Biomarker-Free Relacorilant Combo Broadens Options in Ovarian Cancer

Treatment with relacorilant plus Abraxane (nab-paclitaxel) may offer a broader option for patients with platinum-resistant ovarian cancer because it does not require biomarker testing, potentially allowing more patients to access therapy compared with targeted drugs limited to specific subgroups, according to an expert.

In an interview with CURE, Dr. Alexander B. Olawaiye, director of gynecologic cancer research at Magee-Womens Hospital of UPMC, explained that many newer therapies rely on precision medicine approaches that restrict treatment to patients whose tumors express markers such as folate receptor alpha or HER2. While effective, those drugs only apply to a minority of patients.

In contrast, relacorilant targets the glucocorticoid receptor pathway, which is broadly expressed in ovarian cancer, and benefit was seen across patient subgroups without selection. He added that side effects primarily reflect those already known with Abraxane, with no unique toxicities linked to relacorilant.

Transcript

Why is it important to note that treatment with relacorilant and Abraxane does not require biomarker selection?

Because, we are in this new era where we’re basically trying to promote precision medicine. Precision medicine, however, is based on the fact that if you select out patients who are likely to gain maximum benefit from a therapy, you give it to that group of patients alone, right, and not the old approach where you basically throw the medication to everybody when only a uniquely small group would benefit.

And we have seen that all around. I mentioned the drug mirvetuximab soravtansine. That’s a great drug, but patients who have low expression of folate receptor alpha are unlikely to benefit from that medication. So it’s not a good idea to give it to everybody. It’s better to test the patient’s tissue and give it only to those with high folate receptor alpha expression who are going to maximally benefit.

And the same thing with trastuzumab deruxtecan that we talked about, which is a drug that benefits people with HER2 expression in their tissues. And that group is, in some data, under 20% of ovarian cancer patients who have that expression. You don’t want to give it to 10 patients when only two would benefit, right? You want to give it to the two who will benefit.

That is the big deal with relacorilant, because when we give this medication to patients, regardless of their glucocorticoid receptor expression level, most of them benefited.

And we did something called a forest plot, where we divide the patients into all sorts of different groups — younger age, less than 65, over 65, previous treatment with PARP inhibitors, patients who had large tumors and so on and so forth. If you look at the forest plot, all the dots — okay — if the dots line up on the left side of what they call the line of equity, that means that group benefited. Almost every single dot was on the left side, which is the side of benefit.

Transcript has been edited for clarity and conciseness.

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