Ovarian Cancer Patients Who Are Considered Platinum-Resistant Meaning Their Cancer Returned After Prior Treatment, Have a New Treatment Option
- The FDA has approved the cancer drug (generic name: relacorilant – brand name: Lifyorli) for use with (generic name: nab‑paclitaxel – brand name: Abraxane) for certain platinum‑resistant ovarian cancer patients, meaning these patients’ ovarian cancer returned within six months after treatment.
- In the ROSELLA trial, the combination of relacorilant and nab‑paclitaxel modestly improved progression‑free survival (length of time after starting treatment that a person lives without their cancer worsening) from 6.5 months compared to 5.5 months. The overall survival of patients participating in the trial was 16 months compared to 11.9 months in patients who took nab‑paclitaxel alone.
- “The regimen improved both progression‑free and overall survival in a randomized trial, with very few new side effects,” says Dr. Dana Chase of UCLA’s David Geffen School of Medicine.
- Patients using the treatment combination experienced side effects such as low blood counts, fatigue, nausea, diarrhea, rash, and decreased appetite.
While many oncologists welcome the added option, some urge caution. - “This is an extremely small improvement with only a 1-month difference in progression-free survival and only a 4.4-month difference in overall survival. It seems to me that the cost of relacorlilant will determine if this regimen is commonly used,” Dr. Bobbie Rimel, Clinical Director, Gynecologic Oncology, Fred Hutch Cancer Center, explained to SurvivorNet.
If recurrence occurs within six months, the cancer is classified as platinum-resistant. In these cases, oncologists typically shift to alternative therapies tailored to overcome resistance.
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The FDA approval is based on results from the ROSELLA trial, which compared an intermittent regimen of relacorilant plus nab‑paclitaxel against nab‑paclitaxel alone in patients with platinum‑resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer who had received one to three prior treatments, including the targeted therapy cancer drug (generic name: bevacizumab – brand name: Avastin).
Dr. Bhavana Pothuri, professor of ob/gyn at NYU Langone’s Perlmutter Cancer Center, notes that the combination addresses a significant unmet need. She explains that relacorilant, which is an oral selective glucocorticoid receptor modulator, works by blocking cortisol, a stress hormone that can influence tumor behavior.
In the trial, patients receiving the combination therapy had a median progression‑free survival (length of time after starting treatment that a person lives without their cancer worsening) of 6.5 months compared with 5.5 months for those on nab‑paclitaxel alone. Median overall survival improved from 11.9 months to 16 months with the addition of relacorilant.
Common side effects included low hemoglobin, reduced neutrophils, fatigue, nausea, diarrhea, low platelets, rash, and decreased appetite.
“The regimen improved both progression‑free and overall survival in a randomized trial, with very few new side effects,” says Dr. Dana Chase, a professor of gynecologic oncology at UCLA Health’s David Geffen School of Medicine.
Still, some experts urge caution.
Dr. Bobbie J. Rimel, a Clinical Director, Gynecologic Oncology, Fred Hutch Cancer Center, points out that while the gains are meaningful, they are modest.
“This is an extremely small improvement,” she says, adding that the cost of relacorilant may ultimately determine how widely the regimen is adopted.
Understanding an Ovarian Cancer Diagnosis
Ovarian cancer has been called the “cancer that whispers” because women often don’t experience symptoms until their cancer has already reached its late stages. The symptoms that do appear at first are hard to identify as cancer.
“Ovarian cancer does not have any specific symptoms,” Dr. Beth Karlan, a renowned gynecologic oncologist at UCLA Medical Center in Santa Monica, California, explained.
The symptoms of ovarian cancer may include the following, according to SurvivorNet experts.
- A feeling of bloating or fullness
- Pain in the pelvis or abdomen
- Nausea
- Vomiting
- Changes in bowel habits
WATCH: Fighting “Platinum Resistant” Ovarian Cancer
The Phase III ENGOT‑ov65/KEYNOTE‑B96 trial has shown great promise for platinum-resistant ovarian cancer, exploring adding immunotherapy, where the patient’s own immune cells are reengineered to fight cancer, to chemotherapy.
Dr. Thaker says, “We all know, checkpoint inhibitors have made a big splash in many cancers, and we have been trying so hard in ovarian cancer to try to use these immune checkpoint inhibitors…”
For patients whose tumors had a PD-L1 (a protein on the surface of some cancer cells) combined positive score, also called CPS (measuring how much PD-L1 a tumor expresses) of 1 or higher, treatment with pembrolizumab helped them go longer without cancer progression.
