Advances in Gynecologic Cancer Care Explained

In an interview with CURE, Dr. Susana Campos, clinical director of the Division of Gynecologic Oncology and assistant professor of medicine at Harvard Medical School, discussed recent advances in the treatment of gynecologic cancers. She highlighted progress in ovarian, endometrial and cervical cancers, including the use of PARP inhibitors as maintenance therapy in ovarian cancer and the addition of immunotherapy to chemotherapy in endometrial cancer.

Campos also noted research showing benefits from adding immunotherapy to chemotherapy and radiation in cervical cancer. She emphasized the growing role of tumor molecular profiling and targeted therapies such as antibody-drug conjugates in helping physicians tailor treatment plans for individual patients.

CURE: When patients are newly diagnosed with a gynecologic cancer, what treatment advances should they know about today that were not available even a few years ago?

Campos: That’s an excellent question. Gynecologic cancers are really divided into several areas — ovarian cancer, endometrial cancer, cervical cancer, and vulvar or vaginal cancers. If we focus first on the three most common — ovarian, endometrial and cervical cancer — we’ve seen important advances in each.

In ovarian cancer, we still focus heavily on optimal surgical debulking, which remains extremely important. Achieving what we call an R0 resection — meaning no evidence of disease after surgery — is one of the most important prognostic factors. We are also very excited about the use of PARP inhibitors as maintenance therapy, particularly for patients who carry BRCA mutations or who are what we call HRD-positive, which stands for homologous recombination deficiency.

Endometrial cancer is a different area, and several key trials have changed treatment in recent years. Studies such as the NRG-GY018 trial and the RUBY study showed that adding immunotherapy to the backbone of chemotherapy improved progression-free survival. That has been very important in the management of patients with uterine cancer.

Cervical cancer has also seen significant progress. In patients with locally advanced disease, research such as the KEYNOTE-A18 study showed that adding immunotherapy to the standard backbone of chemotherapy and radiation therapy improved both progression-free survival and overall survival in select patients. So although each disease area is different, there have been advances across all gynecologic cancer types.

Patients often hear that there are many treatment options. How do you help them understand what the right treatment path looks like for them?

That really depends on the individual patient. We consider several factors, whether the diagnosis is ovarian, endometrial or cervical cancer. We look at the stage of the disease, where the cancer is located and whether the disease can be surgically removed. We also consider how many prior lines of therapy a patient has received.

Another key factor is the tumor’s molecular profile. We often perform next-generation sequencing, which helps identify mutations that may open the door to additional treatment options. For example, in ovarian cancer this might include antibody-drug conjugates. In endometrial cancer, it may involve immunotherapy combinations. In cervical cancer, there may also be antibody-drug conjugates available. Ultimately, we examine the patient’s medical history, the molecular features of the tumor and other clinical factors to create a treatment plan tailored specifically to that individual.

From a patient standpoint, how are newer treatments such as targeted therapies and immunotherapies changing what people can expect from care?

That’s a very good question. In endometrial cancer, for example, the use of immunotherapy has changed expectations for many patients. Two immunotherapies that have been studied include pembrolizumab, often known as Keytruda (pembrolizumab), and Jemperli (dostarlimab). Both were evaluated in separate studies, and patients can now expect that their cancer may remain controlled for longer periods.

Some patients may even experience long-term remission. Targeted therapies are also giving patients additional options. One important group of treatments is antibody-drug conjugates, which act as vehicles that deliver a very potent chemotherapy directly to tumor cells that express a specific biomarker.

Because of that targeted delivery, the responses we see today can be greater than what we historically observed with conventional chemotherapy. For example, in ovarian cancer there is an antibody-drug conjugate called mirvetuximab that targets folate receptor alpha. Another example involves HER2 expression. Based on results from the DESTINY-PanTumor02 trial, we now test tumors for HER2 expression in ovarian, endometrial and cervical cancers. If the tumor tests positive — typically 2+ or 3+ — patients may be eligible for treatment with Enhertu (trastuzumab deruxtecan), which showed encouraging response rates and progression-free survival in that study. These are just a few examples of how targeted therapies are changing treatment.

Patients frequently ask what’s coming next. What areas of gynecologic cancer research give you the most hope for the future?

One of the most exciting areas is the continued development of antibody-drug conjugates. These therapies have really changed how we think about delivering chemotherapy because they allow us to target cancer cells more precisely.

Researchers are identifying new biomarkers that these drugs can target. In ovarian cancer, for example, we already have therapies targeting folate receptor alpha, and more are being studied. There are also drugs targeting other biomarkers, such as cadherin and claudin-6.

Another area of interest is combining antibody-drug conjugates with immunotherapy. Researchers are also studying entirely new approaches. For instance, one study presented at the American Society of Clinical Oncology Annual Meeting evaluated relacorilant combined with nab-paclitaxel, which works by blocking the glucocorticoid receptor. The results showed promising activity, and we are waiting for more mature overall survival data.

More recently, data presented at the European Society for Medical Oncology Congress evaluated pembrolizumab plus weekly paclitaxel. The study showed encouraging progression-free and overall survival results. With so many emerging options, physicians must carefully evaluate which advances are most appropriate for each individual patient.

Clinical trials can feel intimidating to patients. How do you explain their role and help patients decide whether a trial might be right for them?

Clinical trials can certainly feel intimidating. The first step is asking patients what they already know or believe about clinical trials. Some people view them as exciting and innovative, while others worry that they are experimental.

We try to explain clearly what the trial is studying, what question researchers are asking and why the study is being conducted. We also walk patients through the protocol and the time commitment involved. Clinical trials are supported by a multidisciplinary team, including physicians, nurse practitioners and clinical research staff.

I always emphasize that the trial must work for the patient, not the patient for the trial. Clinical trials can provide access to promising therapies that are not yet widely available because they are still being studied. Not every trial leads to a positive result, but many of the treatments we use today began as clinical trials.

As treatments evolve, how do you balance effectiveness with day-to-day quality of life for patients?

Quality of life is extremely important, and it is very personal. What one patient considers a good quality of life may be different for someone else. Oncology is unique in that we often get to know patients very well — their families, their plans and the events that matter to them.

We try to organize treatment schedules so patients can continue many of their daily activities. Our goal is to make the time they spend in the clinic efficient so they can return home and focus on their lives outside of treatment. This approach often involves a multidisciplinary team, including physicians, nurse practitioners and social workers who help address needs that might otherwise be overlooked.

Many patients rely on caregivers during treatment. How can caregivers best support patients?

Caregivers are incredibly important. Often the most valuable thing they can do is simply listen and help support communication between the patient and the care team.

At the same time, it’s important to remember that caregivers also need support. Caregivers are often family members — spouses, children or siblings — who may be dealing with their own challenges. It’s important to ask who is caring for the caregiver and to make sure they also have the resources they need.

What advice would you give to patients in general?

Breathe. A cancer diagnosis can feel overwhelming and frightening. No matter how long someone has worked in oncology, you never truly understand that feeling until it affects your own family.

Take a moment to breathe, listen and ask questions. Patients should feel comfortable asking any question they have, and that question should be answered as many times as needed so they feel informed and supported.

Transcript has been edited for clarity and conciseness.

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