Examining Treatments for Gynecologic Cancers

In the plenary session on the third day of the Society of Gynecologic Oncologists 41st Annual Meeting, Moroney and colleagues discussed the preliminary results of a novel phase 1 combination of liposomal doxorubicin, bevacizumab, and temsirolimus. This regimen is of particular interest in gynecologic cancers due to the known activity of liposomal doxorubicin and bevacizumab and the theorized role for temsirolimus in favorably impacting potential resistance mechanisms for antiangiogenic agents. In a group of 59 patients who participated in this trial, an objective response rate of 24% was observed. Of particular note was activity in cancers of the endometrium and breast. Although there was considerable toxicity, including one fatal bowel perforation, further exploration of this interesting combination regimen appears to be indicated.

Horowitz and associates reported a very interesting experience of a group of 19 patients with squamous cell carcinoma of the vulva treated with erlotinib. This is a most difficult malignancy as regards the biological activity of any antineoplastic agent. Patients were either treated with this anti-EGFR agent prior to definitive chemoradiation or following documentation of recurrent/metastatic disease. Five (26%) partial responses were observed. Of interest, several patients were documented to have EGFR amplifications, and each of these patients either exhibited a partial response or had a period of stable disease prior to progression.

Two studies reported from the Gynecologic Oncology Group by Morgan and colleagues examined the side effect profile associated with the delivery of intraperitoneal carboplatin in the management of advanced ovarian cancer when given with systemic paclitaxel. The trials explored intraperitoneal carboplatin with and without paclitaxel also administered regionally. In both cases, the investigators reported that such therapy could be safely delivered with an acceptable toxicity profile. As anticipated, bone marrow suppression was found to be the major side effect of this therapeutic strategy. Trials evaluating the potential substitution of carboplatin for cisplatin in routine practice when the platinum compound is administered intraperitoneally are currently in progress in several multi-institutional randomized clinical trials. The hope is that this strategy will maintain the documented improved survival outcome associated with regional delivery of platinum in small volume, residual, advanced ovarian cancer while at the same time improving the toxicity profile of this approach.