Advancements in Gynecological Oncology

January 27, 2015

Could the approval of bevacizumab for advanced cervical cancer and platinum-resistant ovarian cancer last year lead to patient-specific therapies?

Treatment of gynecological cancers had a big year in 2014, and it looks like a big plus for women, too. Bevacizumab (Avastin), a recombinant drug, was already approved for three tumor types, but August brought an additional approval for the treatment of advanced cervical cancer and in November, a hallmark was achieved when bevacizumab was approved for the treatment of platinum-resistant ovarian cancer.

In many cases in women with advanced cervical cancer, diagnosis is late and patients have not had routine gynecological care. With ovarian cancer, symptoms may be vague and difficult for a woman to identify, often making discovery late as well.

Until the approval of bevacizumab, treatment guidelines have called for a “traditional” approach with expected traditional adverse effects and limitations commonly seen with other chemotherapeutic drugs, such as paclitaxel and carboplatin or gemcitabine and cisplatin. Bevacizumab is a new type of drug-a generational advance which has been shown to slow the progression of both ovarian and cervical cancer.

Different gynecological oncologists certainly have different experiences in terms of patient demographics and payer environments. Though many physicians may have used bevacizumab off-label, reimbursement was predictably difficult, and providers may have been reluctant to use the medication, depending upon institutional guidelines. The recent approvals have removed the question mark and all women, regardless of geographic location or area demographics and payer situation, will be more likely to have this drug as a treatment option.

Gynecological oncologists on both sides of the country with patients coming from different demographic groups are reporting an increase in patient quality-of-life issues. One obvious benefit is the potential for extension of disease-free progression in ovarian cancer or increased life expectancy in cervical cancer, which can provide some relief to a patient with a poor prognosis.

Although bevacizumab does have its unique side-effect profile, including the risk of GI perforation, Cheryl Saenz, MD, clinical professor at the University of California, San Diego School of Medicine has noted she has seen a reduction of severe cancer-related occurrences, such as ascites, with symptoms including nausea and anorexia, often requiring hospitalization, and a reduction of other side effects, such as fatigue, in patients treated with bevacizumab.

While not all physicians have reported specific drug-related quality-of-life improvements, all agree that the larger benefit may be in the use of pharmacogenomics, with bevacizumab being a building block for future development of drugs that can be more closely tailored to a specific patient.

“No one wants to treat a patient with medication that won’t be likely to work for them. The identification of biomarkers will hopefully define a stratification strategy for bevacizumab. This will improve the quality of care of patients and enable a strategic and cost-effective approach to the delivery of targeted therapy,” said Susana Campos, MD, MPH, assistant professor of medicine at Harvard Medical School.

Dr Campos sees significant change for certain patients, noting that not all patients will have the correct genetic profile for biologics. In patients who do, however, we may be able to avoid the side effects of traditional chemotherapy, she said.

Both Drs Campos and Saenz, as well as many other, have stated, “This is huge.”