What Clinical Trials Are Recruiting for Recurrent Ovarian Cancer?

00:00:00:00 – 00:00:35:21
Unknown
Hello and welcome to today’s webinar. What Clinical Trials Are Recruiting for Recurrent Ovarian Cancer? I’m Maggie Nicholas Alexander, the senior director of Gynecologic Cancer Patient Support and Education at SHARE. Before the presentation begins, I’d like to tell you a little bit about SHARE.

SHARE is a national nonprofit that supports, educates and empowers anyone who diagnosed with breast or gynecologic cancer and provides outreach to the general public about signs and symptoms.

00:00:35:23 – 00:00:52:20
Unknown
Because no one should have to face breast, ovarian, uterine, cervical or metastatic breast cancer alone. For more information about our upcoming webinars, support groups and helplines. Please visit our website at sharecancersupport.org

00:00:53:02 – 00:01:03:08
Unknown
And today’s program is extra special because it shares 10th annual Joan Sommer Educational program.

00:01:03:10 – 00:01:39:02
Unknown
Joan was a nurse diagnosed with stage four ovarian cancer at the birth of her third child. She lived with ovarian cancer for 22 years with her natural right humor and intelligence. Joan and her family inspire the share community. The summer legacy continues with programs like this. We’re very excited to have Dr. Cohen joining us as today’s speaker. And now I’d like to hand it over to you, Dr. Cohen, to introduce yourself.

00:01:39:07 – 00:02:00:14
Unknown
Thank you very much, Maggie. And it’s so wonderful to spend the evening with you discussing the clinical trial opportunities for recurrent ovarian cancer. I want to thank share first for all of it, all that you do for our patients and their families. Really grateful for the efforts of the entire organization. I also want to say thank you to Ms..

00:02:00:14 – 00:02:25:04
Unknown
Sommer and her family for making this possible. Truly a wonderful opportunity for me to be here and and I’m so excited to get to to talk to everyone about different research opportunities for patients who are impacted by ovarian cancer. I’m based in Irvine, California, at City of Hope, Orange County. I’m the medical director for gynecologic Cancer at City Pope Orange County.

00:02:25:06 – 00:02:59:00
Unknown
We are in the process of building a brand new billion dollar hospital here in Orange County designed specifically for cancer patients. And we’re so excited to be a part of that and really excited about the research opportunities that we’re going to discuss today. I spent many years at UCLA and I grew up in Southern California, so it’s great to be practicing in the place that I grew up in and help hopefully improve the care for patients that are impacted by gynecologic cancer in Southern California, City of Hope has a national footprint, and I’ll talk more about that at the end, because I think that is important when we talk about clinical trial opportunities to know

00:02:59:00 – 00:03:20:05
Unknown
that there are networks out there that you can reach out to and and whether you live in Georgia or Illinois or Arizona, you know, potentially be able to meet with a specialist who can give you insight into those trials. So with that, we’ll move to the next slide, please. And what we’re going to talk about today is going to be a summary of available clinical trials.

00:03:20:05 – 00:03:42:11
Unknown
It’s really impossible in about 40 minutes to go into every in-depth trial available across the country. So I picked a certain group of trials to be representative of what is available for you with the goal that if there is something that you think you may be interested in, or you have a family member who may be interested in, or if you’re watching for them, that you then can target that and I’m going to give you some resources and where to go to find those trials.

00:03:42:13 – 00:04:02:24
Unknown
Again, whether you live in upstate New York or Idaho or New Mexico or California, because I think those tools are going to be the most important part of tonight’s talk, not necessarily the exact trial itself, but I will go through specific trials and I’ve written down I was talking to Maggie earlier in Victoria. I’ve written down as many of the states as I can give you a sense of where these trials may be opened for you.

00:04:03:01 – 00:04:25:11
Unknown
But but first and foremost, I just wanted to discuss the things to think about when you’re perhaps a patient or family member with a patient dealing with recurrent ovarian cancer, you want to have your medical team and when they talk to you about recurrent cancer, it’s really important to understand how they’ve defined that. Do they believe you have recurrent cancer based on a blood test to see a 1 to 5, which is a protein in the blood?

00:04:25:13 – 00:04:44:06
Unknown
Do they believe it’s based on imaging, a CT scan or a PET scan or an MRI? Do they believe you have recurrence based on a physical exam, finding perhaps a mass that they can feel in your abdomen? And then do you need a biopsy? And that comes up as a question. And you may think it’s obvious, of course, we’re going to get a biopsy, but your doctor may not think about that.

00:04:44:06 – 00:04:58:05
Unknown
Your doctor may say, hey, you have a history of ovarian cancer. I see a mass. I think this is a recurrence. We’re going to treat you as such. But there can be a role for getting a biopsy depending on if there’s a concern for a second cancer or even a new tumor analysis, which we’ll talk about as well.

00:04:58:07 – 00:05:15:10
Unknown
You want to address Do you need more imaging? Have you just had a CT scan of your abdomen, pelvis? Do we know what’s happening in your chest? Maybe there’s an equivocal finding. Maybe there’s a lymph node that’s one centimeter. It’s a little bit bigger than it was before. You need a PET scan. Is that going to be additive to the way that you approach things?

00:05:15:12 – 00:05:31:01
Unknown
And these are questions I talk about with my patients all the time, whether we should do more imaging or not. So I would encourage you to interact and ask this of your providers. We know that patients do better when you have a multidisciplinary team working with you, and if you have ovarian cancer, you should have a gynecologic oncologist involved in your care.

00:05:31:03 – 00:05:56:18
Unknown
We know that most patients actually get their treatments through a medical oncologist. A medical oncologist is an internal medicine doctor who specializes in cancer care. They do a special training called a medical oncology or hematology oncology Fellowship. They’re board certified. They’re excellent and you certainly will benefit from their care. But we have very clear data that for ovarian cancer patients, they do better when they have a gynecologic oncologist working with them in partnership with medical oncology often.

00:05:56:20 – 00:06:16:04
Unknown
But you should be seeing someone like me who is able to give you guidance as a board certified gynecologic oncologist. You also want to ask, is your case being presented on a tumor board? Even if it’s not a comprehensive cancer center, Most hospitals or cancer centers now have a tumor board. It’s basically a meeting where radiation colleges, medical oncologist, gynecological colleges all get together.

00:06:16:04 – 00:06:33:08
Unknown
And we talk about you. We talk about the imaging, we talk about your treatment history, we review the pathology. And you should really ask, is my case going to be presented? Do you feel my case should be presented? Because every now and then a new idea pops up because you have 12 to 20 cancer doctors, all thinking about you.

00:06:33:10 – 00:07:03:12
Unknown
And we know that that can be beneficial for the patient thinking opinion, if you can, at a National Comprehensive cancer center. It’s called Ed and can is basically a group of cancer centers that meet certain guidelines. They’ve been basically approved by the government because they have these metrics where wherever you live, if you can get within driving distance to an NCCN cancer center, if your insurance allows, seek it out, get an opinion there, because you will find that you’ll have more resources and opportunities at that cancer center, more likely perhaps, than maybe where you’re being seen currently.

00:07:03:14 – 00:07:23:07
Unknown
And just know there’s not always one answer to what to do next. This is an art. It is a chronic condition when cancer comes back and we have to be cognizant of both your wishes, what’s available. So there’s going to be more than one option. And that’s why getting another opinion is okay, because you may hear something different that could spark your interest and maybe you pursue a different path with treatment.

00:07:23:09 – 00:07:42:17
Unknown
Next slide, please. So when we talk about different types of DNA testing, it’s really important to understand there’s DNA that you inherit from your mom and your dad, and there’s DNA inherent in the tumor itself, the DNA that you inherit from your mom and your daughters in every cell in your body. It’s everywhere. It’s your blueprint to your body.

00:07:42:18 – 00:08:03:05
Unknown
The DNA in the tumor is a spontaneous mutation that can happen. And that’s most of the time how cancer forms a spontaneous mishap of the blueprint. As the cells are dividing, we as cancer doctors want to know both the blueprint of the DNA from your mom and your dad, as well as the blueprint from the tumor itself, because it has implications for what drugs you may respond to.

