Kathleen G. Essel, MD, gynecologic oncology fellow, Stephenson Cancer Center, University of Oklahoma, discusses the rationale to explore quantitative computed tomography (CT) image feature analysis in gynecologic cancers.

Immunotherapy is used in several gynecologic cancers; however, it is unknown which patients within each indication are the most likely to benefit from the approach. Notably, investigators in melanoma have been able to identify 4 distinct types of response to immunotherapy. The first 2 types of responses were reflective of how responses are typically evaluated after chemotherapy in gynecologic cancers, says Essel. In the latter types, investigators noted that the tumor grows before it gets smaller, or that the primary tumor shrinks and new lesions develop, even though the overall tumor burden is reduced.

These data suggest that traditional RECIST criteria are not sufficient to evaluate response to immune checkpoint inhibitors, explains Essel. As such, Essel and colleagues sought to evaluate the use of quantitative CT image feature analysis as an alternative to RECIST criteria in predicting response to immunotherapy.

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Kathleen G. Essel, MD, discusses the rationale to explore quantitative computed tomography image feature analysis in gynecologic cancers.

Dr. Essel on Rationale to Explore Quantitative CT Image Feature Analysis in Gynecologic Cancers

Kathleen G. Essel, MD, gynecologic oncology fellow, Stephenson Cancer Center, University of Oklahoma, discusses repeat exposure to PARP inhibitors in the treatment of patients with ovarian cancer.

Currently, there are no robust data on re-challenging patients with PARP inhibitors in ovarian cancer, says Essel. It is an area of active investigation, as all 3 FDA approved PARP inhibitors—olaparib (Lynparza), rucaparib (Rubraca), and niraparib (Zejula)&mdash;hold indications in the frontline maintenance setting for patients with 

The ongoing phase IIIb OReO trial will be the first study to examine re-challenging patients with PARP inhibitors, adds Essel. In the study, patients with relapsed nonmucinous epithelial ovarian cancer and a 

 mutation will be randomized to receive either maintenance re-treatment with 300 mg of twice daily olaparib (Lynparza) or placebo until radiological disease progression or unacceptable toxicity. The study began in June 2017 and has an expected completion date of May 2021.

Kathleen G. Essel, MD, gynecologic oncology fellow, Stephenson Cancer Center, University of Oklahoma, discusses repeat exposure to PARP inhibitors in the treatment of patients with ovarian cancer.
 

Dr. Essel on Repeat Use of PARP Inhibitors in Ovarian Cancer

Kathleen G. Essel, MD, fellow at the University of Oklahoma Health Science Center with the Stephenson Cancer Center, discusses the benefits of using quantitative computed tomography (CT) image feature analysis to predict response to immune checkpoint inhibitors in patients with gynecologic cancers.

In a recent trial, Essel and colleagues set out to prove the hypothesis that quantitative image feature analysis computed from CT images prior to and following the start of therapy with an immune checkpoint inhibitor would better predict patient response to treatment than conventional RECIST and immune RECIST criteria and they were successful. The analysis was found to accurately predict response to these inhibitors in patients with recurrent gynecologic cancer.

Essel says that not only is it a very useful tool, it is a cost-effective one compared with other imaging tools that have been explored, such as MRIs or PET CTs, which are also very hard to access in rural areas without many academic health centers. CTs are much more universal, she adds; they’re a quick, viable option that will help providers figure out whether a patient is responsive to treatment. Prospective clinical trials incorporating this tool into immunotherapy studies are needed, Essel concludes.

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Kathleen G. Essel, MD, gynecologic oncology fellow at the University of Oklahoma Health Science Center with the Stephenson Cancer Center, discusses the benefits of using quantitative computed tomography image feature analysis to predict response to immune checkpoint inhibitors in patients with gynecologic cancers.

Kathleen G. Essel, MD

Articles

Dr. Essel on Rationale to Explore Quantitative CT Image Feature Analysis in Gynecologic Cancers

Dr. Essel on Repeat Use of PARP Inhibitors in Ovarian Cancer

Dr. Essel on Quantitative Computed Tomography Image Feature Analysis in Gynecologic Cancers