Markman Reflects on Career, Progress in Gynecologic Cancers

Maurie Markman, MD

The treatment paradigm of gynecologic malignancies is expanding with approved targeted agents and a greater focus on maintaining quality of life (QoL). According to Maurie Markman, MD, the field is moving in a precision-based medicine direction.

Within the last few years, 3 FDA-approved PARP inhibitors have altered the way oncologists treat select patients with ovarian cancer. In May 2018, rucaparib (Rubraca) joined niraparib (Zejula) and olaparib (Lynparza) as having maintenance-setting indications for the treatment of patients who are in complete or partial response to platinum-based chemotherapy.

To further advance treatment, researchers are exploring combination strategies that include immunotherapy to overcome PARP resistance. While checkpoint inhibitors in this field have not had the dramatic impact that has been reported in other solid tumors, such as melanoma and lung cancer, physicians are hopeful this class of agents will still play an important role in treatment.

Markman is president of medicine and science at Cancer Treatment Centers of America and editor-in-chief of OncologyLive. He was also named the 2018 Giants of Cancer Care^® award winner in Gynecologic Cancer.

OncLive: You received the 2018 Giants of Cancer Care^® award in Gynecologic Cancer. What are your thoughts on winning this award?

In an interview with OncLive, Markman reflected on practice-changing advances during his career and discussed the future of gynecologic cancer treatment.Markman: Obviously, I have somewhat of a unique perspective on the Giants of Cancer Care^® since I had the privilege of being involved with the program from the beginning, both as chair and as a member of the committee. I'm very aware of the extraordinary effort that goes into exactly what it says: peer-nominated, peer-selected, and the awards are really meant to say, "Your peers have looked at you as having an impact in the field and on patients."

What are some of your career milestones that you are particularly proud of?

Going back to the question, to be nominated and selected is a great honor and I'm deeply humbled. It means an incredible amount to me. It's an honor and privilege to me to help create this program. I really can't say more than it is just an incredibly humbling experience.Milestones are really interesting because when you look back at them, you say, "Oh, that was important." You don't really think about it at the time. Certainly, there are a number of things that I'm proud of in retrospect. One of these is the identification—which to us now is obvious—that not only do patients who previously received platinum-based chemotherapy have a high probability of responding again, but we can look at the duration of that prior response as a prediction factor. I had a lot to do with helping to come up with that clinical definition. I've been very proud of the role I played in developing intraperitoneal therapy and putting drugs in the abdominal cavity. This is mostly cisplatin-based therapy. I also look back on the role I played in paclitaxel, which is still a very important drug in the disease.

What kind of ongoing research in gynecologic cancers are you excited about?

The concept of maintenance therapy has also grown during my career, and now it's pretty much the standard of care. Bevacizumab (Avastin) and the 3 [FDA-approved] PARP inhibitors have changed this dramatically. This concept of continuing treatment in a patient who responds is a very useful one. The most important contribution I've had is looking at general strategies to improve the survival of women with gynecologic malignancies, but also maintaining the critical factor of QoL as defined by the patient—not by me or anybody else.It couldn't be a more exciting time to be a clinician or a clinical investigator in the area of gynecologic malignancies. This is from the perspective that we are still learning about antiangiogenic agents. Looking at PARP inhibitors, we have 3 approved as maintenance therapy in ovarian cancer. Checkpoint inhibitors will soon play a role in subsets of patients with ovarian cancer, cervical cancer, and perhaps endometrial cancer.

Expanding on that, where do you think the future is specifically headed?

There is also the “giant” in the room: the paradigm-changing concept of precision cancer medicine. This has shown great promise in lung cancer, and this will extend into gynecologic cancers. Identifying abnormalities that are driving a tumor and developing drug strategies to go along with it—this is the future. I'm really excited about where we are today and, more importantly, where we will be tomorrow and the next day.We will increasingly see a focus on more precision-based and targeted approaches. Of course, immunotherapy will also play a huge role. There's no question that we are just at the beginning of this. When I finished my principal residency at NYU Langone School of Medicine, I went to the National Cancer Institute's Laboratory of Immunology because I was convinced many years ago that the immune system was important. I did this a couple of decades too early. We simply did not know enough at the time. Those ideas from back then, that we could somehow harvest the immune system, are now bearing fruit today.

We are just at the beginning with checkpoint inhibitors, immunomodulatory agents, and chimeric antigen receptor T cells. The ability to manipulate the immune system, such that it can control and possibly cure cancer, is very exciting.