00:08:03:07 – 00:08:23:12
Unknown
So when you’re meeting with your cancer team, ask, Hey, I’ve, I had DNA testing of of the germline, which is the DNA from my family. And have I had the recent testing of the tumor, which is the somatic testing because again, it has implications for what drugs you may respond to. Next slide, please. Things that you should also ask, where is the tumor located?

00:08:23:15 – 00:08:40:17
Unknown
Is it in one spot? Is it in many spots? Is it in my lung? Is it in my abdomen? Is in my pelvis? What type of tumor do we we’re dealing with? Ovarian cancer is a group of diseases. In many ways. It’s not just one tumor type. And that has implications for the clinical trials that you may qualify for in the setting of recurrent ovarian cancer.

00:08:40:19 – 00:08:56:09
Unknown
And we’ll I’ll show this slide in a little bit that shows the different types. Again, the genetic testing. Did I get testing of my DNA from my mom and my dad? That’s a blood test and saliva test, one or the other. Have you sent my tumor for testing? Do we have an updated molecular signature to know if my tumor will respond to other drugs?

00:08:56:11 – 00:09:09:16
Unknown
Dr. Cohen, what about surgery? Is this lesion? If it’s just one location, take me to the O.R.. Let’s cut it out. Let’s do something different. And we do that. We do that at City of Hope. We do that other cancer centers do that. And there can be a role for surgery, but it has to be in the right setting.

00:09:09:16 – 00:09:29:23
Unknown
It’s not for everybody. Has the tumor been tested for something called folate receptor alpha? This is a new target as far as treatment. It’s been FDA approved now for a drug called nerve protection, absorbed TANZI in the setting of recurrent ovarian cancer. Your tumor should be tested for folate receptor alpha. If you have recurrent epithelial ovarian cancer as your tumor didn’t have been tested.

00:09:29:23 – 00:09:50:24
Unknown
For her to H.E.R to this is a target that was often used in breast cancer and we now use it in ovarian cancer as well. And if your tumors positive for her too, you probably have some good options with drugs that target that receptor as your tumor been tested for estrogen receptor progesterone status, is your tumor sensitive to hormones, e r pressures and receptor progesterone receptor?

00:09:51:01 – 00:10:09:14
Unknown
The response rates may or may not be as good as standard chemotherapy, but for patients in the right setting, hormonal therapy just like in breast cancer, can have an option. And then the most important question, which is what we’re talking about today, is, Dr. Cohen, do you have a clinical trial that I will qualify for? And if so, what are the benefits and disadvantages of that trial?

00:10:09:16 – 00:10:39:01
Unknown
Next slide, please. Different types of ovarian cancer require different trials and they require different expertise. Sometimes they’re just like colors of the rainbow or colors or crayons. There are different types of ovarian cancer. There’s low grade serious ovarian cancer, clear cell tumors. ARCENEAUX Sarcomas are endometrium. Stromal sarcoma is granulomas in cell tumors of the ovary. The one that I want to make caution of is if someone tells you that you have you since ovarian cancer, that’s a diagnosis of exclusion.

00:10:39:03 – 00:10:58:17
Unknown
Usually mucin as tumors start in the GI tract and they spread to the ovary. And so your doctor needs to have done a formal workup, including likely removing the appendix and doing an EGD and colonoscopy. An EGD is a camera looking at the stomach and the upper upper intestine to make sure this is not a cancer coming from the intestine because that has different treatment options.

00:10:58:19 – 00:11:17:15
Unknown
Instead of a primary use of this tumor of the over meaning, instead of a tumor that truly arose from the ovary. And then endometrial tumors of the ovaries. These are all different types. I’m sure the people who are listening are wonderful. Patients are thinking, what type is mine or you know exactly what type yours is. But you should know that because it has implications for your clinical trial enrollment possibilities.

00:11:17:17 – 00:11:41:01
Unknown
Next slide, please. Other things that are important to know when you’re talking about recurrent ovarian cancer are your prior treatments. When we as physicians are making decisions with you about the next treatment? The one of the most important things is, well, what treatment have you been on? And when was the last time that you received it? And that has implications for both clinical trials and other drugs that you may qualify for.

00:11:41:03 – 00:11:58:03
Unknown
The other thing is that, again, the subtype of ovarian cancer is is my tumor high grade? Is it low grade? Meaning does it look like it’s dividing slowly or quickly under the microscope? Is this a serious tumor? The most common form of epithelial ovarian cancer is high grade serous? Is it an enemy truly tumor or is it a clear cell tumor?

00:11:58:05 – 00:12:21:18
Unknown
And then is the tumor considered platinum resistant or refractory carboplatin? And cisplatin are the two most common chemotherapy drugs we use for ovarian cancer, and we use it in the recurrent setting as well. But if the tumor grows within six months of receiving these drugs, we’re less likely to use that same chemotherapy because we think it may not be as effective moving forward if the tumor grows while you’re receiving carboplatin or cisplatin.

00:12:21:18 – 00:12:37:14
Unknown
We call it refractory, meaning that we really don’t think it’s going to respond to that drug moving forward. And you want to know this yourself because it has implications for what drugs you can qualify for, for trials, and also what we can use in the future to treat you outside of a clinical trial. Have you received a drug called bevacizumab?

00:12:37:14 – 00:12:58:16
Unknown
I’m guessing most people on this webinar side or who are going to watch this separately have received bevacizumab. If they started with stage three or stage four ovarian cancer, that has implications because some trials will not let you enroll unless you’ve already been on bevacizumab. Have you received a PARP inhibitor? PARP inhibitors are oral pills and we used to give these in the recurrent setting and we moved it up to the initial setting.

00:12:58:18 – 00:13:19:07
Unknown
Many trials will not allow you to enroll if you’re BRCA positive in the tumor or the DNA or the tumor or the DNA of your parents, unless you’ve received a PARP inhibitor already and you should have received a PARP inhibitor, or you should if you have an if you qualify for that based on your genetic makeup. And then there are other conditions which make it hard to qualify for trials based on the type of drug.

00:13:19:07 – 00:13:39:12
Unknown
So people who are dealing with with kidney failure, liver failure, if they have a second cancer that we’re treating actively, it can be hard to enroll in trial because they they try to limit out, unfortunately, to know if the drug is working based on on your medical history. If you have a second cancer, it may be hard to know which is what’s working and what’s not working If the two cancers are growing at the same time.

00:13:39:14 – 00:14:02:06
Unknown
If you have autoimmune disease, sometimes immunotherapy drugs can be dangerous for you. So we have to be careful with that. Also, how many prior prior lines of treatment have you received? Trials tend to limit out patients who have had multiple prior lines of treatment, meaning they have multiple treatments already because the trial pharma companies that are sponsoring this know that drugs are harder to show benefit if you’ve already received a lot of treatment.

00:14:02:08 – 00:14:22:09
Unknown
When I talk to patients about ovarian cancer, I describe it as a chronic condition. Here in California. Magic Johnson is a well known Laker, and he was diagnosed to HIV in the early nineties. We didn’t think Magic Johnson was going to live a long time, but he’s living a long, happy, healthy life because we made HIV chronic with antiretroviral drugs and that’s how I view ovarian cancer.

00:14:22:09 – 00:14:39:00
Unknown
Now for the patients where it does recur, which is sadly most, we’re not looking at cure, but we’re looking at remission or we’re looking at keeping the cancer at a low volume. And that’s really the goal. Can we make this chronic and keep you on a drug and adjust with new drugs if we need to? We can. But the number of prior lines impacts clinical trial enrollment.

00:14:39:00 – 00:15:06:05
Unknown
So sometimes it actually makes sense to enroll in a trial earlier If there’s an exciting drug we think you’re going to respond to and then use the standard drugs later on if we need them. And then other things are significant. Neuropathy or vision changes may impact your trial enrollment and then how independent you are. If you’re not able to eat or drink on your own, if you’re not able to walk on your own, if you’re not having you able to use the bathroom normally, you may not be able to enroll in a trial because these drugs can make you very sick.

