In Ovarian Cancer Advancements, Finding New Biomarkers Is Key

Finding new biomarkers should be the top priority in ovarian cancer research, Maurie Markman, M.D., says. 
The search for validated, actionable biomarkers may be more important than initiating more phase 3 trials in the field of ovarian cancer, according to Maurie Markman, M.D.

“In the ovarian cancer arena, we have 30 years of history of doing phase 3 randomized trials in the cytotoxic space with drugs that have response rates of somewhere between 10 percent and 20 percent, and the history is known—they’ve been negative trials,” said Markman. “It’s just not enough biological/clinical activity. So I would strongly urge investigators in this space, and biopharmaceutical companies in this space, to spend the effort now to find validated reasonable biomarkers which, quite frankly, may lead to accelerated approval of these drugs, because of very high response rates in those selected populations.”

The influx of new drugs into the treatment paradigm of ovarian cancer is undoubtedly exciting, but Markman is keen to exercise caution when administering these novel agents to patients, as combination therapies can potentially lead to more serious immune effects for patients.

In an interview with CURE, Maurie Markman, president of Medicine and Science, Cancer Treatment Centers of America, discussed his presentation from the recent 2016 Chemotherapy Foundation Symposium (CFS), and comments on both recent advances and remaining challenges in the treatment of ovarian cancer.

Can you provide us with an overview of your talk at the CFS?

The topic that I discussed is immune targeting of ovarian cancer. It’s a very interesting, and very provocative, and to date, a quite challenging area. There’s really quite sound scientific reason to believe that immune targeting of ovarian cancer makes sense. There are a tremendous number of preclinical data points looking at infiltration of various lymphocyte subtypes into ovarian cancer. There are cells that suggest that there is both an immuno-augmentative effect and also an immuno-suppressive effect. The idea that one could somehow modify that with a variety of manipulations —whether it’s vaccines, or immuno-stimulation, or today, the most exciting areas in checkpoint inhibitors — it makes a lot of sense.

However, trials to date have, quite frankly, been disappointing. Vaccine approaches have not been shown to have an impact in the illness. Although one can definitely show an immune response, and measure an immune response, a therapeutic effect has not been seen. And in the area of checkpoint inhibitors, there’s a lot of interest. There are several drugs that have been reported either in the peer-reviewed literature, or mostly still in abstract form, that have shown that there are actually some short-term responses. But the percentage of patients that exhibit true objective responses — a major shrinkage or disappearance of the tumor, on the basis of imaging — that percentage is low, somewhere between 10 percent and 15 percent, maximum 20 percent. This is the same story that we see with multiple cytotoxics that have been examined over the last two or three decades.

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