Dana Chase, MD, is an associate professor of obstetrics and gynecology in the Division of Gynecologic Oncology at UCLA Health.

Dr Chase on Considering Patient Preferences for Treatment Planning and Development in Gynecologic Oncology  

"In general, patients seem to like having longer intervals in between treatment…and [they] prefer to take an oral medication and not have to come into an infusion center. However, if you tell the patient that IV therapy might give them a greater disease benefit or control of their treatment compared with the oral treatment…they might change their mind."

Dana M. Chase, MD, associate professor of obstetrics and gynecology, Division of Gynecologic Oncology, UCLA Health, discussed how assessments of quality of life and patient-reported outcomes can be used to inform treatment planning and drug development in gynecologic oncology.

The preference for oral vs intravenous (IV) therapies among patients with cancer is an important consideration in drug development and treatment planning, Chase began. Patient satisfaction surveys consistently indicate that many individuals prefer oral medications over IV therapies, primarily due to convenience, reduced clinic visits, and fewer disruptions to daily life, she reported. Additionally, extended dosing intervals—whether in the context of oral or IV therapies—tend to be preferred over more frequent treatment schedules, she added.

However, treatment decisions are often more complex than methods of administration, Chase continued. When patients are informed that IV therapy might provide superior disease control or longer survival benefits compared with an oral alternative, their preferences may shift, she explained. This suggests that efficacy, rather than convenience alone, remains a key factor in decision-making, Chase stated.

For drug developers, these insights highlight the need to balance efficacy with patient convenience, Chase noted. Although oral therapies are often preferred, they must demonstrate comparable or superior clinical benefit to IV options to be widely adopted, she said. Moreover, patient adherence is a critical factor—daily oral regimens may seem more convenient but could pose challenges related to missed doses or variability in drug absorption, Chase emphasized.

Future research and drug development should continue to integrate patient preferences while maintaining a focus on maximizing therapeutic efficacy, Chase concluded.

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Dana M. Chase, MD, discusses how patient preferences can inform treatment planning in gynecologic oncology.
 


Dr Chase on Considering Patient Preferences for Treatment Planning in Gynecologic Oncology

Dr Chase on the Importance of QOL and PRO Measures in Gynecologic Oncology

Dana M. Chase, MD, associate professor of obstetrics and gynecology, Division of Gynecologic Oncology, UCLA Health, discusses the importance of quality of life (QOL) and patient-reported outcome (PRO) measures in gynecologic oncology.

Quality in medicine is a topic that encompasses many domains, including patient centeredness, according to Chase. Patient centeredness revolves around satisfaction and experience, which can be affected by how the patient feels on treatment, Chase says. Another aspect of patient satisfaction is tied to their overall assessment of their physician or care team. Patients are bound to evaluate their physicians, Chase explains, and it is important that those ratings are taken seriously as they may have implications on health policy decisions from insurance companies and even governmental agencies.

Despite this, there may be elements of patient satisfaction that are not always top of mind in routine care, Chase explains. For example, there may be a preconceived notion that a patient would prefer more hopeful messaging during their office visits. However, research has shown that patients appear more satisfied when their oncologist is more direct with them regarding their diagnosis and prognosis, Chase says.

Another element of quality in medicine comes in the form of PROs or surveys that are used to measure a patient’s experience of treatment during their participation in a clinical trial. These outcomes can provide a more in-depth understanding of the adverse effects patients may experience on therapy. Several tools can be used to evaluate PROs and in different ways, Chase says. Given their availability, it has become mandatory to include PRO assessments in clinical trials as exploratory, if not secondary, end points. Notably, research has also shown that PROs are independently associated with survival, suggesting that how poor patients feel at baseline is indicative of how long they are going to survive, Chase concludes.

Dana M. Chase, MD, discusses the importance of quality of life and patient-reported outcome measures in gynecologic oncology.

Dr Chase on the FDA Approval of Dostarlimab Plus Chemotherapy in Endometrial Cancer

Dana M. Chase, MD, associate professor, obstetrics and gynecology, Division of Gynecologic Oncology, the University of California, Los Angeles, discusses the significance of the FDA approval of dostarlimab-gxly (Jemperli) plus chemotherapy for patients with primary advanced or recurrent endometrial cancer.

the FDA approved dostarlimab in combination with carboplatin and paclitaxel

, followed by single-agent dostarlimab maintenance therapy, for the treatment of adult patients with primary advanced or recurrent endometrial cancer. This approval expanded 

 for adult patients with mismatch repair–deficient (dMMR) or microsatellite instability–high (MSI-H) primary advanced or recurrent endometrial cancer.