00:15:06:07 – 00:15:35:12
Unknown
Next, next slide, please. I mentioned that different types of ovarian cancer and it is a misnomer to call this one cancer. It’s also a misnomer to call this just ovarian cancer. We actually know that most ovarian cancers, especially this serious subtype, actually come from the fallopian tube, the distal end of the fallopian tubes. So for what we what we were calling ovarian cancer for years and actually probably fallopian tube cancer that being said, the three main categories of ovarian cancer are epithelial germ cell and sex cord stromal.

00:15:35:14 – 00:15:56:12
Unknown
And on the slide you can see the differences. The most common type is epithelial ovarian cancer. But just know there are trials out there for all patients with these different subtypes. It’s a matter of finding the right cancer center that has these trials for you. That’s why it’s important to talk to your medical team about the specific cancer type you have and whether you’ve had molecular testing.

00:15:56:13 – 00:16:20:04
Unknown
And again, is this an ovarian cancer or do we think it came from the fallopian tube or the peritoneal cavity? We do treat them similarly, but sometimes it has implications for the tumor treatment approach in the tumor testing based on where it originated. Next slide, please. There are different types of clinical trials, and I know for this group is logging in, I’m guessing many of you have already become familiar with some of these these these terms.

00:16:20:06 – 00:16:37:01
Unknown
But phase one is an early trial. It means that the drug is really new. We’re excited about the drug, but we haven’t really shown how safe it is. And the benefit of these trials is that you get exposed to the latest and greatest drugs may be potentially lifesavers, but it’s a little bit more high risk, high reward because we don’t know if these drugs are going to work.

00:16:37:06 – 00:16:55:03
Unknown
We also don’t know all the side effects, but you can get exposure to some really unique, exciting drugs depending on on your how well you feel and what you’re willing to undergo. These drug trials are drugs that have been tested already. There’s some data on them, and we’re really trying to see exactly how well they work. What’s the response rates?

00:16:55:03 – 00:17:11:09
Unknown
And and and these are the more common trials for that, where you’re going to see cancer centers that are not comprehensive in cancer centers. Phase three are the bigger trials and these are the trials that you’re going to probably be able to do closer to home in the community setting. These are trials that are more vetted. They’ve already been through the initial testing.

00:17:11:10 – 00:17:30:12
Unknown
And now we’re trying to see again how safe it is in the general population and comparing it to the standard treatment arm, meaning that the standard chemotherapy we would use otherwise involves randomization, where you may be randomized to the standard of care drug like Carboplatin and Taxol, or a new investigative drug, which is the study drug. And the last phase is phase four.

00:17:30:12 – 00:17:50:08
Unknown
These are the final phase. This is where the drug is pretty much already FDA approved. It’s shown to have benefit. But now they’re doing the trials to see how much risk there is for the larger population. When we when we look at patients of different backgrounds, is there any is there any safety signal that we missed? And those are call phase for next slide, please.

00:17:50:10 – 00:18:13:07
Unknown
So why do a trial, Dr. Cohen? Why why would I experiment? Why would I put something in my body that hasn’t been proved thousands of times over? Why would I take that risk? Why would I want to do that? As a cancer patient, I’m already dealing with the challenges of the cancer itself. Well, this is why you may gain access to a new lifesaving drug that you would otherwise get, because the insurance companies are not going to pay for a drug that’s not FDA approved.

00:18:13:09 – 00:18:32:01
Unknown
It’s even hard to get them to pay for drugs that are FDA approved. You’ll be answering important questions for other women who are dealing with this cancer in the future. You’re going to get extra attention when you’re on a trial. You’re watched like a hawk. You’ve got a clinical trials nurse, maybe, too. You’ve got a research coordinator. It’s a little bit more involved because you have to answer questions about how you feel.

00:18:32:01 – 00:18:46:05
Unknown
You do have to come in more for blood draws, but they’re not going to miss something in that trial because the whole point of the trial is to monitor you very closely for all these different things. So if you’re someone who likes the idea of a little bit closer follow up with the team. A trial is a good way to do that.

00:18:46:07 – 00:19:03:02
Unknown
And then you may gain imported from Asian about your tumor. I mentioned the tumor testing. Sometimes we do different testing that’s not approved by the insurance. If you enroll in a trial and we may figure out that your tumor responds to certain drugs, we may not have otherwise known simply because of the testing needed to enroll on the trial itself.

00:19:03:04 – 00:19:28:01
Unknown
Next slide, please. So the remember, I mentioned the tools, the tools that that I want you to take away from this as far as finding the right trial, This slide is the tools share is an amazing organization. So go to share cancer support, Speak out. Maggie and Victoria in the team. They will help guide you if you need as far as maybe trial opportunities or at least get you to the right cancer center that can.

00:19:28:03 – 00:19:48:02
Unknown
ClinicalTrials.gov is the most important website I’m going to say tonight as far as finding a trial, clinicaltrials.gov, it’s a publicly available website. Every trial in the U.S. has to enroll on this on this website, you go to the website, you type in ovarian cancer, you type in trials, and then maybe your state that you live in and it will generate a list of those trials.

00:19:48:04 – 00:20:05:11
Unknown
And so that’s where you can start. So clinicaltrials.gov, check it out tonight if you’re interested in a trial and we’ll tell you if you live in Florida, what trials are in Florida for ovarian cancer? If you live in Idaho, what trials are there for ovarian cancer, clinicaltrials.gov, other websites that are really helpful, other great organizations, and share is amazing.

00:20:05:11 – 00:20:23:23
Unknown
We’re also fortunate that we have a lot of other partner organizations. The Foundation for Women’s Cancer, the Cindy Roman Ovarian Cancer Foundation, Claroty Foundation for Sharing the NCC, and I mentioned the Society of Gynecologic Ecology, which I’m a part of, and you can see the list here. So a wonderful list. Take this for what it’s worth, these are great organizations.

00:20:24:00 – 00:20:43:24
Unknown
Start with share and then clinicaltrials.gov and go from there. Next slide, please. There are different types of treatment for ovarian cancer and ovarian cancer. I have patients who come in and say, Dr. Colon, I don’t want that that poison in my body. I only want to go with natural supplements. That’s my my preference. And I’m okay with that.

00:20:44:01 – 00:21:00:20
Unknown
And I want you to know that as a as a doctor, while I have to I have to follow the clinical evidence. I have to hold myself to a higher standard with what’s available to recommend to you based on standard clinical trials. I also know that patients there’s there’s other things out there and that’s okay. We want to partner with you.

00:21:00:22 – 00:21:22:06
Unknown
But but just know for an example, Taxol, which is a chemotherapy, it comes from a tree. That’s Taxol. What they’re collecting on that on that that screen. Okay. So Taxol is actually the most maybe the most basic natural product that we have, but it’s a chemotherapy that we’ve made from trees. That being said, there’s chemotherapy, there’s targeted agents, there’s hormonal therapies, there’s immunotherapies, there’s surgery.

00:21:22:06 – 00:21:38:03
Unknown
I’m fortunate that I get to do surgeries and do systemic treatments with clinical trials. Gynecologic colleges are very unique. We’re one of the few cancer fields where you get to do both, which is amazing. And that’s what many of us do. Some of us only do surgery. Some of us only do systemic treatments. I’m fortunate that I get to do both for my patients.

00:21:38:05 – 00:21:57:13
Unknown
There’s radiation, there’s integrative medicine. We’re fortunate. City Pope. We have an integrative medicine program run by one of our wonderful medical oncologist, Dr. Richard Lee. So I love I love when patients get to me with him and talk to him about integrative medicine because they can work together. They’re not mutually exclusive. Next slide, please. This is a summary slide.

00:21:57:13 – 00:22:18:23
Unknown
I’m not I’m not going to go through all these drugs, but this is basically our armamentarium that’s FDA approved or are approved by the insurance for platinum sensitive disease, meaning that the cancer should respond to Carboplatin or Taxol, I’m sorry, carboplatin and cisplatin, because it’s more than been more than six months since you receive that chemotherapy. And if the cancer returns more than six months later, we want to include platinum in your treatment arm.

