Dr Cosgrove on the Evolution of ADC Treatment in Ovarian Cancer

Casey M. Cosgrove, MD, gynecologic oncologist, assistant professor, Department of Gynecologic Oncology, The Ohio State University College of Medicine, The Ohio State University Comprehensive Cancer Center—James Cancer Hospital and Solove Research Institute, discusses the evolution of treatment with antibody-drug conjugates (ADCs) for patients with ovarian cancer.

Approximately a century ago, the concept of ADCs emerged, initially perceived as a potential “magic bullet” for cancer management. Today, there are over 100 ADCs in various stages of development and investigation, Cosgrove begins. As the understanding of biomarkers—the proteins expressed on the surfaces of tumors—advances, oncologists can increasingly tailor personalized therapies, he says. The science behind ADCs is becoming more sophisticated, particularly in the design of linkers that connect chemotherapy agents to monoclonal antibodies targeting cancer cells, according to Cosgrove. This precision enhances tissue-directed therapies, paving the way for improved treatment outcomes, Cosgrove explains.

As biochemistry and biomarker knowledge evolve, alongside enhancements in chemotherapy payloads, the potential for these therapies appears limitless, he continues, noting that a crucial next step involves determining the optimal timing for administering these agents. Questions arise about whether they should be introduced earlier in treatment and which patients would benefit most from specific markers, he notes. A multidisciplinary approach, incorporating input from pathology departments, is vital in addressing these considerations, Cosgrove emphasizes.

Oncologists anticipate ongoing improvements in the science and chemistry of ADCs, refinement in patient selection, and an increase in available therapies through the identification of new biomarkers, he continues. This class of drugs is likely to remain integral to oncology, necessitating familiarity with the unique toxicities associated with these innovative treatments, he reports. Additionally, it is essential to streamline processes for testing patients at the appropriate times to ensure their timely access to these agents, Cosgrove says. The exploration of ADCs in settings beyond platinum-resistant cases, such as those involving promising new agents, represents an exciting frontier in cancer treatment that oncologists hope to investigate further in the near future, he concludes.

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Casey M. Cosgrove, MD, discusses the evolution of treatment with antibody-drug conjugates for patients with ovarian cancer.

The path to becoming a physician is a long and often surprising one. There is, of course, the actual process of applications, tests, and learning the mechanics of taking care of patients. But I would argue that identifying a specialty that allows for personal and professional happiness should be a major point of discussion starting early in a physician’s career.

Entering medical school, we all have a general concept of what we want to do, whether it’s practicing in the community or conducting research in an academic setting. But life, as they say, happens when you’re making other plans. Despite the blueprint, things often change, and with every decision, the changes can be quite significant. We may go from dreaming of surgery to pediatrics or from picturing an illustrious career in academia to working in a rural private practice.

Why? Because each step on the long path of medical training impacts the next step. We change our priorities. We unexpectedly fall in love with a specialty. We recognize surgery isn’t for us. We have life-changing events. We don’t score as high as we would like on a test, and on and on.

Some of the “whys” are beyond our control. Other things we do not recognize as important until later. In my opinion, there are 2 major ways to combat the loss of opportunities or to respond to a unplanned twist in your career path: First, identify strong mentors. Mentors are exceptionally important as we home in on our ultimate goals, but they also provide guidance and sage advice. A mentor can help you think through big picture decisions or, at the completion of your fellowship, provide crucial insight for contract negotiations and help you identify the nuances that separate a job that is the right fit from one where you will struggle to have success.

The second way to respond to life’s surprises is through preparation. Identifying training opportunities that provide the exposure and training to fulfill your goals is exceptionally important. This is true not only if you have your heart set on a certain specialty or subspecialty, but also if you are unsure about the path of your life and career.

I didn’t always picture myself as a physician. Growing up, I thought I would be a sports broadcaster. As I got older, however, I realized that being a doctor would be an unbelievable honor. Working with patients and providers, building relationships, and pursuing scientific knowledge make being a doctor an amazing career.

Entering medical school, I could rattle off the handful of specialties I had interest in. I was exposed to anatomy, and surgical specialties took priority. I experienced training as an OB/GYN and found I could easily visualize a career rushing to a delivery at lunch time or being in the clinic one day and the operating room the next. I could see myself taking care of patients throughout their lives. I was fortunate to match into obstetrics/gynecology at The Ohio State University, which exposed me to subspecialties of that field, and provided amazing generalist training.

This is where I found my true calling: taking care of women with cancer, with performing complex surgeries, and providing comprehensive medical care. This was not the path I had expected, but the opportunity was there and the experience made me realize this was the career for me. I identified mentors who provided the guidance required to make these complicated decisions and to assist in positioning myself for a career.

After matching into my gynecologic oncology fellowship, I recognized along the way that I wanted to pursue an academic career. My future as a generalist community OB/GYN in Florida, where I grew up, was no longer the plan. I threw out that blueprint and drew a new one. Soon, I will be starting an academic gynecologic oncology position in Ohio, a situation I never would have imagined, even through medical school.

I am so fortunate that the pieces have fallen into place to allow me to have the career that I could never have envisioned. I wonder how any small step in a different direction could have changed everything; acceptance into a different OB/GYN clerkship or working with different residency faculty could have sent me in a different direction. These pieces came together, though, because each individual step not only shaped what my goals and desires were, but also provided the resources to fulfill them.

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Identifying a specialty that allows for personal and professional happiness should be a major point of discussion starting early in a physician’s career. 

Casey Cosgrove, MD

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Dr Cosgrove on the Evolution of ADC Treatment in Ovarian Cancer

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