The expanded regulatory decision was supported by findings from part 1 of the phase 3 RUBY trial (NCT03981796), in which patients in the overall population who received the dostarlimab combination (n = 245) achieved a median overall survival of 44.6 months (95% CI, 32.6-not reached) vs 28.2 months (95% CI, 22.1-35.6) with placebo (HR, 0.69; 95% CI, 0.54-0.89; 1-sided 

 = .002). Furthermore, the median progression-free survival was 11.8 months (95% CI, 9.6-17.1) in the dostarlimab arm compared with 7.9 months (95% CI, 7.6-9.5) in the placebo arm (HR, 0.64; 95% CI, 0.51-0.80; 1-sided 

The most common adverse effects occurring in at least 20% of patients who received the dostarlimab regimen included anemia, increased creatinine, peripheral neuropathy, decreased white blood cell count, fatigue, nausea, alopecia, low platelet count, increased glucose levels, lymphopenia, neutropenia, liver function test abnormalities, arthralgia, rash, constipation, diarrhea, decreased albumin levels, abdominal pain, dyspnea, decreased appetite, increased amylase, urinary tract infection, and vomiting. 

Endometrial cancers are categorized according to their molecular subtype, and some therapies are more effective in certain patient subgroups based on the disease’s molecular classification, Chase begins. Historically, the use of many endometrial cancer therapies has been limited to specific patient subgroups based on the presence of a biomarker or other molecular classification, she says. However, this expanded indication for dostarlimab widens the eligibility criteria for this agent beyond patients with dMMR/MSI-H disease, Chase concludes.

Dana M. Chase, MD, discusses the FDA approval of dostarlimab plus chemotherapy for patients with primary advanced or recurrent endometrial cancer.

Dana Chase, MD, FACOG, assistant professor at the University of Arizona College of Medicine Phoenix and Creighton University at St. Joseph’s Hospital and Medical Center, Arizona Oncology, The US Oncology Network, discusses the use of niraparib (Zejula) as frontline maintenance therapy in ovarian cancer.

The phase III PRIMA trial is one of the first trials to demonstrate the efficacy of PARP inhibitors, specifically niraparib, in frontline maintenance therapy, says Chase. In December 2018, olaparib (Lynparza) was approved by the FDA for the maintenance treatment of adult patients with deleterious or suspected deleterious germline or somatic 

-mutated advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in complete or partial response to first-line platinum-based chemotherapy. However, in the PRIMA trial, investigators administered niraparib to all comers, which is new and unique, according to Chase.

Previously, the standard of care for patients with ovarian cancer who did not have a 

mutation was chemotherapy followed by surveillance, says Chase. Other patients received bevacizumab (Avastin) with chemotherapy and continued bevacizumab as frontline maintenance. Until PRIMA, there was no access to use PARP inhibitor therapy in the all-comer patient population, concludes Chase.

Dana Chase, MD, discusses niraparib as frontline maintenance therapy in ovarian cancer.

Dr. Chase on Niraparib as Frontline Maintenance Therapy in Ovarian Cancer

Dana Chase, MD, gynecologic oncologist, Arizona Oncology, discusses the standard of care for the treatment of patients with uterine leiomyosarcoma.

If disease is recurrent or advanced upon presentation, it is standard to give systemic treatment, says Chase. The standard treatment for those patients include chemotherapy. There are currently several FDA-approved options that can be used in that setting, per the guidelines.

Traditionally, gynecologic oncologists used docetaxel and gemcitabine. That has really been the go-to regimen for these tumors, says Chase. Recent data suggests that single-agent doxorubicin or doxorubicin with olaratumab (Lartruvo) are good alternatives. Chase states that doxorubicin with olaratumab could potentially be superior to docetaxel and gemcitabine, though physicians do not have data on that yet. These data are expected within the next year or 2, says Chase.

Dr. Chase on the Standard of Care for Uterine Leiomyosarcoma

Dana Chase, MD, gynecologic oncologist, Arizona Oncology, discusses the presentation of uterine sarcomas.

Uterine sarcomas are very rare in the gynecologic oncology world. Only about 2% to 4% of uterine cancers are uterine sarcomas, Chase explains. Physicians estimate that a gynecologic oncologist has approximately 2 or 3 active patients in their practice, and most uterine sarcomas present in the form of leiomyosarcomas. Carcinoid sarcomas are the most common type of uterine sarcomas, but they are classified as more traditional endometrial cancers.

After that, uterine leiomyosarcomas are the next most common type of uterine sarcoma. Those patients typically don’t present with uterine bleeding. They may have been found to have this tumor because they were having a hysterectomy for fibroids. In the metastatic setting, patients may have been found to have abdominal pain or shortness of breath and received a biopsy that revealed uterine leiomyosarcoma. Often in the early-stage setting, the gynecologic oncologist meets with the patient after they were operated on by a gynecologist. From that point, the physician has to determine whether to administer chemotherapy or observation.

Dana Chase, MD

Articles

Dr Chase on Considering Patient Preferences for Treatment Planning in Gynecologic Oncology

Dr Chase on the Importance of QOL and PRO Measures in Gynecologic Oncology

Dr Chase on the FDA Approval of Dostarlimab Plus Chemotherapy in Endometrial Cancer

Dr. Chase on Niraparib as Frontline Maintenance Therapy in Ovarian Cancer

Dr. Chase on the Standard of Care for Uterine Leiomyosarcoma

Dr. Chase on the Presentation of Uterine Sarcomas