Biomarkers, targeted and immunotherapies for , ovarian and primary peritoneal cancer
This section covers the following topics:
- Genetic testing for inherited mutations for treatment selection
- Tumor testing for treatment selection
- Targeted therapies
Genetic testing for an inherited mutation may be used to guide treatment selection for people diagnosed with ovarian cancer.
- People with advanced recurrent ovarian cancer who test positive for an inherited or mutation may benefit from treatment with a type of known as a .
- People who test positive for other inherited gene mutations may qualify for clinical trials looking at targeted therapies to treat hereditary ovarian cancer.
- People who test positive for a gene mutation may benefit from treatment with an agent.
tests look at samples of blood, tumor or other tissue for changes or abnormalities caused by cancer. These tests can give doctors clues about the cancer, including:
- how fast the cancer is growing
- which treatments are most likely to work
- whether or not the cancer is responding to treatment or growing
- whether or not the cancer has come back after remission
tests may be used to select treatments, and help patients avoid side effects from treatments that will not work for them. tests used to select a specific treatment are sometimes called companion diagnostic tests. These tests may be done on tumor tissue or (in many cases) on blood. See our Testing section for more information.
Biomarkers for treatment selection
Examples of tests used in , ovarian and primary peritoneal cancer include:
- Tests can be done to look for or gene mutations in the tumor. Women who test positive for a or mutation in their tumor may benefit from a type of therapy known as a . A tumor test positive for a or mutation in one of two situations:,
- when women who have an inherited mutation in or develop ovarian cancer, their tumor is very likely to display the same mutation.
- women who test negative for an inherited mutation in or may still develop an acquired mutation in their tumor. Women with a mutation in their tumor may also respond well to treatment.
- Some ovarian cancers will have an abnormality known as (“ high") also known as "" ( or ). cancers are common in people with a gene mutation. These cancers may respond well to a type of treatment known as an immune checkpoint inhibitor. One example of an agent used for MSI-H cancers is Keytruda (pembrolizumab).
Biomarkers to monitor recurrence or response to treatment
CA125 is a type of protein that is produced in large amounts by some ovarian cancers. Doctors may use CA125 blood tests monitor recurrence or response to treatment.
Immunotherapies are cancer treatments that hlep the body’s immune system detect and attack cancer cells. There are several different categories of immunotherapies.
- Keytruda (pembrolizumab) is known as an immune checkpoint inhibitor. approved for treatment of patients with cancer that tests . Although this is not common in ovarian cancer, it is often seen in people with a gene mutation who develop cancer.
Two types of targeted therapies are commonly used to treat advanced ovarian cancer:
- Avastin (bevacizumab)
- PARP inhibitors
PARP inhibitors work by blocking a protein used by cells to repair damaged . They were initially developed to treat cancers in people with an inherited gene mutation or mutation. Three PARP inhibitors have been approved for treating ovarian cancer:
- Lynparza (olaparib)
PARP inhibitors have received approval for treating ovarian cancer in two settings:
- as treatment of advanced, recurrent ovarian cancer
- after chemotherapy as for advanced ovarian cancer
Research is ongoing to learn if PARP inhibitors are also affective for treating ovarian cancer in other situations, including:
- people with an inherited mutation in a different gene that repairs damage (for example: , , , ).
- people who do not have an inherited gene mutation, but tumor testing found an acquired tumor mutation in a gene that repairs damage.
- in combination with or other agents.
- For treating people with advanced, recurrent ovarian cancer, two PARP inhibitors have received FDA-approval as for treating people with a mutation. The two approved drugs are:
- Lynparza (olaparib)
is given after chemotherapy to try to keep the cancer from returning. The goal is to extend the length of time before recurrence or to turn remission into a long-term cure.
Table of targeted and immunotherapies for , ovarian and primary peritoneal cancer
|Name of drug||Type of agent||Line of therapy||Indication|
|Monoclonal antibody targeting vascular endothelial growth factor (VEGF)||First-line maintenance||Combined with Lynparza (olaparib) for platinum-sensitive cancer||
|Monoclonal antibody targeting vascular endothelial growth factor (VEGF)||First-line||Combined with chemotherapy, followed by Avastin as a single agent following initial surgical resection||No required|
|Monoclonal antibody targeting vascular endothelial growth factor (VEGF)||Second or third-line||Combined with chemotherapy for platinum-resistant recurrent disease||No required|
|Monoclonal antibody targeting vascular endothelial growth factor (VEGF)||Second-line or later||Combined with chemotherapy, followed by Avastin as a single agent, for platinum-sensitive recurrent diesase||No required|
|First-line maintenance||For women who had a complete or partial response to platinum chemotherapy||Inherited or acquired (tumor) mutation in or|
|First-line maintenance||Combined with Avastin (bevacuzimab) for women who had a complete or partial response to platinum chemotherapy||
|First-line maintenance||For women who had a complete or partial response to platinum chemotherapy||No inherited or acquired mutation or other tumor
|Second-line or later maintenance||For platinum-sensitive or partially sensitive recurrent cancer||No inherited or acquired mutation or other tumor
|Third-line or later treatment||For treatment of advanced, recurrent ovarian cancer||Inherited or acquired (tumor) mutation in or|
|Fourth-line or later treatment||For treatment of advanced, recurrent ovarian cancer||Inherited mutation in or|
|Fourth-line or later treatment||For treatment of advanced, recurrent ovarian cancer|| mutation or
|Keytruda (pembrolizumab)||Immune checkpoint inhibitor||or unresectable||For treatment of that have progressed after treatment and for which there are no other treatment options||High (MSI-H) or ()|
|Keytruda (pembrolizumab)||Immune checkpoint inhibitor||or unresectable||For the treatment of that have progressed after treatment and for which there are no other treatment options||High (TMB-H)|
The following are studies looking at treatment for people with advanced .