00:22:19:00 – 00:22:39:18
Unknown
And the exciting thing is this is growing by the month. And so now that org provides this list for patients and for providers. And so this is a really good place to go. Look, if you’re looking for the names of drugs. Next slide, please. Platinum resistant disease. Platinum resistant disease is basically disease that’s recurred within six months of the last platinum.

00:22:39:20 – 00:22:53:08
Unknown
And it’s a it’s a disease process that’s a little bit tougher to treat because the platinum is our go to initially. But you can see the list is growing and that’s why this slide is up is to show you that we do have options. Even if you don’t do a clinical trial. There are there are new options out there.

00:22:53:08 – 00:23:15:05
Unknown
And this try this this list is growing by a third within the last year or two. So we’re really excited about how quickly these options are changing. Next slide, please. I mentioned PARP inhibitors. PARP inhibitors. Every every person with ovarian cancer epithelial should ask their doctor, Dr. Cohen and team should I have been on a PARP inhibitor? Dr. Cohen And team, Why did I not get a PARP inhibitor part of it?

00:23:15:05 – 00:23:32:08
Unknown
It was our oral pills. About 50% of patients will benefit from a PARP inhibitor, and we know that the data says that you need to do the right genetic testing to figure that out. The FDA has come back in recent years based on safety profiles and said that you really shouldn’t use PARP inhibitors in the setting of recurrent ovarian cancer and the data does support that.

00:23:32:08 – 00:23:49:20
Unknown
It’s better used in the upfront setting in your initial treatment course. But if you’re someone who did not receive a PARP inhibitor when you were treated at your initial diagnosis or after chemotherapy, you still may benefit from a PARP inhibitor. And that’s why this slide is here. Talk to your doctor about this. If you’ve never received a PARP inhibitor, there could potentially still be a role for it.

00:23:49:22 – 00:24:10:17
Unknown
But it’s becoming harder to justify that because there are safety signals now that say in the setting of recurrent cancer, PARP inhibitors may not be the best choice really if you have a BRCA mutation in your genes, your mom, your mom and dad genes or your tumor genes and you’ve truly never received department batter, there probably still is going to be a role for for you in the recurrent setting aside of that patient population.

00:24:10:17 – 00:24:38:07
Unknown
It really probably should be used only in the upfront setting. Next slide, please. And PARP inhibitors function. They basically are are drugs that stop cells, cancer cells from saving themselves. They they they are often used in combination with a drug called bevacizumab bevacizumab blocks new blood vessel growth. PARP inhibitors are again really good drugs. They should be used in the upfront setting and if they’re use them that recurrent setting, they have a role but they have side effects as well.

00:24:38:07 – 00:24:55:08
Unknown
The most common ones are fatigue, nausea and, and constipation and, and that usually gets better in addition to some bone marrow changes that usually get better after the first two or three months. But but you’ve got to get through the first two or three months to really get there. As far as the side effects improving. Next slide, please.

00:24:55:10 – 00:25:21:05
Unknown
Antibody drug conjugates represent the latest and greatest. They represent really a newfound treatment paradigm for our patients with recurrent ovarian cancer. And the way I describe them is is essentially Trojan horses or smart bombs. They’re they’re chemotherapy, which is a warhead. And I don’t really like that term, but that’s that’s you know, it’s it’s linked as a warhead, so to speak, to a linker that degrades and a receptor that binds to certain cells in your body.

00:25:21:05 – 00:25:40:03
Unknown
So the antibody receptor has the linker and the warhead. And this is a better way to give chemotherapy because again, as a as a Trojan horse, as a smart bomb, it tries to find the exact cells. It wants to attack chemotherapy when given in the IB form or even the old form attacks many cancer cells that that don’t express receptors consistent with cancer.

00:25:40:09 – 00:25:59:08
Unknown
This is trying to overcome that and be more targeted. Next slide, please. Antibody drug conjugates One of the real success stories in the last year or two has been HER2 targeting antibodies. The HER2 again I mentioned is the receptor. It’s found in breast cancer, but we do know that it’s also expressed in ovarian cancer and we now have some really good drugs that target this.

00:25:59:08 – 00:26:14:15
Unknown
One of them is called trastuzumab directly. Can if you have recurrent ovarian cancer and you’re listening to this, ask your doctor, have you been tested for her to both the on the slides how they look under the microscope and in the DNA of the cell? Because if you express HER2 at a high rate, you should be on this drug.

00:26:14:19 – 00:26:41:01
Unknown
Her trastuzumab directly can be because the response rates are really very, very good. Next slide, please. Another target is fully receptor one, f0 LR one and we now have a phase three trial that was published. Dr. Katie Moore was the lead author. The study is called Mirasol, and it showed a survival benefit. The first time we’ve seen a survival benefit with one drug in the setting of recurrent ovarian cancer, platinum resistant in a decade.

00:26:41:03 – 00:26:57:21
Unknown
And that that’s a game changer if you express fully receptor in your tumor. This is a drug that’s now FDA approved merit text maps, urban financing. You don’t need to be on a clinical trial for this. You can receive this now. So please talk to your doctors about this. If you if you have recurrent epithelium ovarian cancer, ask your doctor what your folate receptor alpha expression is.

00:26:58:02 – 00:27:19:02
Unknown
And if it’s more than 75%, you can get the FDA approved drug here on its own. It’s called remember text maps, urban taxi trade name here. Next slide, please. So again, the first ADC or novel treatment to show survival benefit for platinum resistant ovarian cancer. And it’s the new standard of care for patients who have folate receptor alpha positive platinum resistant disease.

00:27:19:04 – 00:27:44:24
Unknown
Next slide, please. So now we’re going to transition to trials that are currently open, are proving again, this is not there’s just no way to do an exhaustive list here for you that without talking really, really fast or perhaps going over time. So I’ve tried to pick some trials that highlight the new exciting pathways for per ovary, platinum resistant platinum sensitive ovarian cancer, and maybe maybe where you can see these trials.

00:27:45:01 – 00:28:04:11
Unknown
So glorious is a Phase three study. So this is one that has more data to it. It’s a larger study now. It’s in the setting of platinum sensitive recurrence, and that’s what the red line is, their try to say. So again, patients that are responding to platinum, where your last chemotherapy was more than six months ago, if you test positive for fully receptor alpha currently, you could only receive it if your tumor was platinum resistant.

00:28:04:17 – 00:28:20:24
Unknown
But this trial is looking at whether women who are platinum sensitive would also benefit from this drug. So basically, if you enroll, you finish your standard of care drug treatment, which is what I would do with you or another provider, and then you would get randomized to receiving the drug myrbetriq snaps, sort of enhancing with or without bevacizumab.

00:28:21:01 – 00:28:41:08
Unknown
And so this drug, this trial is going to answer the question. The women who have folate receptor alpha positive tumor, will they get will they get more benefit by moving this drug into the second recurrence versus waiting for this to recur after the tumor is already platinum resistant or the first recurrence? I’m sorry. Next slide, please. And that trial is open in many locations.

00:28:41:08 – 00:29:02:17
Unknown
So I think if you’re in New York, Florida, California, Illinois, really any major comprehensive cancer center that’s NCCN designated, that trial may be open. So if you go to the clinicaltrials.gov and type in Glorioso under search, it’s going to pop up and tell you where the where that whether that trial is in your state and if it’s within driving distance.

00:29:02:19 – 00:29:25:07
Unknown
Another trial, which I’m really excited about, is something called a phase one trial one because an earlier study, as Searle asserted, is an ATR inhibitor. An ATR inhibitor is a drug that targets the ATR kinase in cells, and it’s now being given in this study in combination with a new PARP inhibitor. So a PARP inhibitor that’s not publicly available on the market.

