Groundbreaking new treatments, including a handful of clinical trials, are now available for patients at Roswell Park Comprehensive Cancer Center, says gynecologic oncologist Karen McLean, MD, PhD, FCAOG.
Women diagnosed with cervical cancer historically have been encouraged to have a radical hysterectomy, but two new clinical trials – the SHAPE trial and the CONSERVE trial – both have shown that less invasive, more concentrated surgery can be very effective in a subset of patients, allowing them to have less aggressive treatment and fewer side effects.
Dr. McLean walks through a series of other new clinical trials and treatment options, adding that with new treatments it’s important for patients to be under the care of experts who know what new side effects might be observed, including heart and eye monitoring. “It’s really important that a woman receive care at an institution that is familiar with the side effects and has a structure for doing these surveillance visits,” she says.
Hi, my name is Karen mclean. I'm a gynecologic oncologist here at Roswell Park Comprehensive Cancer Center. I'm excited to share with you today our advances in cervical cancer treatment and opportunities we can provide for your patients here at Roswell. Historically, patients would undergo a surgery that's called a radical hysterectomy. We're taking the tissues that are next to the cervix, some of the upper vaginal area, really a broad margin around the area of the cancer and two big trials, one that's called the shape trial and one that's called the Conserve trial, both illustrate that there are a subset of patients for whom we can be much less aggressive. This matters because uh it allows similar outcomes from a cancer standpoint but less post operative side effects for those patients. The next sort of category of cervical cancers is those that are uh very large in the cervix or have spread into other areas still in the pelvis but not to far away places. And we classify this as what we call locally advanced cervical cancer. We're now learning if we increase the chemotherapy side or the immune therapy side, we can get even better outcomes for these women. So there are two big trials that have been performed lately. One's called Keynote A 18. Looking at the use of immunotherapy, a medicine called pembrolizumab or immune checkpoint blockade prior to starting the radiation therapy. Excitingly, the result from the keynote trial has led to a new FDA approval to add this immune checkpoint blockade in women who are getting chemo radiation for locally advanced cervical cancer. The other is called the Interlaced trial, starting with some chemotherapy before starting radiation. Both these trials are showing that women treated with additional agents beyond just traditional chemo radiation, have improved progression free survival and encouraging results with regard to overall survival in both cervical cancer and oncology. At large. There's an exciting new field of treatments that are called antibody drug conjugates. These are medicines where an antibody is used to target a treatment specifically to cancer cells that express that target and then it pulls in the chemotherapy precisely to the tumor to help those tumor cells. There are actually two new treatments that were recently FDA approved specifically for cervical cancer patients. One is called trastuzumab Duan and it's targeting a protein on cervical cancers that is called her two. The studies looking at this agent uh called the destiny pan tumor trial illustrated a response rate of about 50% in cervical cancer patients with recurrent metastatic disease, which is an excellent response rate in this hard to treat patient population. The second treatment is called szab vodo and it is also an antibody drug conjugate. And again, recently FDA approved for recurrent metastatic disease. So both of these new antibody drug conjugates are available here at Roswell Park. And one of the things we're learning as oncologists using these medications is that new medicines come with new side effects. Therefore, there are some very specific things we need to watch for in patients that are getting these treatments. This includes cardiac monitoring, ophthalmologic monitoring. And because of these special side effects, it's really important that a woman receive care at an institution that is familiar with the side effects and has a structure for doing these surveillance visits. Our hope is we can be as least aggressive as possible while still providing important cancer uh outcomes for patients. But a consultation early on in treatment may allow us to de escalate therapy. Also to consider approaches such as fertility preservation and consultation with reproductive endocrinologists to make sure that we're preserving fertility in women for whom that's important. One of the approaches to treatment that Roswell Park can uniquely offer is that of adoptive cell therapy. This is a global approach where immune therapy is utilized to treat a cancer. And in cervical cancer specifically, we know that it's an immune mediated disease and therefore, clinical trials such as adoptive cell therapy are particularly relevant for this patient population. In addition to learning a lot about treatment approaches for cervical cancer patients, there is also a tremendous amount of work from a disease prevention standpoint HPV, vaccination remains our primary approach. But there are also strategies for pre invasive disease where we may be able to prevent cancer formation as we get better and better at treating cancers. Patients are faced with survivorship issues such as quality of life and sexual health that become more and more relevant because we can have long term survivors from their cancer. We are pleased to now have a sexual health clinic here at Roswell Park in the Gynecology Group, which is a great environment for being able to address these concerns that are often not addressed in other clinical settings. Additionally, our symptom Management Clinic can help with side effects from treatment and we can help facilitate any needs that are associated with prior treatments. If you're interested in learning more about these groundbreaking treatment options or have a patient for whom you think a consultation might be appropriate. Please reach out to us.
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