Stéphanie Lheureux, MD, PhD, is a clinician investigator in the Cancer Clinical Research Unit at Princess Margaret Cancer Centre.

Dr Lheureux on Advancements in Targeted Treatment Delivery for Ovarian Cancer

“The future is bright for [ovarian] cancer. There are a lot of potential new targets not only [directed] at cancer cells but also targeting the microenvironment. Still, a lot of questions remain that we need to answer in the future.”

Stéphanie Lheureux, MD, PhD, clinician investigator, site lead, Gynecologic Oncology, Cancer Clinical Research Unit, Princess Margaret Cancer Centre; and associate professor, Faculty of Medicine, University of Toronto, discusses emerging technological advancements in the oncology field that could optimize the delivery, timing, and sequencing of treatment for patients with ovarian cancer and other gynecologic malignancies.

The ovarian cancer treatment paradigm continues to evolve with promising advancements in targeting both cancer cells and the surrounding tumor microenvironment, Lheureux begins. However, significant questions remain that need to be addressed for further progress, she notes. One key consideration is the role of technology in optimizing cancer treatment, according to Lheureux. The ability to deliver therapies at the correct dose and timing is crucial, and advancements in this area are essential for improving patient outcomes, Lheureux emphasizes. Tools to determine the optimal sequence of treatments will help enhance therapeutic efficacy, she says.

One research focus has been antibody-drug conjugates (ADCs), which represent a new frontier in cancer therapy, Lheureux states. ADCs aim to deliver treatments directly to cancer cells, potentially increasing the therapeutic index by concentrating the effects of the drug at the tumor site and minimizing damage to healthy tissue, she explains. This targeted delivery could improve the precision and effectiveness of cancer therapies, Lheureux reiterates.

Additionally, innovation in radiation therapy is an area of great interest, especially for gynecological cancers, Lheureux continues. A notable development is the use of brachytherapy for addressing distant metastatic disease, she details. This innovative approach allows for the delivery of high-dose radiation directly to the tumor site, reducing the effect on surrounding healthy tissues, Lheureux explains. Overall, despite considerable excitement around these treatment innovations, there remains much to explore in terms of refining treatment delivery and improving outcomes, she concludes.

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Stéphanie Lheureux, MD, PhD, discusses technological advancements in ovarian cancer that could optimize treatment delivery, timing, and sequencing.

Dr Lheureux on the Evolution of ADCs Since Mirvetuximab Soravtansine in Ovarian Cancer

"What is interesting [with] these new ADCs that [are] being developed is that the biomarker assessment is a little bit different. For mirvetuximab soravtansine, we know that the biomarker was based on the intensity and the percentage of expression. That [cutoff] is a little bit different with new ADCs, so [it may enable] potentially more patients to be eligible for this specific [type of] drug."

Stéphanie Lheureux, MD, PhD, clinician investigator, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, discusses the evolution of antibody-drug conjugates (ADCs) since mirvetuximab soravtansine-gynx (Elahere) in ovarian cancer.

Mirvetuximab soravtansine was the first ADC to receive an indication in ovarian cancer. The drug was granted accelerated approval in November 2022 for the treatment of patients with folate receptor–alpha (FRα)–positive, platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer, who have received 1 to 3 prior lines of systemic therapy. The accelerated approval was converted to full approval in March 2024. 

The approval of mirvetuximab soravtansine has set the stage for further development of ADCs in ovarian cancer, some of which contain different antigens, payloads, and linkers, Lheureux explains. She adds that patients may coexpress potential targets of interest for ADCs; this is an area in which more data are needed to determine which marker to target first in the sequence of therapy. Additional work is required to tease out whether patients who are not traditionally thought of as being chemotherapy sensitive may benefit from FRα-directed ADCs given that FRα expression may be expressed outside of high-grade histology, Lheureux says.

As research continues, it will be interesting to see whether biomarkers of response are needed for new ADCs as with mirvetuximab soravtansine. If the efficacy of newer ADCs is not tied to a specific expression threshold, that may potentially extend the reach of these agents to patients who would have previously been ineligible to receive them, Lheureux explains. Ultimately, more time is needed to better understand and weigh the safety and efficacy of these agents, Lheureux adds. To that end, significant work is underway to define the optimal dose that is needed for these agents, Lheureux concludes. 

Stéphanie Lheureux, MD, PhD, discusses the evolution of antibody-drug conjugates since mirvetuximab soravtansine in ovarian cancer. 

Stéphanie Lheureux, MD, PhD

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Dr Lheureux on Advancements in Targeted Treatment Delivery for Ovarian Cancer

Dr Lheureux on the Evolution of ADCs Since Mirvetuximab Soravtansine in Ovarian Cancer