00:29:25:09 – 00:29:53:03
Unknown
It’s designed really for patients who may be platinum sensitive. Unfortunately, if you if there’s Mucin use in its component to the tumor or it’s a low grade histology or a sarcoma component, the trial would exclude the patients. It’s really designed for patients who are going to be likely beneficially receiving a PARP inhibitor. So those who are positive homologous recombination, deficient, positive or have a red 51 C or D mutation or poor B mutation or BRCA mutation.

00:29:53:05 – 00:30:12:19
Unknown
And again, it allows for patients who are high grade serious or endemic, right histology, but not using this or sarcoma test. It’s open in California, it’s opened in Boston, it’s opened in Charlotte, it’s opened in Philadelphia. And so really, again, clinical trials that will tell you exactly where it is. And again, I one of the things I love about City Pop is I’m fortunate that we have a lot of trials.

00:30:12:19 – 00:30:34:06
Unknown
And so oftentimes it’s the rare patient that we won’t have a trial that that you would qualify for. Next slide, please. So Georgi threes. So Georgi stands for the Gynecological College Group. The Gynecological College group is a larger organization that I’m a part of that we all it’s a cooperative group, meaning that doctors like me work with the trials through this.

00:30:34:08 – 00:30:55:21
Unknown
The Gynecologic Ecology Working Group. This is a phase three trial. This is for platinum resistant patients. This is a very exciting trial in that it has a virus in it. So there are some trials that have genetically engineered viruses that we use as doctors to see if we can improve response rates to standard chemotherapy. This trial is a good trial in that it has no maximum limit.

00:30:55:22 – 00:31:18:05
Unknown
So whether you’ve had five lines of chemotherapy or two lines of chemotherapy or ten lines of chemotherapy, you can enroll in this trial. And that’s really important because some patients who’ve had a lot of prior trials, adjusted lines of treatment are limited by what’s available. But again, if you’re a patient who has ovarian cancer epithelial and you’ve had a certain number of trial lines of treatment, whether it’s two or six or ten, it does not matter.

00:31:18:07 – 00:31:38:23
Unknown
You can enroll in this study, but you have to have had at least three prior lines. And it’s very lenient as far as the different histologic subtypes, high grade serous carcinoma sarcoma, clear cell, these are subtypes that you can enroll in. This study does not allow for use this low grade or small cell. The you must have received bevacizumab previously.

00:31:38:23 – 00:32:01:16
Unknown
It must be platinum resistant or refractory disease and it’s an infusion. So a doctor like me would put a port laparoscopically into your abdominal cavity and you get admitted to the hospital and you get an infusion of this virus vector into the abdomen potentially. And then you get standard chemotherapy after seeing if you get a better response rate with the standard chemo therapy, that’s if you’re randomized to the virus arm.

00:32:01:18 – 00:32:20:12
Unknown
The other option is that you may get randomized to the standard of care, which is a good option to many, that if you are not enrolled in the trial, you would still get the best available drug that that’s available for you outside of a trial, which is why I like this study, because you’re going to get the standard of care or you’re going to get this exciting new virus that may or may not improve your response rates to chemotherapy.

00:32:20:14 – 00:32:46:22
Unknown
This trial is opened in Alabama, Arizona, California, Florida, Maryland, Missouri, Michigan, Nevada, North Carolina, Ohio, Oklahoma, Tennessee, Washington, and I think a couple of others. Next slide, please. This is an up and coming trial. So this trial is open in in Japan and China right now, but it is coming to the US. So I bring it up because it’s going to be hot off the presses for you soon.

00:32:47:03 – 00:33:13:19
Unknown
It’s a phase two three trial is opened again through the Gynecologic Ecology Group. It’s another antibody drug conjugate. It’s targeting something called CD8 sticks and the name is a challenging name. It’s rallied to tag direct again and it’s going to be for patients with high grade serious or high grade and to Metroid carcinoma it does a prescreening biopsy, which means that radiology would have to do a biopsy with you and you have to, if it’s received just one prior line of therapy.

00:33:13:20 – 00:33:35:20
Unknown
And you could have also received the drug myrbetriq, some absorbent TANSY, which is the other ADC I mentioned earlier that’s now FDA approved for folate receptor positive patients. It does exclude patients who are using this low grade serious or are borderline tumors. And so this is, again, an up and coming trial. It’s not yet open, but it will be open here within the next six months to a year.

00:33:36:00 – 00:33:56:08
Unknown
And so I would encourage you to keep an eye out for this trial. ClinicalTrials.gov if you type in the rejoice rej0ic or you type in cd six in ovarian cancer, it should pop up for you. Next slide, please. We have this trial opened at City of Hope. We’ve enrolled a number of patients on this trial. This is the Fontana trial.

00:33:56:08 – 00:34:12:16
Unknown
It’s a phase one two. So again, an earlier trial. It’s a new folate receptor alpha target. So I mentioned that merger talks about more vertex MAB is FDA approved. It’s a really great drug. It’s an amazing drug in that it’s again showing an overall survival benefit, but it does have toxicity. There is neuropathy, it does cause some toxicity.

00:34:12:16 – 00:34:34:22
Unknown
So you need to be on eyedrops and see an ophthalmologist. So we have new drugs coming out that target the fully receptor alpha that maybe have potentially less toxicity or maybe they act a different way. And this is one of those drugs. It’s a different it’s a different drug, it’s a different smart bomb targeting the same receptor. And so this is aid for platinum resistant patients, and it’s really for patients who don’t have to express the 75% I mentioned.

00:34:34:22 – 00:34:55:06
Unknown
The FDA approved the more of a Texan MAB ADC, but the tumor has to have 75% lighting up on the screen. When you look under the microscope this trial, you only need 25%. So that’s at the lower threshold. The more patients will qualify for this drug. And the nice thing about it is that it’s it’s something where you can have up to three prior lines of treatment, which is great.

00:34:55:08 – 00:35:17:17
Unknown
And it’s it’s something where it is open. It’s open in California here where we are in Southern California, Colorado, Kentucky, Texas, Ohio, Massachusetts, Oregon, Rhode Island. It’s also opened up in Canada with in Quebec and Toronto, in Edmonton. For anyone who may be listening from Canada. And you’ll find it at clinicaltrials.gov, but we’re going to see a number of these fully receptor alpha targets.

00:35:17:17 – 00:35:33:14
Unknown
So this is one trial. Even if you don’t live in a state that has this trial, you may qualify for another folate receptor alpha trial. So look at look at, you know, what your expression is on your tumor, because that has implications for whether you would qualify for one of these trials that targets this new receptor, which is exciting.

00:35:33:16 – 00:35:57:14
Unknown
Next slide, please. Acrobat. Acrobat. And if you go to clinicaltrials.gov and type in Acrobat and this is going to pop up for you, this is a drug that’s called ACR 368, ACR three, six eight. It’s given by itself or in combination with a chemotherapy called gemcitabine. It’s designed for platinum resistant patients, meaning that the cancer’s come back within six months of receiving carboplatin or cisplatin.

00:35:57:16 – 00:36:12:22
Unknown
And the nice thing is that it allows for up to six prior lines of treatment. So I mentioned three prior lines or, you know, the all the back study allows for any number of lines. But this is a trial where you can have up to six prior lines, which can make a difference for patients, again, who have been treated already for a few years.

00:36:12:22 – 00:36:31:18
Unknown
And so this is a drug this is a trial you would qualify for. Potentially, it allows for platinum resistant patients who have high grade epithelial a primary partial or fallopian tube cancer. And the nice thing it does is also allows for patients with a carcinoma sarcoma, which is a rare histology. And unfortunately, sometimes we have trouble getting patients with carcinoma sarcoma in trials.

00:36:31:24 – 00:37:04:23
Unknown
This trial allows for that. So so it’s a trial that’s opened in Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Georgia, Florida. Maryland, Massachusetts. Miami, Mississippi. New Jersey. New York. North Carolina. Ohio. Oklahoma. Oregon. Pennsylvania. Rhode Island. South Dakota. Texas. Washington, Wisconsin. Utah. Oregon. So a lot. Number of places. I tried guys. I tried to find it. I tried to go through the list and generate where some of these places where these trials are open.