Their median progression-free survival was 8.3 months compared with 7.2 months for those who received a placebo, a difference that was statistically meaningful.
Dr. Robert Coleman, a gynecologic Oncologist at Texas Oncology in Houston, remarks, “We saw no new adverse events outside our expectations, nor did we see an acceleration of adverse events with the combination, including the triplet.”
Dr. Coleman explains, “In the platinum-resistant setting, I believe these will be favored regimens, so as a second-line therapy…Ultimately, cross-trial comparisons will drive some of the influence of those trials and the sequencing of therapy. This will likely be further augmented by biomarker expression, which we expect to be more robust as time goes on.”
WATCH: Using Imaging To Understand Your Ovarian Cancer
With regard to how this treatment may fit in with other systemic options, such as antibody drug conjugates, Dr. Chase explains, “The sequencing of the treatment is really dependent on the patient’s tumor biomarker profile. We will need to take into consideration: 1) biomarker profile, 2) prior toxicities, 3) patient’s performance status, and/or goals of care/treatment.”
Depending on these three factors, Dr. Chase says the appropriate treatment course is decided.
Dr. Chase adds that, “The sequencing of the treatment is really dependent on the patient’s tumor biomarker profile. We will need to take into consideration: biomarker profile, prior toxicities, patient’s performance status, and goals of treatment.” Depending on those three factors, doctors can best decide which treatment to pursue first.”
The Standard of Care for Ovarian Cancer
The standard of care for ovarian cancer patients is chemotherapy, which helps many patients reach remission.
WATCH: How to Manage Recurrence of Ovarian Cancer.
With recurrence (cancer returning) a strong possibility for this disease, especially in the later stages of ovarian cancer, certain drug treatments to deal with it are giving many women hope.
Maintenance therapy is continued treatment after the patient finishes their initial treatment. After an ovarian cancer patient completes a round of treatments, such as surgery and chemotherapy, her doctor may recommend some form of maintenance therapy to try to delay possible recurrence. Maintenance therapy can involve taking an oral pill called a PARP inhibitor every day after chemotherapy and can keep cancer in remission longer.
Genetic testing helps doctors determine the best maintenance therapy.
The type of treatment recommended for recurrence can depend on several factors:
- The period within which the cancer recurred
- The kind of chemotherapy the woman underwent in the past
- Side effects that came as a result of past treatments
- The length of time between the last treatment the woman underwent and the recurrence
- The specific mutations and molecular features of your cancer
What’s the Standard of Care for Ovarian Cancer Recurrence?
In many cases, platinum-based chemotherapy is an effective starting point for multiple cycles. As the cancer cells develop resistance, a different approach is explored between the patient and her care team.
Platinum Sensitivity vs. Resistance: What It Means for Treatment
- Platinum Sensitive: If a patient remains cancer-free for more than six months after platinum therapy, they’re considered platinum sensitive. This signals that the cancer is still responding, and doctors may continue using platinum-based drugs.
- Platinum Resistant: If recurrence occurs within six months, the cancer is classified as platinum resistant. In these cases, oncologists typically shift to alternative therapies tailored to overcome resistance.
Adjusting Chemotherapy Strategies
- Taxol (Paclitaxel): Commonly paired with platinum in initial treatment. For platinum-resistant patients, doctors may increase its frequency—administering it weekly instead of every three weeks.
- Other Options: Drugs like Gemzar (gemcitabine), Topotecan, and Doxil (liposomal doxorubicin) are often introduced, sometimes alongside Avastin (bevacizumab).
WATCH: A New Wave of Cancer Patients Using SurvivorNet’s My Health AI Tools For Support
Questions for Your Doctor
If you’ve been diagnosed with ovarian cancer and are looking for ways to better understand your disease and treatment options, here are some key questions to bring to your doctor.
You can also turn to SurvivorNet’s proprietary AI tool, “My Health Questions“, which helps patients and caregivers navigate a new diagnosis and prepare thoughtful, personalized questions for their care team.
- What type of ovarian cancer do I have?
- What stage is my cancer in?
- Do you recommend I get genetic testing for any gene mutations, such as the BRCA gene mutation?
- What initial treatment options do you recommend?
- What are the possible side effects of the recommended treatment, and how can they be coped with?
- Will insurance help cover my recommended treatment?
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