Advances in gynaecological cancer research could change the treatment landscape

Results from a number of highly anticipated phase 3 clinical trials across the range of gynaecological cancers, including new data that cover the entire spectrum of managing patients with cervical cancer, were presented at the ESMO Congress 2023 in Madrid, Spain.

“These are exciting results that address unmet needs in gynaecological cancers,” said Prof Krishnansu S Tewari, Director, Gynaecologic Oncology Programme, University of California, Irvine, US.

Two trials presented at the ESMO Congress revealed new ways of treating locally-advanced cervical cancer that significantly delay relapse.

In one study, 68 per cent of women who received pembrolizumab on top of standard treatment were cancer-free at two years, compared to 57 per cent of women allocated to placebo on top of standard treatment.

A second study tested the impact of giving a combination of two different chemotherapy drugs ahead of standard treatment with chemotherapy plus radiation. Women with locally-advanced cervical cancer who received induction chemotherapy were 35 per cent more likely to be cancer-free at five years and 39 per cent more likely to be alive at five years compared to those who received standard treatment only. “Induction chemotherapy could be an accessible treatment option because these drugs are available around the world, including in low-resource countries,” noted Prof Tewari.

Also in cervical cancer, trials were presented showing improvements in survival and delays in relapse with new treatments for women with cancer that has spread to other parts of the body or had recurred after initially being treated with chemotherapy plus radiation. One trial tested the novel therapy tisotumab vedotin in women who had already received treatment for their metastatic or relapsed cervical cancer. The drug, which combines an antibody and an anti-cancer drug, lengthened survival, delayed relapse, and more often caused tumour shrinkage compared with chemotherapy.

In ovarian cancer, achieving remission is a high unmet need, as approximately 85 per cent of patients experience recurrent disease, with almost no long-term survival after recurrence. At the ESMO Congress 2023, randomised trial data was discussed showing that a novel targeted therapy, senaparib, delayed the time to relapse in patients with newly-diagnosed advanced disease.

Studies were also presented in endometrial cancer, the most common gynaecological cancer in the US and Europe. While there is no screening test, there is an early symptom – post-menopausal bleeding – which means that most endometrial cancers can be cured with a hysterectomy.

Prof Tewari said: “Unfortunately, for the 15-to-20 per cent of patients that have more aggressive disease, treatment options are very limited and that’s why the studies that will be presented at the ESMO Congress are remarkable. Two trials showed that adding immunotherapy to standard chemotherapy treatment significantly delayed relapse of the cancer in women with advanced/recurrent endometrial cancer compared to chemotherapy alone.”

Prof Tewari commented that the results presented at the Congress have a very good chance of leading to regulatory approval of new treatments.