Douglas A. Levine, MD, professor, Department of Obstetrics and Gynecology, director, Division of Gynecologic Oncology, NYU Langone's Perlmutter Cancer Center, discusses the randomized NRG Oncology Group 86P study for patients with endometrial cancer.

This was a phase III trial that randomized patients with advanced or recurrent endometrial cancer who had not received prior chemotherapy to 1 of 3 arms, either taxol, carboplatin, and bevacizumab (Avastin), taxol, carboplatin, and temsirolimus, or ixabepilone (Ixempra), carboplatin, and bevacizumab. The primary outcome was progression-free survival, which was compared with a historical control from the GOG-209 study.

Physicians are still trying to validate the data. There have not been a lot of studies that have investigated bevacizumab in endometrial cancer. According to Levine, it is important to find a study that has been completed and has collected tissue to confirm the biomarker of beta-catenin for patients treated with bevacizumab. Determining who will benefit from bevacizumab is an additional area that needs to be investigated further.

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Dr. Levine Discusses a Combination Study in Endometrial Cancer

Douglas A. Levine, MD, professor, Department of Obstetrics and Gynecology, director, Division of Gynecologic Oncology, NYU Langone's Perlmutter Cancer Center, discusses the sequencing of agents for patients with ovarian cancer.

Due to precision medicine, sequencing is quite easy, explains Levine. However, it is the interpretation of the sequencing that is more challenging. For newer laboratories, it is important to understand how the validation is done and ensure that the details of the sequence analysis are done well.

It is possible to use the sequencing to determine what mutation is in the tumor, and then refer that patient towards a clinical trial or off-label use of clinical therapies.

Dr. Levine on Sequencing of Agents for Ovarian Cancer

Douglas A. Levine, MD, professor, Department of Obstetrics and Gynecology, director, Division of Gynecologic Oncology, NYU Langone's Perlmutter Cancer Center, discusses immunotherapy for patients with endometrial cancer.

Immunotherapy has capitalized on what was already known regarding endometrial cancer, states Levine.

Some microsatellite instability-high tumors are inherited through a defect in mismatch-repair genes, which is important for genetic screening. There is another link between inherited genetic events that are leading to effective treatments, states Levine.

Dr. Levine on Immunotherapy for Endometrial Cancer

Douglas A. Levine, MD, professor, Department of Obstetrics and Gynecology, director, Division of Gynecologic Oncology, NYU Langone Medical Center, discusses the PARP inhibitor landscape for patients with ovarian cancer.

The PARP inhibitor landscape is getting more complex, states Levine. A main question that still faces physicians is when to use PARP inhibitors and for which types of patients.

Some of the agents are indicated only for those patients who have a germline and/or somatic mutation. Nirparib has an indication for all-comers, yet the effect of the drug is much less when an patient does not have a BRCA mutation, explains Levine.

Dr. Levine on the PARP Inhibitor Landscape for Ovarian Cancer

Douglas A. Levine, MD, professor, Department of Obstetrics and Gynecology, director, Division of Gynecologic Oncology, NYU Langone Medical Center, discusses some of the ongoing challenges that researchers need to tackle in the field of ovarian cancer.

Levine hopes that researchers will be able to stratify patients better for treatments, adding that much progress has been made for patients with 

 mutations. Additionally, physicians are working to ensure that every patient with ovarian cancer is tested for 

Secondly, there is a very aggressive group of patients who have cyclin E1 amplifications but ongoing research is exploring therapeutic approaches. However, there is another patient population that does not have the 

 mutation, a homologous recombination deficit, or a cyclin E amplification. How can researchers develop therapies that will target that group? Levine says that is what the community will see in the future.

Douglas A. Levine, MD, professor, Department of Obstetrics and Gynecology, director, Division of Gynecologic Oncology, NYU Langone Medical Center, discusses some of the ongoing challenges researchers need to tackle in the field of ovarian cancer.

Dr. Levine on Challenges in Ovarian Cancer

Douglas A. Levine, MD, professor, Department of Obstetrics and Gynecology, director, Division of Gynecologic Oncology, NYU Langone Medical Center, discusses what potential PARP inhibitors could have with chemotherapy regimens as a treatment for patients with ovarian cancer.

Combining PARP inhibitors with chemotherapy agents has been a little bit difficult, Levine says. However, an ongoing trial will explore if this strategy has actual potential. PARP inhibitors will likely show higher levels of efficacy in the recurrent setting and in combination with immunotherapy, angiogenic therapy, and possibly cell cycle inhibitors.

Additionally, there will be many PARP inhibitors to choose from over time, he explains. Researchers will begin to face big questions on where and how to give them, whether to administer them in the maintenance or treatment setting, and whether to use them early or late. Personally, Levine says, he prefers to use them early on in the treatment cycle. Further research will elaborate on whether these agents belong in the maintenance or treatment setting.

Dr. Levine on Combos With PARP Inhibitors in Ovarian Cancer

Douglas A. Levine, MD, professor, Department of Obstetrics and Gynecology, director, Division of Gynecologic Oncology, NYU Langone Medical Center, discusses the recent strides made in the treatment of patients with cervical cancer.

The highlight of the progress in the treatment of this disease, says Levine, is in prevention, particularly with the HPV vaccine. He expects that we will see a dramatic decrease in cervical cancer diagnoses as more and more people continue to receive the HPV vaccine.

As for therapeutic advancements, Levine discusses effective treatments involving angiogenic inhibitors as well as the more novel PARP inhibitors.

While cervical cancer screening continues to be highly effective and helpful for patients, ovarian cancer screening still needs further development, says Levine. Overall, though, the treatment landscape is quickly changing, and Levine believes experts in this field are succeeding in helping their patients and advancing their mission.

Douglas A. Levine, MD

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