- NCT05169437: () in patients with inherited or tumor mutations in advanced (PAVO). PAVO is a Phase II study investigating if the study drug, a called , is safe and effective for certain people who have been diagnosed with an advanced solid tumor with either an inherited or tumor mutation.
- NCT02264678: Ascending Doses of Ceralasertib in Combination With Chemotherapy and/or Novel Anti Cancer Agents. This is a study of ceralasertib administered orally in combination with chemotherapy regimens and/or novel anti-cancer agents, to patients with advanced cancer. The study is enrolling people with inherited mutations including , , , , and people with tumors that are HRD-positive.
- NCT03162627: Selumetinib and Olaparib in . The goal of Phase 1 of this clinical research study is to find a tolerable dose combination of selumetinib and olaparib that can be given to people with advanced or recurrent . This study is open to people whose cancer stopped responding or progressed on PARP inhibitors.
- NCT04644068: Study of AZD5305 as Monotherapy and in Combination With Anti-cancer Agents in Patients With Advanced Solid Malignancies (PETRA). This research is designed to learn if treatment with a new , AZD5305, alone, or in combination with anti-cancer agents is safe, tolerable, and has anti-cancer activity in patients with advanced . The study is open to people who have previously been treated with PARP inhibitors.
- NCT04267939: ATR Inhibitor Plus Study in Advanced and Ovarian Cancer. This study will look at how well how well people with advanced respond to treatment with the BAY1895344 in combination with the . This study is open to people with inherited mutations in , , and others. Contact the study coordinator for information about eligilibity for people with mutations in other genes.
- NCT04657068: Treatment with ATR Inhibitor for Advanced or Solid Tumors. This study will look at how well a new oral known as an ATR inhibitor works on advanced or with mutations in genes linked to damage repair. This study is open to people who have an inherited or acquired or mutation or people with tumors that are HRD-positive. This study is open to people whose cancer stopped responding or progressed on PARP inhibitors.
- NCT04197713: Olaparib Combined with AZD1775, an Investigational for People with Advanced with Mutations in , , , or Others. This study is looking at how well the oral therapy AZD1775 works when combined with the Olaparib for treating advanced cancers in people with an inherited or tumor mutation in , , , or other genes or biomarkers. The study is open to people who have stopped responding or progressed after treatment with a .
The following are studies looking at PARP inhibitors and similar agents for treating people with ovarian cancer.
- NCT03462342 Combination ATR inhibitor and in Recurrent Ovarian Cancer (CAPRI). This study will look at how well patients with recurrent ovarian cancer respond to treatment with a known as an ATR inhibitor when combined with a .
- NCT02502266: Combination Cediranib and Olaparib in Comparison to Each Drug Alone or Chemotherapy in Recurrent Platinum-Resistant Ovarian Cancer. This studies how well cediranib and olaparib work when given together or separately, and compares them to standard chemotherapy in treating patients with platinum-resistant or platinum-refractory ovarian cancer.
- NCT04586335: Study of CYH33 in Combination With Olaparib an Oral in Patients With Advanced . The purpose of this study is to assess the safety, tolerability and preliminary efficacy of the CYH33 in combination with olaprib in patients with DDR gene mutations and/or PIK3CA mutations, in patients who have progressed on prior , and in patients with recurrent high grade serous ovarian, , or primary peritoneal cancer who are platinum resistant or refractory.
- NCT03579316: Adavosertib With or Without Olaparib in Treating Patients With Recurrent Ovarian, Primary Peritoneal, or Cancer. This studies how well adavosertib with or without olaparib work in patients with ovarian cancer that has come back (recurrent).
- NCT04267939: ATR Inhibitor Plus Study in Advanced and Ovarian Cancer. This study will look at how well how well people with advanced ovarian cancer or other respond to treatment with the BAY1895344 in combination with the . This study is open to people whose ovarian cancer progressed on a .
- NCT04525183: REVITALIZE: A Telehealth Intervention for Women With Advanced Ovarian Cancer and PARP Inhibitor-Related Fatigue. This study is testing whether a 6 week skills-based telehealth intervention can help ovarian cancer patients experiencing PARP inhibitor-related fatigue reduce the impact of fatigue on their daily life and activities.
A number of other clinical trials for people with ovarian cancer can be found here.