the FDA accepted a supplemental biologics license application (sBLA) for the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) for the frontline treatment of patients with advanced non—small cell lung cancer (NSCLC) with TMB ≥10 mutations per megabase. The sBLA is based on data from the CheckMate-227 trial.

Additionally, data from the CheckMate-586 trial indicated that TMB was predictive of patients with NSCLC who were more likely to experience benefit from the frontline combination of nivolumab and ipilimumab. The combination showed response rates of 9% with TMB less than 5, 15% with TMB 5 to 10, 44% with TMB ≥10, and 39% for those with TMB levels of ≥15.