00:37:04:23 – 00:37:28:19
Unknown
But clinical trials, I’d go, okay, next, next slide, please. So this is a trial that’s unique to City of Hope and Florida and New York. There’s a couple of places that do. This is called Pressurized Intraperitoneal aerosol chemotherapy or pipette. So the chemotherapy is actually given in an aerosolized form. You know, like the bottle Lysol, if you spray the whole cans, it’s a gas is going to release.

00:37:29:00 – 00:37:47:12
Unknown
This is done now directly in the abdominal cavity with chemotherapy. And it’s experimental. It’s only done in a handful of locations in the US and we were one of them. But it can be a game changer. There are some patients who have really good responses to pipe that. Dr. Dellinger, who’s my colleague here at City Hope, is one of the it’s the national one of the national PIs and a world leader in this.

00:37:47:14 – 00:38:05:08
Unknown
And so I would encourage you, if it’s something where you’re interested, to seek out one of these institutions, again, there’s really just two or three in the country. But if you have disease that’s really localized to the abdominal cavity you’re in, you’re not a candidate for surgical excision. This may be a way to to treat some of those lesions with an aerosolized form of chemotherapy.

00:38:05:10 – 00:38:30:06
Unknown
And and it’s really very open as far as it doesn’t have prior restrictions with regard to the number of prior lines of chemotherapy as well. So that’s going to be a more unique trial. It’s more of a niche trial, but something to be aware of because the technology is there. It’s AIPAC is the acronym. Next slide, please. This is a phase one B trial, and this is a car T therapy.

00:38:30:06 – 00:38:54:13
Unknown
So car T represents the probably the most new version of how we treat ovarian cancer. And it really represents the hope for immunotherapy. Immunotherapy treatments haven’t quite panned out as well as we had hoped in ovarian cancer, but car T, cell therapy, or T cell related therapies are the next phase of how we’re going to do this. And we all are extremely positive that this represents a better opportunity to use your immune system to attack cancer.

00:38:54:15 – 00:39:15:22
Unknown
So this trial is targeting tag 72, which is an antigen on car T cells. T cells are basically the cells that attack in your immune system when you’re sick. The T cells are the warriors that go out and kill the foreign body, the bacteria or the virus, or in this case the cancer. And so City of Hope is a leader in leukemia lymphoma treatments.

00:39:15:22 – 00:39:39:00
Unknown
But that means their world experts in how to use car T because car t’s been used in those drug and those disease processes for years. And so we have a homegrown CAR-T program. Dr. Lorna Rodriguez For patients with platinum resistant ovarian cancer, there are there are other trials open in a handful of other states. And that’s why I mentioned this, because it’s not the only CAR-T cell therapy trial open, it’s one of them.

00:39:39:00 – 00:39:59:20
Unknown
But look up clinicaltrials.gov, type in CAR-T and look up ovarian cancer and you’ll find what’s available for you. But it is a specialized trial that requires comprehensive care with hematologists and gynecological colleges and medical oncologist. You have to express certain receptors on the tumor and in your own immune system. And that’s what’s on the slide. But just know the future is here.

00:39:59:20 – 00:40:24:11
Unknown
And these trials are very exciting. Next slide, please. This is another example of t cell therapy. This is not CAR-T therapy. Basically, these T cells are being used to generate a way. They’re trained to attack the tumor to your body, but you have to have certain expressions of these receptors. And that’s what’s on this slide. The ATP, a two and four CD eight cell.

00:40:24:13 – 00:40:52:01
Unknown
You have to have a certain human leukocyte antigen expression and you have to have a certain meizu A4 expression and your doctor can test for these. This is called surpass three. This is a trial that’s really one of the first national trials or international trials looking at t cell therapy for ovarian cancer. It’s open. It’s Georgi 3084. It’s open in Arizona, California, Georgia, Michigan, New Jersey, South Dakota, Texas, Washington, Ohio, Oklahoma and Toronto.

00:40:52:07 – 00:41:12:16
Unknown
And there are other versions of these trials out there. So t cell therapy is here. It’s experimental. This is not something you’re going to get as a standard of care. I would say the time to use this is when you’re you’re doing a little bit better. This is not that you don’t want to wait and use this when you’re in a tough spot with chemotherapy after eight prior lines, you want to try to use this earlier because these drugs can make you pretty sick.

00:41:12:16 – 00:41:31:16
Unknown
But again, if you respond, they could be game changers for you. Next slide, please. We’re almost done with this and then we’ll get to questions. Okay. So really, I’m going to move through a little more quickly through a couple of these studies. This is a study looking again at another folate receptor target. It’s called IMG, one five IMG and 151.

00:41:31:22 – 00:41:55:21
Unknown
It’s looking at platinum resistant ovarian cancer. It’s targeting high grade serous patients. And it’s opened in California. It’s opened in Florida, Michigan, New York and Buffalo, Roswell Park, Oklahoma, Tennessee, Texas. So really, another opportunity for you to use folate receptor and be treated on this. And you could have already been on a prior folate receptor. So a lot of these new trials that are available for folate receptor allow for prior folate receptor drug exposure.

00:41:56:02 – 00:42:14:14
Unknown
So even if you’ve already received rituximab, you still may qualify for a trial like this. If it’s not this one, it may be another one. Next slide, please. This is an example of something called a Bispecific antibody. So this is a phase one. Two. This is Regeneron. This is a drug that has to linkers on it that target two receptors in your immune system.

00:42:14:16 – 00:42:35:20
Unknown
And it’s really an exciting opportunity to target, activate and target T cells in your body. It’s opened in California, Florida Illinois, Massachusetts, Michigan, New York, Ohio and Washington. It also is something that does require at least one prior line of platinum chemotherapy. But otherwise you can have had prior lines of treatment and it’s really open to the different histology.

00:42:35:20 – 00:42:59:23
Unknown
If you have carcinoma sarcoma, you wouldn’t qualify. But clear cell and a meteoroid, all these others, you likely would qualify. So this is a good trial for someone who’s looking for a trial that that unfortunately may not qualify for others. Next slide, please. This is a drug that is another antibody drug conjugate and it’s targeting b h dash h for the name of the drug is used to tattoo tags.

00:42:59:23 – 00:43:22:15
Unknown
IMRT can I know that’s a mouthful for me too, but it’s a drug that’s that’s targeting this antibody on cells. It’s an antibody drug conjugate. You have to have measurable disease, meaning you have to have recurrent cancer that’s not responding to other treatments. And it’s open in California, Florida, Louisiana, Maryland, Massachusetts it’s Missouri, New Mexico, New York, North Carolina, Pennsylvania and Texas.

00:43:22:17 – 00:43:43:13
Unknown
And so this is again, another antibody drug conjugate that’s that’s moving up the chain here as far as it may be. The next bullet receptor alpha, we’re not quite sure we’re looking for that. Next slide, please. I want to switch to talk about low grade serious ovarian cancer for a moment. I know I have not touched upon it a lot, but but it is a drug that it is a tumor that we’re to we do have trials for.

00:43:43:19 – 00:44:05:08
Unknown
The biggest trial right now is Georgi 3097, which is the ramp 301 study. I think there was a talk to share about in June or July that talked about low grade serous ovarian cancer. You can certainly reference that. But this is involving two drugs. Abbott two met Knibb and de facto Knibb, and they’re being used in the setting of recurrent ovarian, recurrent low grade serous ovarian cancer where you may get those drugs or being randomized to a standard of care.

00:44:05:08 – 00:44:30:04
Unknown
Chemotherapy. And the nice thing about this for low grade cirrhosis has opened in many states Arizona, California, Connecticut, Florida, Illinois, Louisiana, Michigan, Minnesota, New York, North Carolina, Missouri Pennsylvania, Oregon, Ohio. And so if you go to clinicaltrials.gov and you type in ovarian low grade or ovarian cancer, or if you want to just type in ramp in ovarian cancer, this will pop up and you’ll be able to find this trial.

00:44:30:06 – 00:44:52:11
Unknown
It’s open near where you live. Okay. Next slide, please. And so just kind of some summary slides here to finish out the presentation. So things to keep in mind, seek out an organization such a share, talk to people with share. They’re here to help And it’s a it’s a great way to get started in the setting of recurrent disease to maybe get your get your bearings where you need to go next, stay connected with your family and friends.

