TAPUR Study Aims to Give Strength Back to Patients With Ovarian Cancer
Kristie L. Kahl
Even when a patient thinks they may have exhausted their very last treatment option, the Targeted Agent and Profiling Utilization Registry (TAPUR) Study is just the thing they may need.
The American Society of Clinical Oncology (ASCO)’s TAPUR study is a non-randomized trial designed to describe the safety and efficacy of targeted anticancer drugs that are prescribed to treat cancer that may have an actionable genomic variant. ASCO collects this data to learn about additional uses of these drugs outside of their current indications, all in hopes of treating more patients successfully and to conduct additional trials.
Cancer Treatment Centers of America (CTCA) is one of the clinical sites enrolling patients in this trial – including one patient, Loaunda Holmes, who has battled cancer for more than 22 years. Before entering the trial, Holmes underwent a variety of treatment combinations, had a full hysterectomy, including a two-pound tumor that removed from one of her ovaries, and endured a heart attack along the way.
CURE spoke with Holmes and her oncologist, Shayma Kazmi, M.D., RPh, a medical oncologist at CTCA, about the TAPUR trial and what it can do for patients with cancer moving forward.
Dr. Kazmi, can you explain the aim of the TAPUR trial?
Kazmi: The aim of the TAPUR study is to evaluate whether some of these targeted agents that are approved on the market right now can be used for a wider group of patients with solid tumors. So, in essence, a lot of drugs today get approved for a specific tumor type, like breast cancer or lung cancer, based on a mutation that the patient has. And really the harder question is: Does it matter where the cancer came from if we have a target; why not use that agent for those patients? And the question it is trying to answer is: Does it work the same way?
Loaunda, can you tell me about your treatment journey prior to the TAPUR trial and since joining it?
Holmes: I’ve had so many different types of [drug] cocktails – very strong ones. They really affected me negatively even though they had slight changes in the condition [of my cancer]. But what I find now is [there is still] a change, but I feel normal. I feel I can function. I can go on with my life, and live and feel more so like a normal person. I might have an ache, or pain, or a headache, or something to that effect, but from where I came from, that is very minor. So, I feel stronger, I feel healthier, and I feel more productive with this type of treatment.
Question: How did you both get involved?
Holmes: Well, the doctor introduced it to me because we’ve been together so long, and she has tried so many things. She is excellent at what she does, she is very creative and she constantly thinks of different things. She is very smart and attentive to her patients. And what I find is that she is always trying to find something to make it better. And sometimes the stuff that is chosen, it is not due to her, it is due to the chemical itself – is very strong. She is just trying to make a better life for me and get rid of the tumors as much as possible. But the difference with this is that it is less stress on my body. I feel more powerful, stronger and healthier, actually.
Kazmi: We began the TAPUR study here at CTCA around November 2016. Her testing, from a genomic standpoint, was done earlier in that year. At that time, there were no target mutations, per say. An interesting arm of the TAPUR study is an entity called tumor mutation burden, which is really a calculation. And they were trying to assess if patients with a high tumor mutation burden can benefit from immunotherapy. That was not reported out on our original genomic study. So, what I did was I asked them to run those numbers on her since she did not have any other particular targets on that genomic analysis. And it looked like she qualified based on the tumor mutation burden based on the therapy arm of the TAPUR study. And so, I think she ended up officially enrolling and starting [the trial] in February 2017. But I had probably asked that question in December when we opened the study to really see: Who are my patients that have had a difficult course, difficult cancers, and not really great options, and who can I see may benefit from this study?
What do you think this trial means for other patients with cancer?
Holmes: For other patients that have gone through a stressful time like I have in the last 22 years that I’ve had cancer, or for the last 11 years that I’ve been with Dr. Kazmi, I feel that it will give people hope. It will put a more positive existence in them to feel that they can survive, and they can go on and have a better life, and a longer life at that.
Kazmi: And that is exactly what I echo. What I find is that we tend to group people based on the types of cancer they have, and really for a lack of a better way, that has been the way we conduct studies in cancer. I think that has been lifted because every single cancer, even though they look typically the same on a slide, behave differently in different people. I think what the paper does is give us another way of targeting a particular patient’s cancer, which would not be reflected on other studies.
What kinds of discussions should patients be having with their doctors around this?
Kazmi: The TAPUR trial is just one of many of what we call “basket” or targeted trials. Because the world of oncology is changing so fast and there is so much more information coming out literally on a daily basis, the only questions I would make sure that patients always ask is: What is new in the literature about my cancer? What are the new potential treatments? Is there any way to analyze my cancer for broader genomic testing to look for other potential trial options? Those questions should be discussed routinely. More often than not, patients trust that the physicians just know what is best for them. More often than not, physicians get bogged down with a myriad of information and may overlook a potential treatment – not because they don’t want to help the patient, just because it is an overwhelming amount. If patients are questioning more, and advocating for themselves, they may be able to find that physicians are also much more engaged.
Holmes: I think that is true and what I tended to do. Being with her for so long and trusting her and her choices has been so great. I have faith in her. And I just got information now that I need to be more active in my own situation, which is true. Other than just trusting the fact that she does such a great job. I trust everything that she says, and I feel safe with her because I feel that the doctor looks out for me. She is very dedicated in her work and I think she loves what she is doing and she is very creative. So, that is what I deal with. But from what we are talking about now, I will be more active.
Is there anything we have not touched upon that you think our patient audience should know about?
Kazmi: I want to again emphasize, there is a lot of information on the Internet and commercials, and often, a patient will take that information or not. But it is important to always discuss with the physician and see whether that applies to them, because a lot of times drugs are not going to work for them, or maybe they are, but to constantly be curious and say, “You know, I’ve heard about that,” and have that open dialogue really makes for a better outcome.