Osu 2014 asco review salani pres gyn onc
Upcoming SlideShare
Loading in...5

Osu 2014 asco review salani pres gyn onc



Ohio State's 2014 ASCO Review Gynecologic Oncology Update Presentation by Dr. Ritu Salani

Ohio State's 2014 ASCO Review Gynecologic Oncology Update Presentation by Dr. Ritu Salani



Total Views
Views on SlideShare
Embed Views



1 Embed 2

http://www.slideee.com 2


Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
Post Comment
Edit your comment

Osu 2014 asco review salani pres gyn onc Osu 2014 asco review salani pres gyn onc Presentation Transcript

  • Best of ASCO 2014 Gynecologic Oncology Ritu Salani, M.D., M.B.A Associate Professor Division of Gynecologic Oncology Department of Obstetrics & Gynecology The James Cancer Center
  • Objectives • Review studies in recurrent ovarian cancer – Platinum sensitive – Platinum resistant – Additional studies • Discuss the developing role of metformin in endometrial cancer • Provide an update on cervical cancer screening with HPV testing
  • Gynecologic Cancer Cases American Cancer Society. Cancer Facts & Figures. 2008. Atlanta: American Cancer Society; 2008. Estimated cases per year Estimated deaths per year
  • Ovarian cancer • 21,980 cases and 14,270 deaths in 2014 • First line response rates: ~75-80% • Recurrence rate: 60% overall • Defined by the time between primary treatment and detection of relapse – Platinum sensitive: ≥6 months – Platinum resistant : <6 months – Platinum refractory: Progression on therapy
  • Randomized Phase II • Cediranib – Oral tyrosine kinase inhibitor of VEGFR – Toxicities: fatigue, hypertension, diarrhea – Phase II trials in recurrent ovarian cancer • Overall response rate 17% • PFS 5.2 months • Olaparib – Oral PARP inhibitor – Toxicities: fatigue, myelosuppression, anemia – Phase II trials • Overall response rate 24- 40% • PFS 7-9 months • Synergistic activity • Phase I study demonstrated response rate of 44%
  • Study design • Phase 2 open-label randomized study • Platinum sensitive recurrent ovarian cancer • 1:1 randomization Cediranib 30 mg daily and Olaparib 200 mg BID Olaparib 400 mg BID Disease progression by RECIST v1.1 criteria
  • Progression free survival
  • PFS based on BRCA mutation status
  • Overall response rate
  • PARP inhibition: Next steps • Primary setting in combination with bevacizumab and cytotoxic therapy • Recurrent platinum sensitive disease – BRCA positive – BRCA negative or unknown • Maintenance setting • Combination with targeted agents
  • Platinum Resistant Ovarian Cancer • Pazopanib is a tyrosine kinase inhibitor – Targets VEGFR, PDGFR, and ckit – Demonstrated activity in maintenance setting
  • Study design
  • Survival outcomes
  • Platinum resistant ovarian cancer
  • Study design
  • Progression free survival
  • PM01183 Results • Overall response rate (p=0.006) • Response rate 30% in platinum resistant group
  • Study Study group Arms Outcomes Conclusion OVA-301 Platinum resistant ovarian cancer PLD + Trabectedin versus PLD -OS 22.2 months vs 15.1 months Promising activity PD1 (Nivolumab) Platinum resistant ovarian cancer Nivolumab Response rates of 17% Further studies JGOG 3017 First line therapy for clear cell cancer Carboplatin/ Paclitaxel versus Irinotecan/Ci splatin 2 year PFS and OS similar Need for new treatments CAN-003 Stage III/IV in complete remission CVAC versus observation Improved PFS in second remission Promising activity
  • Molecular biomarkers • Samples from ICON 7 trial • TCGA subclasses: – Immunoreactive – Differentiated – Proliferative – Mesenchymal
  • Survival based on TCGA subclasses
  • Subtype analysis
  • Uterine cancer • 52,630 cases and 8590 deaths in 2014
  • Results • Short exposure of metformin – Reduction of 83% in MAPK and 90% in Phospho- AKT • Current studies – GOG 286 B: recurrent/advanced endometrial cancer with carboplatin/paclitaxel +/- metformin – Phase II studies with everolimus, letrozole, metformin in advanced/recurrent endometrial cancer
  • Cervical cancer • 12,360 cases and 4,020 deaths in 2014
  • Cervical cancer screening • Pap smear/test – Introduced 1941 – ~65 million Pap tests/year – 3.5 million abnormal Pap tests • Human Papillomavirus (HPV) – Discovered in 1956; Cancer link in 1984 – HPV test approved by FDA in 2003
  • ATHENA trial • Designed to evaluate the clinical utility of HPV testing compared to cytology • All women had baseline HPV testing and cytology • At the 3-year visit, all women underwent repeat evaluation.
  • ATHENA trial • 3-year follow-up data from the ATHENA trial indicate that hrHPV primary screening with triage to colposcopy based on genotyping and reflex cytology provides a more sensitive cervical screening strategy than cytology and is more efficient than cotesting. • HPV may be used as primary screening alone!
  • Summary • Ovarian cancer – Promising agents in platinum resistant disease – Further study using PARP inhibition – Understanding of the role of molecular biomarkers and personalized therapy • Endometrial cancer – Supplementation of therapy with metformin – Education on lifestyle behaviors • Cervical cancer – Improved screening tests – Access to care and HPV vaccine need to be highlighted
  • Thank you Ritu.Salani@osumc.edu