00:44:52:11 – 00:45:05:18
Unknown
I know it’s really hard because we get sad. We get depressed. We’re dealing with cancer, but we know patients do better. When you have a support group, we know that you do better when you have friends or family. You know, don’t don’t don’t be worried about sharing this with them. They want to be there for you. They want to share this with you.

00:45:05:18 – 00:45:19:14
Unknown
It’s not a burden to them. So to reach out to them, we want you to be there, your doctors, what we want to we want to be there with you. You know, share with us how you’re feeling too, because we want to help in any way we can. Cancer centers offer more than just drugs. We don’t just just push trials.

00:45:19:14 – 00:45:40:21
Unknown
We don’t just push chemo or Taxol, which is a plant. We also offer symptom management, nutritionist, mental health, integrative medicine. And if your cancer center doesn’t offer that, find one that does. Comprehensive cancer centers usually have to offer that. And can cancer centers decode second opinion? It’s okay. Get the path reviewed, get your imaging reviewed, see, get it, and talk about clinical trials.

00:45:40:21 – 00:46:00:15
Unknown
This is your life. It’s okay. Advocate for yourself. If insurance is a barrier, there are ways to overcome that depending on the institution, that’s a little harder. But but with telemedicine and travel, there are ways to do second opinions that you may not have thought possible. Next slide, please keep physically active. Take control of your diet and exercise.

00:46:00:15 – 00:46:18:07
Unknown
Those are things you do have control over, say to healthy weight. Those are things we have a moderate amount of control over. I get I spend a lot of my day talking about drugs and diet and fads. You know, everything in moderation, you know, fruits and vegetables, whole grains. That’s really the approach here. I recommend a mediterranean diet.

00:46:18:13 – 00:46:36:21
Unknown
There’s not one fad diet that’s really better than anything else out there right now. There’s not a product that everybody should be taking as a supplement. But but everything in moderation, avoiding sugary drinks, highly processed foods. That being said, completely removing sugar from your diet is not the be all end all. If you’re out with your family and you want to have something and splurge, it’s okay to do that.

00:46:36:21 – 00:46:53:13
Unknown
If it’s enjoyment once in a while is okay. Just everything in moderation as much as you can. Don’t live CT scan, do CT scan or see a 1 to 5 to 1 to 5 the every day is a gift. And I know that for myself and you have to make the most of it. But but just know that the drugs are the drugs, the trials and the trials.

00:46:53:15 – 00:47:07:17
Unknown
The doctors are going do their best to follow you, but you can’t just wait for the next 1 to 5 because life has to happen in between. You have to enjoy time in your family and between every three month scans or every six months scans. So don’t wait for those results. Make the most of it because I think we all need to do that.

00:47:07:19 – 00:47:24:03
Unknown
And then if you can avoid alcohol, the idea one red glass of wine a day is actually not accurate. We’ve moved away from that. We don’t think red wine actually helps your heart. So just just know that it’s okay a little bit. But, you know, I wouldn’t do more. I would try to stay away from alcohol routinely if you can if you’re out with your friends and family, by all means, go for it.

00:47:24:05 – 00:47:46:12
Unknown
But just in moderation. Next slide. Please meet with your medical team, advocate for yourself, ask questions. It’s okay to get a second opinion. Ask about the tumor board. No, there’s more than one option. Stay connected to friends and reach out to organizations that share. Next slide, please. So three key takeaways for me. For you ask What the tumor testing has been done already.

00:47:46:12 – 00:48:06:07
Unknown
If you have recurrent ovarian cancer, you should have fully receptor testing, You should have HER2 testing, your tumor should be tested for antigen and progesterone receptors, and there are more targets out there, but at the very least know what’s been done. Know if you have if you’re the term is deficient, HRT, positive or negative, and then discuss the role of additional imaging surgery and whether you need a new biopsy.

00:48:06:07 – 00:48:26:19
Unknown
Everybody with recurrent ovarian cancer should have this discussion with their doctor or doctors. And then clinical trials are opening and changing all the time. Your medical provider should send you to a location that has trials. Even if they don’t, they should be able to offer that to you. Because in the day and age of recurrent ovarian cancer, we have a lot of exciting new treatments that you will have access to through a trial that you will not otherwise see.

00:48:26:24 – 00:48:46:11
Unknown
And if they can offer to you in that setting, that’s okay. That’s not that’s not the expectation of every cancer center or every group in the country. But you will you should be able to hear from someone who has trials to offer you. Next slide, please. I mentioned City of Hope. I love working at City of Hope. We announced the doors in California, Orange County, where I am.

00:48:46:11 – 00:49:00:02
Unknown
There’s also City Hope, Atlanta, Phenix and Chicago. So if you live in one of these states, you can certainly seek information from City of Hope. But but I know there’s lots of great places out there, and I’m happy to give you any input I can as far as where you might be able to go, depending on where you live.

00:49:00:04 – 00:49:21:06
Unknown
Again, clinicaltrials.gov is the key, though, to start with looking for trials. Next slide, please. So this is my email address. This is my Twitter handle, our handle now and Instagram. I try to be active on there possible with with things that are coming up with ovarian cancer, at least maybe new new things that are being said in the literature.

00:49:21:08 – 00:49:25:10
Unknown
And so with that, I’m open for questions.

00:49:25:12 – 00:49:50:08
Unknown
Thank you, Dr. Cohen. That was an excellent presentation. You covered a ton of ground, really appreciate it. So now let’s start the Q&A. There were a lot of pre submitted questions and you can still submit questions in the Q&A section at the bottom of your screen. We will try to get through as many questions as we can in the time remaining.

00:49:50:10 – 00:50:23:12
Unknown
All right. So let’s get started. So I know that you touched on I believe that was at least one trial that was open for those with clear cell tumors. But I’m wondering if there’s any other clinical trials you can speak to that are recruiting for clear cell. And then also those sort of follow up to that, we received a question about sort of how can we sort of get the medical community to include clear cell or do more trials on clear cell ovarian cancer.

00:50:23:14 – 00:50:40:03
Unknown
Yeah. And thank you for that question. I think we we actually have trials that are that are in the pipeline in upcoming. There are trials looking at combination with immunotherapy. I think one of the things about clear Cell is that it’s not just within ovarian cancer. There’s clear cell cancer of the kidney, which is probably more common, actually.

00:50:40:09 – 00:51:00:04
Unknown
And so when you’re looking for a trial, even just typing in clear cell into clinicaltrials.gov and maybe not limiting it to ovarian cancer, because many of these trials are agnostic of tumor origin. And then there’s maybe the fact that someone has a clear cell tumor. You may find a trial locally that’s not specific to ovarian cancer, but it may offer you the opportunity to enroll on that trial.

00:51:00:06 – 00:51:25:10
Unknown
We do know that clear tumors respond better to immunotherapy. And I know that I mentioned that we we are looking for CAR-T and T cell therapy, but honestly, clear cells are some of the few tumors that that do respond really pretty well to pembrolizumab, which is already approved or nivolumab in pembrolizumab. So there are some trials looking at response rates to nivolumab and pembrolizumab together or other combinations of immunotherapy in specifically clear cell populations.

00:51:25:12 – 00:51:43:21
Unknown
So they are trials out there. Immunotherapy can be an option for you. I have patients who have clear cell tumors where maybe they weren’t offered immunotherapy before and they may not have the molecular signature, but we’ve put them on immunotherapy and they’ve responded. And we’re still trying to figure out why that’s the case. So if you have a clear cell and you’re listening, talk to your doctor about immunotherapy.

00:51:44:00 – 00:52:05:23
Unknown
Ask them about trials that may not be specific to ovarian cancer, but include clear cell tumors. And but they are out there. Great. Thank you for that. And then we’re also getting a question again, more rare type, A rare tumor types. But why is it more challenging to find trials for a low grade serous or Mucinex?

