Faced with a cancer that still leaves little respite, two names now come up in oncology meetings:
Keytruda And Lifyorli. These American treatments have just been detailed in the medical journal The Lancetwith results considered encouraging for a particularly feared form of ovarian cancer.
Ovarian cancer remains one of the deadliest in women, partly because it is often diagnosed late, when the disease has already spread to other organs. When the tumor becomes resistant to platinum chemotherapies, options become scarce, making any improvement in survival valuable and closely observed.
Platinum-resistant ovarian cancer: a common dead end
In its form platinum resistantovarian cancer reappears less than six months after a first course, the mainstay of treatment. According to the American Cancer Society, this disease has a terrible prognosis: approximately half of women die within 5 years of diagnosis, often made at a metastatic stage where surgery is no longer enough.
For these patients, doctors turn to other chemotherapies, such as paclitaxel combined or not with bevacizumab (Avastin ®), with responses that are often modest and short-lived. Every year, approximately 20,000 women in the United States, and at least as many in Europe, find themselves in this situation of platinum-resistant ovarian cancer.
Keytruda and Lifyorli: what the last two studies show
The first treatment, Keytruda
(pembrolizumab, Merck/MSD laboratory), is an immunotherapy. In the phase 3 KEYNOTE-B96 trial, it was administered with paclitaxel, with or without bevacizumab, in patients whose tumors expressed the PD-L1 protein. Compared to placebo, median survival increased from 14.0 to 18.2 months, or almost four months saved. “Pembrolizumab combined with weekly paclitaxel, with or without bevacizumab, significantly improved progression-free and overall survival in participants with platinum-resistant recurrent ovarian cancer who had received one or two prior systemic treatments, confirming the value of this regimen as a new treatment option for this population” conclude the authors.
The second medicine, Lifyorli (relacorilant, Corcept laboratory), blocks the glucocorticoid receptor, a pathway by which the hormone cortisol helps certain tumors resist chemotherapy. In the phase 3 ROSELLA trial, added to nab-paclitaxel, it reduced the risk of death by 35% and extended median survival from 11.9 to 16.0 months. “ROSELLA’s safety and efficacy results are remarkable,” said Alexander B. Olawaiye, professor at the University of Pittsburgh and principal investigator of the study.They give hope to patients and oncologists now that we have a new gold standard for this devastating and difficult-to-treat cancer“, cited by Corcept Therapeutics.
Both researches produced similar results with an average gain of 4 months in survival, although a direct comparison is impossible due to methodological differences.
What do Keytruda and Lifyorli change for French patients?
The scheme based on Keytruda has just been approved by the European Commission for platinum-resistant epithelial ovarian, fallopian tube or primary peritoneal cancers, in adults whose tumor expresses PD-L1 and who have already received one or two treatments. In France, its wide use will still depend on reimbursement decisions.
Earlier this year, these two treatments already received approval from the United States and the European Union for use against ovarian cancer resistant to platinum chemotherapies.