Understanding Antibody Drug Conjugates (ADCs) in Cervical Cancer
Dr. Abigail Zamorano of McGovern Medical School at UT Health Houston explains essential details about antibody drug conjugates (ADCs) for cervical cancer, including benefits, side effects, and their impact on quality of life. She discusses the importance of maintaining a strong patient-provider relationship, especially when navigating side effects like ocular issues and neuropathy, and emphasizes the role of regular eye exams.
[ACT]IVATION TIP
“…maintain close communication between provider and patient in order to share the experience of receiving an antibody drug conjugate.”
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Transcript:
Lisa Hatfield:
Dr. Zamorano, for patients and care partners learning about antibody drug conjugates for the first time, what key information should they know about the benefits, the potential side effects, and overall impact of these treatments on quality of life?
Dr. Abigail Zamorano:
So I think that you touched on something really important here, and that is quality of life. Antibody drug conjugates are really amazing. They’re a really great way of delivering really high doses of chemotherapy targeted to cancer cells. They do have side effects. One of the most significant side effects that we see with our ADCs in cervical cancer are ocular or eye side effects. So we work very closely with an ophthalmologist or an optometrist, some eye doctor, for very frequent exams during this treatment phase.
It’s really important for both the provider and the patient to understand how, what symptoms might result, when to bring up symptoms to the provider, the oncologist, or the eye doctor, and then what they can do to help prevent any symptoms from occurring. There’s a lot of eye drops involved. It can feel very tedious. But it’s important, because we want to both treat the cancer, but also maximize their quality of life.
There are other side effects that can come up, such as neuropathy, which is numbness and tingling of the hands or the feet. This can be very common with these ADCs. Again, it’s just important for a patient to know that this could be a possibility and then to bring it up with their provider so that they can talk about management strategies. Because ADCs are given in the recurrent disease setting, I do counsel patients that I have a lot of hope in ADCs and their ability to treat cancer, but this is still recurrent cancer, and I can’t take away that fact.
And so I am very hopeful that this treatment will work, and we will see that the cancer stabilizes or shrinks, goes away in the best scenario. But that might not happen. And I really want to maximize quality of life during this treatment process in the off chance that it’s not working and that these are the last, you know, months to years that this patient has.
I always keep that type of conversation open with my patients, because I want them to tell me really how they’re feeling in order to maximize quality of life. So my [ACT]IVATION tip for this question is to maintain close communication between provider and patient in order to share the experience of receiving an antibody drug conjugate. Both the experience of going through the various eye exams and using the eye drops to any symptoms that the patient is receiving and how the treatment is impacting their quality of life.
Lisa Hatfield:
So let’s say you have a patient that comes in, has recurrent cancer and is considering antibody drug conjugate. We might have a patient watching this who is going through this, trying to consider if they want to start this therapy. Can you explain from say day one, what that might look like?
They’re trying to organize their schedule with work and kids. What will that patient experience starting on the first day of that treatment and maybe the subsequent months of treatment? How often do they have to come in? How is that dose delivered? How much time will that take away from their work or their family? Can you explain that a little bit, what the course might look like?
Dr. Abigail Zamorano:
So this is delivered not unlike other more traditional chemotherapies. So it is delivered in an infusion suite with an infusion nurse with an oncologist available if there are any issues or questions. Similarly to when the patient has had chemotherapy for, they get labs beforehand to make sure that the chemotherapy is delivered at an appropriate dose and that they’re safe enough to receive the dose of chemotherapy. What is unique about receiving antibody drug conjugates is that the patient also does need a close relationship with an eye doctor. Either an optometrist or an ophthalmologist.
And so we and many other centers have developed very close relationships with local eye doctors to help facilitate this. It doesn’t need to be an ophthalmologist in the medical center. A lot of optometrists that could be local to the patient could see the patient, which are sometimes a little bit easier to get into. Also the company that provides the antibody drug conjugate has really great resources for providers that are, and also for patients that are just starting on this journey to help make it as easy, as seamless as possible. They provide a lot of literature, they are there to answer questions.
They have lists of eye doctors that other providers have worked with. So there, there are ways of making this a little bit easier for the patient. There are also start kits that the patient can receive that again help them navigate this a little bit better. In terms of the patient experience, it is an infusion every few weeks just like other chemotherapies. The typical feelings afterwards, there can be again some nausea, predominantly there’s fatigue afterwards. I do counsel patients that the first cycle is their learning experience.
They’re learning how, what symptoms to think about. They’re learning how the regimen of the eye drops, and then they’re learning how they’re going to feel on each day. The second cycle in my experience, working with patients is typically a little bit easier. And this is not unique to ADCs, this is any chemotherapy. Because they’ve already been through one cycle, they kind of know which days are going to be their low days and then which days are going to be their high days. Typically, they’re feeling kind of fatigued for about 10 days, and then they start to feel better.
So the second half of the treatment cycle, they’re more able to get back to their routine activities and can kind of reinsert themselves into their usual life. But every patient is different. Sometimes, they need a little bit of extra help, or sometimes patients are feeling really great. These ADCs are designed to be continued until toxicity or progression. And so patients are potentially on these for quite a long time depending on their response both cancer-wise and then other body side effect-wise. And so this could be something that someone is on for some time.