00:52:06:00 – 00:52:31:03
Unknown
Or is it? It is more challenging and if you think about trials, really, when when when trials are designed and this is the challenge, they’re designed with the intent to hopefully show benefit. And when you’re developing a drug, the way to show benefit is trying to focus on perhaps one specific tumor type to make sure it’s consistent and make sure that you have a response that makes that that that’s real.

00:52:31:05 – 00:52:46:10
Unknown
When we go to the FDA for approvals, the Fed, the FDA is the governing body for whether drugs can be given to a human being in the U.S. or not, or at least where the insurance companies will pay for them if they’re FDA approved. They want to see the data. They want to see what is the likely type response and patient populations.

00:52:46:12 – 00:53:05:15
Unknown
And unfortunately, mucin as tumors are rare and low grade serous are rare, they’re also they tend to act differently than than standard high grade serous ovarian cancer. So when you’re designing a drug for ovarian cancer, most pharma companies will design it and focus on high grade serous because it’s the more common type, it’s the more likely type that they’re going to get patients to enroll.

00:53:05:17 – 00:53:22:07
Unknown
And that’s why that’s that’s that’s the unfortunate reason. That being said, we as doctors are committed to treating patients with Mucin as cancer and low grade serous. And we have trials open sometimes based on molecular signatures. Again, the trial may not say by name. Low serious, it may not say by name useless, but you may have a mutation.

00:53:22:09 – 00:53:45:09
Unknown
Now, I will tell you, for Mrs. Tumors, you should get her to testing. Because if you’re her many needs in his tumors, not. Not more. Not more than half, but a number are HER2 positive. And if you’re HER2 positive, guess what trastuzumab Dexter rex can that ADC I mentioned, that’s a game changer for you. So if you’re out there and you’re listening and if you you’ve a business tumor, make sure you’ve been HER2 tested because it’s probably there’s a good chance you may respond if you’re positive for it.

00:53:45:11 – 00:54:02:13
Unknown
For low grade serous, there are actually more trials upcoming. We actually have an upfront trial looking at an aromatase inhibitor alone versus chemotherapy for patients with low grade or very low grade serous ovarian cancer. And there are more trials. I presented ramp because that’s the biggest one and most available right now. But but they are out there. So there are more trials that are coming out for low grade serous.

00:54:02:15 – 00:54:21:22
Unknown
Again, talk to your doctor. Go to an NCCN cancer center. Go to clinical trials that get that. But they’re coming out and get that edge yet. Get that sequencing of your tumor because that’s going to open up the door for other treatments that may not just be specific to low grade serous. Great. And then we’re getting a question about what is the benefit of pressurizing chemo?

00:54:22:01 – 00:54:51:13
Unknown
Does it act differently? Yeah. So when it’s aerosolized in the abdominal cavity, it covers the entire surface area of the abdomen and penetrates the tissue. So it basically is covering or bathing the abdominal surface in chemotherapy, and then it gets absorbed through the lining or the saran wrap called the peritoneum. So it’s a nice way to deliver chemotherapy droplets throughout the abdomen, whereas where if you’re doing chemotherapy in the IB, it will eventually reach there, but you’re relying on blood vessels reaching those areas through your veins versus direct delivery.

00:54:51:15 – 00:55:06:10
Unknown
It’s a trial. It may not be the be all end all, but actually if you have low grade, serious or very cancer, there’s been some really good responses with high tech in our study. So that’s an example of if you have a disease confined to the abdomen and you have low grade serous ovarian cancer, you may want to seek out a study on pipette.

00:55:06:11 – 00:55:31:09
Unknown
You can enroll in that trial. Pippa And we’ve had some really good responses with Dr. Dillinger’s work. Right. And then we also getting a question about age limits. When it comes to clinical trials. Are there cases where patients are too old to participate? It’s no, it’s been really rare. I mean, there are some, but but honestly, the nice thing that we we’ve seen movement in trials now is being more inclusive.

00:55:31:15 – 00:55:48:08
Unknown
The age of the younger ages is a harder stop. 18 or older is really kind of the cutoff unless you’re a pediatric designated trial, which has its own regulatory body. But really outside of that, most patients can enroll. It’s going to be more performance status. Are you able to do things, activities of daily living? Are you can you button your clothes?

00:55:48:08 – 00:56:05:19
Unknown
Can you feed yourself? Can you eat and drink and supply yourself and nourishment? That’s going to be more the rate limiting step into someone who’s 80. I would I would still talk to someone who’s 80 about a clinical trial. I enroll patients who are older that in trial. So I don’t think age is the limit. It’s going to be more of the term is frailty and performance status great.

00:56:05:20 – 00:56:26:11
Unknown
And this is just a more general question about sort of the the role of clinical trials, like is that the doctor’s job to bring clinical trials to the patient or should patients be going to their doctor asking about clinical trials? Advocate for yourself? I mean, it depends on the provider. I would say I love it. I love I love going to work and talking about trials with patients.

00:56:26:11 – 00:56:41:10
Unknown
Many of us do, but not all providers do that. That may not be their strength. So advocate for yourself. Thank you for listening to this. If you’re a family member, advocate for your family member, everybody should have the opportunity to discuss clinical trials because there are some really exciting things, but it may not be the provider. So unfortunately it may be you.

00:56:41:10 – 00:57:10:24
Unknown
And so it was on my slide. I’ll say it again Advocate, advocate, advocate. Right. So important. And then in instances where a patient may be on a treatment, but having a side effects, is that a good time to think about clinical trials for other treatments? I think it depends on the side effects. It depends. We usually try to keep you on a drug if it’s if you’re responding and I mentioned this as a chronic condition like HIV, if the drug is working, we can try to dose reduce it.

00:57:10:24 – 00:57:24:12
Unknown
We can try other treatments for the side effects like neuropathy, different medications. So I would really try to keep you on that drug as long as the cancer is responding. But sometimes you can. Sometimes you have to change direction. And if it if you’re having a lot of toxicity, then yes, that’s a good time to think about a trial.

00:57:24:14 – 00:57:39:14
Unknown
I think trials should be moved up. We should think about them earlier in the setting of recurrent cancer versus later. They’re not just they’re not a last ditch effort. They should be moved up because you could get a really great drug that could change the course of how you’re being treated. But but unfortunately, I feel like most patients don’t hear about trials.

00:57:39:19 – 00:58:09:23
Unknown
It’s much later in their disease course. But toxicity alone would not be a reason to move away from a drug. And then this person is asking about the FDA. Clear an investigational new drug application for zw191, which is another ADC for folate receptor alpha in ovarian cancer in other tuna tumors. Is that an option or now or only in clinical trials?

00:58:10:00 – 00:58:26:10
Unknown
The only the only FDA approved drug right now that’s being that’s that’s is more of a Texas MAB that’s being approved and paid for by insurance companies. That being said, if you have a drug, you can always go to the you can have your your provider go to the company and ask for use perhaps outside of a clinical trial.

00:58:26:10 – 00:58:46:18
Unknown
That’s where you have to have your your provider advocate for you. But but I would say if it’s on a trial and you’re going to qualify, that’s the best place to get it on a clinical trial, because that’s you’re going to get that drug as that part of the trial sponsor paying for it. But if it’s not on the guidelines, the list I gave you and it’s not FDA approved, the insurance companies definitely get to say no.

00:58:46:22 – 00:59:07:23
Unknown
And that’s where if you really believe in it and your provider believes in it, they have to get on the phone with a pharma company and start making phone calls and see if there’s a way they can get it for you outside of the the the standard process. Right. And that’s all the time we have for questions. So thank you so much, Doctor Cohen, for this extremely informative program.

00:59:07:23 – 00:59:28:24
Unknown
And thanks to everyone participated today and asked all of these great questions. Please check out shares, upcoming educational programs and support groups and follow up on social media as well. So as you can see, here are some of our upcoming programs.

00:59:28:24 – 00:59:43:15
Unknown
And I concludes the webinar. So thank you again, Dr. Cohen. We really appreciate you participating in this tonight. My honor. Thank you all. And wishing you all the best. Thanks so much.