Lisa Hatfield:

So, Dr. Gamble, this is kind of a three-part question about clinical trials. Can you talk a little bit about ongoing clinical trials that are investigating novel therapies for advanced endometrial cancer? And then maybe talk a little bit about some promising or encouraging results that you’re seeing with trials? And last part of the question is, what do you want people living with endometrial cancer to know about clinical trials?  

Dr. Charlotte Gamble

I’m so glad you asked this question. This is such a valuable question and an area of a lot of interest that has improved over the past several years, not only about clinical trials and the real need to make sure that patients are aware of them and to ensure that these clinical trials represent the populations that we intend to serve as healthcare providers in the United States, but also specifically in the world of endometrial cancer. Really exciting, promising results that we’ve had over the past year, year-and-a-half specifically that address the very desperate need for novel therapeutics to treat patients who have endometrial cancer.

So, for example, two major trials were published last year, presented at international meetings, looking at the real improvement in overall survival, really increasing the length of time patients can live with endometrial cancer that leverage the use of drugs called immunotherapy. So things like dostarlimab-gxly (Jemperli) or pembrolizumab (Keytruda), these are generic names for immunotherapy drugs that work very well in some subsets of patients with endometrial cancer.

This is something, some survival benefits that we have never seen before in the endometrial cancer space and rarely seen in the gynecologic oncology space and is a definite marker of huge success in terms of extending the lifespan of patients who suffer from this challenging to treat understudied, underfunded disease. Endometrial cancer is actually one of the lowest funded studies in the National Cancer Institute at NIH.

And so having major trials come out over the past couple of years that really look at survival opportunities with the leveraged use of immunotherapies is something that is both exciting and invigorating to the field and hopefully can potentiate further funding from the NCI to be able to study this disease type. In terms of your question for what patients should know about, about ongoing trials, I think this dovetails into several of the points that we’ll discuss during this interview of making sure that patients are their own advocate and having an advocate nearby and with them at all of their appointments.

 So it’s really important to ask their subspecialists, their oncologists or their gynecologic oncologists about if there are any clinical trials that the patients are eligible for. A lot of this comes down to, has the patient undergone genetic testing or molecular sequencing that looks at the specific mutations in the cancer tissue that sometimes will make patients eligible for certain clinical trials or others? And other times it’s just understanding that what opportunities are available within the health system and outside the healthcare system in which the patient is seeking care.

A lot of times when we see that these trials that are published might not represent a racially diverse group of patients. Oftentimes it’s because of two reasons. One, patients aren’t even offered clinical trials, even if they are eligible. Or two, patients might be getting care at a health facility that doesn’t have access or the infrastructure to enroll them on these clinical trials that could be available, perhaps at a regionally nearby cancer center.

I oftentimes suggest to patients, please ask me questions about your molecular subtyping. Ask me questions about what clinical trials you might be available for. There is a significant amount of trust that the health system needs to earn back from patients to allow them the headspace to trust the health system again, given historical, massive, ethical issues and trials in the past and patients and their loved ones feeling that clinical trials just means a big experiment and they don’t want to be experimented on. And what I often say to that is really, you have to understand the details of the trial and the science going into it and make sure that your doctor has your best interests at heart. But oftentimes these trials hold significant promise.

And the reason that you might be eligible for them is that the trial drugs might work better than standard of care, certainly for endometrial cancer we’ve seen that in the two major trials that came out this year. So I think my activation tip for this question is really to be able to ask your doctor about if you’re eligible for clinical trials, what your cancer mutational or genetic code is that might make you eligible for certain clinical trials, and where those trials are offered, if it’s at the health system that you are seeking care, or if it’s at a nearby health system, if you’re able and willing to travel.