Lisa Hatfield:

Dr. Eskander, even with recent advancements, what are some of the biggest challenges still facing patients with gynecologic cancers? And how can patients face these challenges head-on in order to get the best possible care?

Dr. Ramez Eskander: T

he management of ovarian cancer and endometrial cancer has really dramatically changed over the last several years, principally because of discoveries of effective treatments. And that’s also motivated by our understanding of the molecular drivers of these cancers. We’re learning more and more about what abnormalities on a molecular or genetic level may exist in these cancers that can inform treatment. When we think about the challenges, despite these advancements, it’s really focused primarily on the fact that we still deal with patients whose disease recurs after treatment.

So, for example, with ovarian cancer, patients have surgery and chemotherapy at diagnosis. And sometimes you start with chemotherapy and do surgery, followed by additional chemotherapy. And sometimes you do surgery, followed by chemotherapy. And that’s a decision that’s made based on multiple factors. Patients receive treatment, as I alluded to in the front line. But unfortunately, despite the advances that we’ve made in molecular testing and in therapeutics, a large proportion of patients with advanced stage disease may develop disease recurrence.

And in the context of disease recurrence, it’s difficult to achieve prolonged remission. So what we deal with is disease that is in remission for a period of time after primary therapy. And if that ovarian cancer recurs, that subsequent remission may be shorter than the primary remission. Now we can go into a lot of detailed conversations about what drugs we’ve identified to be effective in different disease settings.

And as I alluded to, we’ve made significant strides, but we still need to do better and identify more effective treatments, both in the front-line and in the recurrent setting. And I am very passionate about clinical trials, which are essentially the foundation in which we’ve identified effective treatment strategies that are now FDA-approved. And so I really want to empower patients who are dealing with advanced stage ovarian cancer diagnosis, really understand what your options are, understand whether or not you’re eligible for clinical trials in the face of a disease recurrence. 

Some of these studies are limited to specific time intervals during therapy or limited based on the number of prior treatments. And you want to have options available for you. And those options are going to be available by asking questions at these different phases of your treatment so that you can make sure that you’re making the most informed decision. And it’s the same thing with endometrial cancer. A large proportion of our patients are diagnosed with early stage disease that is successfully managed with surgery. Sometimes radiation is required. There are patients with advanced stage disease who are needing chemotherapy.

And again, in those circumstances, in the face of disease recurrence, we need more effective treatment strategies. Recently, we’ve incorporated immunotherapy plus chemotherapy in the management of advanced stage or recurrent endometrial cancer patients. Progressing after that leaves us with more limited options for which there are many clinical trials that are active in accruing patients to offer more effective treatment opportunities.

So my [ACT]IVATION tip in the context of this question is be informed. Ask the right questions. Make sure that you understand your treatment options for every stage of your disease. It is never too early to talk to your clinician or provider about clinical trial opportunities. It is never too early to talk to your provider about what systemic or chemotherapeutic or targeted therapies are available to you if you do recur so that you can begin to make informed decisions and plan towards management of these cancers.

Lisa Hatfield:

And I have a quick follow-up question to that, because you mentioned clinical trials, and I know you’re an advocate for patients seeking a second opinion. So if a patient who lives in an area where maybe there are not a lot of clinical trials, would like more information on that. And I live in an area where we don’t have a lot of clinical trials, and I have a great local oncologist, and he does a great job. But if I wanted to reach out and ask a specialist like you, a one-time consult, maybe, what are my options for a clinical trial? Can a patient do that? Can they do like a one-time consult with a specialist?

Dr. Ramez Eskander:

That is an excellent question. There are specific rules around what providers can do. And I will venture to say I’m not an expert in those rules. I’ll give you a pragmatic example. There are rules that will not allow a provider to have a clinic visit virtually with someone who’s outside of their state. So, it does set some boundaries. Now, what I will say, and you alluded to this already, Lisa, which is talk to your provider. That is a very great starting point.

If you feel like you’re not making as much progress, there are really amazing advocacy organizations that have capacity to help patients make these decisions, whether it’s organizations regionally or if it’s national organizations. I will just say also if you go to clinicaltrials.gov, it’s a website that’s available to us all and you type in a diagnosis like ovarian cancer or endometrial cancer, and you search for Phase III clinical trials, it will provide you with contact information for sites and you can look by sites in your state or regionally.

And I know it can feel daunting to do that. And that’s part of the reason that I’m such a big advocate for second opinions is because when patients are being treated for a cancer diagnosis, searching for your own clinical trial without any real guidance can feel like information overload. So it’s for me, reach out to your primary provider, utilize any advocacy groups that are in your region or national advocacy groups, such as the Ovarian Cancer Research Alliance or the Clearity Foundation. There are many others that can help patients kind of navigate for ovarian cancer diagnosis or second opinions. And then do your homework and try to identify whether or not there’s a provider who might be of greater assistance.