Expert Addresses Issues in Advanced Gynecologic Cancers

Dana Chase, MD

Recent progress, particularly with PARP inhibitors, are rapidly changing the treatment landscape for advanced ovarian cancer; however, similar breakthroughs are not occurring in other gynecologic cancers, says Dana Chase, MD.

The relatively small population of patients with cervix or vulvar cancers, and the limited number of patients with recurrent endometrial cancer has limited the resources needed to develop novel agents for these patients.

OncLive: What potential treatment options are showing promise in gynecologic cancers beyond ovarian cancer, such as endometrial cancer?

In an interview with OncLive, Chase, an associate professor at University of Arizona College of Medicine Phoenix and Creighton University at St. Joseph’s Hospital and Medical Center, and a gynecologic oncologist with Arizona Oncology, discussed obstacles to progress and her hope for the future in advanced gynecologic cancers.Chase: Recurrent high-grade endometrial cancer is very difficult to treat. We do not have anything that is very effective in that patient population. In some subtypes of recurrent endometrial cancer, immunotherapy could potentially make a breakthrough, and maybe there will be some indication coming up soon. That would be very exciting.

Why do you think there has been less progress made in non-ovarian gynecologic cancers?

In terms of other areas, I think combining immunotherapy with antiangiogenesis, or even combining a PARP inhibitor with immunotherapy, maybe those combinations could lead to some interesting outcomes. Cervix and vulvar cancer are just not as common. Endometrial cancer is among the top 10 most common cancers in women—it’s number 4 in the United States. The thing about endometrial cancer, though, is that it’s mostly cured with surgery, except for a small patient population that has recurrent disease. It’s not like recurrent ovarian cancer where most patients are not cured with their upfront treatment. With endometrial cancer, most patients are cured surgically or with their first treatment—surgery and radiation, for example. You just don’t see a lot of recurrent endometrial cancer patients typically, so big randomized studies with those types of patients are more difficult to find funding for.

Are there any type of known risk factors for endometrial or vulvar cancer?

Similarly, cervical and vulvar cancer are just not as common anymore. We have cervical cancer screening, and patients usually don’t present with advanced disease. That’s the challenge in getting drugs approved in those recurrent endometrial, cervical, or vulvar cancer patients, it’s not super common. In endometrial cancer, family history, for sure. Lynch syndrome is associated with endometrial cancer as well, and obesity is a big risk factor for endometrial cancer, which, in certain populations, has led to an increase in rates. In certain areas of the states, we see a lot more cases of endometrial cancer than we used to, specifically related to obesity. The thing about obesity and its relation to endometrial cancer is usually those patients are cured with surgery. Those patients are more likely to die of complications related to their obesity than their endometrial cancer, which they are more likely to be cured from.

What would you like to see accomplished in the treatment landscape of gynecologic cancers over the next few years?

Vulvar cancer is very rare. Some vulvar cancers are HPV-related, but others are just related to increasing age. It’s very rare to get vulvar cancer. For those that are HPV-related, we know why patients get them. But for the ones that are not HPV-related, it’s still pretty much an unknown. I think it’s going to be really interesting if at some point in time, instead of labeling something as a vulvar cancer, or a cervix cancer, or an ovary cancer, we can label it by how it works, and so then you could put a vulvar cancer patient on a study with a lung cancer patient. Now you can do that, but only in the phase I arena. At some point, I think we will biopsy a cancer, whether it be vulvar, lung, breast, or ovary, and we will figure out how it works, and then we will find a drug to match that, instead of lumping all these patients into 1 category based on where the tumor started. I think that would be ideal.