Thomas Herzog, MD: Ovarian Cancer Therapy Update ASCO 2011

Thomas Herzog, MD, Director of Gynecologic Oncology and Professor of Clinical Gynecology and Obstetrics at Columbia University Medical Center. Dr. Herzog gives a ovarian cancer therapy update at ASCO 2011.

The Group Room at the 2011 American Association For Cancer Research Annual Meeting was made possible, in part, by:

 

 

VIDEO TRANSCRIPT

Selma R. Schimmel, Founder & CEO, Vital Options International

This is Selma Schimmel at the annual ASCO meeting in Chicago, 2011.  And we have the opportunity to speak with key opinion leaders and physicians from all different areas and specialties.  And now we are joined by a gynecologic oncologist, Dr. Thomas Herzog; Professor of Clinical Obstetrics in Gynecology in the division of Gynecologic Oncology at Columbia University, College of Physicians and Surgeons, New York City, New York.  Welcome.

Thomas Herzog, MD, Director, Gynecologic Oncology at Columbia University Medical Center

Thank you for having me.

Selma R. Schimmel:

I’d like to talk a little bit about ovarian cancer, a little update on therapy, avastin being one of them.

Thomas Herzog:

Right, well I think that there are some very interesting things going on with ovarian cancer.  I’ve been doing this for a while now and I think that most of the changes we’ve seen with ovarian cancer have been incremental steps, but yet improvements.  And if we look back and look at survival numbers it’s really quite remarkable what’s been done in 20 years.  The median survival has gone from a little over 20-months to now some of our advanced stage studies, over 60-months.  So it is remarkable in terms of more women are living longer with this disease than ever has been the case.  I think you bring up some interesting thoughts in terms of bevacizumab or avastin, which is a drug that keeps new blood vessels from forming.  We had data last year that was very exciting, in terms of the front line setting, and this year we have data looking at treating women with recurrent disease with this particular agent.

Selma R. Schimmel:

I have a question- I remember a few years back when, in the earlier research stage, avastin was pulled because of fear of perforation and all of that.  Now, I would imagine that was a bigger risk for women who had more bulky disease and GI involvement, but where are we at now?  Women might say, “well wait a minute, wasn’t that pulled.”  So explain the progress that we’ve made with this drug.

Thomas Herzog:

Right, it actually was not pulled but there was a red caution flag that came up when one study showed an 11% incidence of GI perforation- so, holes in the intestine, which obviously, to even the casual observer would not be a good thing.  The study that was done had a lot of patients that were heavily pretreated.  And so, what they did with the front line study is they did a safety analysis with the first 100 patients and they did not see any aberrant safety signal, anything that was really concerning.  So they allowed that study to go to full enrollment.  And so, that’s always watched and it’s always brought up in terms of counseling the patients.  But the real risk of that happening is probably somewhere between 3 and 7%.

Selma R. Schimmel:

The PARP inhibitor- Talk to us about where you see this new classification of drugs really making a difference in ovarian cancer, especially for BRCA-positive patients.

Thomas Herzog:

The PARP inhibitor is basically a drug that interferes with DNA repair, which is just critical, obviously, for normal cells to do every day because we are constantly challenged with having to replicate and  maintain our body, but for cancer cells it’s critical.  And if we’re able to inhibit that it will cause the cancer cells to die.  And so, since the cancer cells are multiplying at so much faster rate, we’re able to interdict, if you will, and make a difference in terms of seeing a benefit by using these agents.  It’s even more profound, in terms of the effect, in those who already have a genetic mutation that you referred to, which is the BRCA mutation; which, unfortunately, leads to much higher rates of development of breast and ovarian cancer, but, interestingly, allows us to treat them with a compound that has a very high response rate.  And there’s very interesting data at this meeting that actually looks at using this type of compound in a maintenance setting after recurrence.  And so, treating after chemotherapy with a PARP inhibitor for a prolonged period showed a drastically improved survival.

Selma R. Schimmel:

Do we really understand long term side effects of PARPs yet?

Thomas Herzog:

We do not, in my opinion, and anything that interferes with DNA repair has to be looked at very closely because, as I said, your cells have to repair themselves on a daily basis.  And, what would be the effects of being on something for a long period of time?  And that, I don’t think we know at this point.

Selma R. Schimmel:

Are there any other key studies or points of reference that you would like to bring up?

Thomas Herzog:

I think there’s a lot of interesting compounds that are in the works.  And I’m not even going to name them individually, but there’s a lot of targeted agents where you go after either a pathway or a protein that is overexpressed or upregulated in cancer and some of these studies are starting to bear fruit.  We’re seeing good results.

Selma R. Schimmel:

Clearly, while chemotherapy is the benchmark, or a mainstay of cancer treatment, what we’re seeing across all cancer types, and now the gyncoc cancers included, is this integration of combination therapy, of taking these new biologic agents and integrating them with our classic chemotherapy drugs.

Thomas Herzog:

That’s right.  And what we’re hoping to do is get to an era of what we call personalized medicine, where we know all individuals aren’t the same, certainly not all cancers are the same.  And if we take that knowledge and know how the host immune system will respond to a certain cancer and the various characteristics of that cancer can be exploited, we hope to tailor therapy for that patient based on her cancer and her immune system.

Selma R. Schimmel:

And I think in the gynecologic cancer arena, probably molecular pathology is really going to become quite significant and more and more utilized in tailoring these therapies.

Thomas Herzog:

That’s really where we’re trying to go.  I think breast cancer has been a fantastic model.  Of course, there’s many more cases that they can then split into groups, but we’re really trying to use that type of model with gynecologic malignancies as we move forward.

Selma R. Schimmel:

Well I think everything you’ve discussed with us is hopeful and it’s great for you to be able to now see some of the progress, as you referred, to where we were to where we were 20 years ago, which was a lot more dim than where we are today.

Thomas Herzog:

I think so.  And as I said, it’s these types of meetings, and the efforts of the foundation, and the scientific community, that I think are really starting to make a difference in women’s lives with cancer.

Selma R. Schimmel:

Dr. Thomas Herzog; Professor of Clinical Obstetrics and Gynecology in the division of Gynecologic Oncology, Columbia University, College of Physicians and Surgeons, New York.

Thomas Herzog:

Thank you, Selma.

Selma R. Schimmel:

I thank you.

END OF VIDEO