Gynecologic cancers that recur are typically treated as chronic diseases. Increasingly, oncologists at Fox Chase Cancer Center are turning to immunotherapy as a powerful option for chronic endometrial, cervical, and ovarian cancer management.

Immunotherapy is a type of treatment that helps the body fight cancer more effectively. While the immune system normally works to destroy harmful invaders, cancer cells have ways of disguising themselves to evade destruction and continue to grow and spread. Immunotherapy trains the immune system to better identify cancer cells—and eliminate them.

OPTIONS FOR RECURRING GYNECOLOGIC CANCER

“Immune checkpoint inhibitors such as pembrolizumab are the primary immunotherapies used for recurring endometrial, cervical, and ovarian cancers,” said Gina M. Mantia-Smaldone, MD, a gynecologic oncologist at Fox Chase Cancer Center. These inhibitors work by targeting immune system checkpoints, which cancer cells can use to avoid being attacked by the immune system. Pembrolizumab targets the T-cell protein PD-1, which may enhance a patient’s immune response to cancer cells to shrink tumors or slow their growth.

Individual patients may respond to different immune checkpoint inhibitors—and some may not respond at all. For pembrolizumab to be effective, a patient’s tissue or tumor needs to have biomarkers for the protein PDL-1.

MAKING THE MATCH SOONER

“Where a patient starts their initial treatment for a gynecologic cancer can affect the speed and success
at which recurrences are treated later on,” stated Mantia-Smaldone. Though immune checkpoint inhibitors like pembrolizumab are reserved for gynecologic cancers that recur, patients at Fox Chase undergo genetic and genomic testing while starting their initial treatment.

“We’re always thinking five steps ahead, so we look at each patient and evaluate them from the beginning,” said Kathleen J. Smith, MSN, CRNP, ANP-BC, AOCNP, a nurse practitioner at Fox Chase. “If we have to retreat, we can be more prepared up front.”

SIDE EFFECT MONITORING

Patients receiving immunotherapy should be monitored closely by experts who are trained to spot side effects early and manage them effectively so treatment can continue. Immunotherapies may hyperstimulate the immune system and cause symptoms, including rashes or diarrhea. However, serious inflammatory responses can potentially occur, particularly in patients with conditions such as type 2 diabetes, hypertension, or an autoimmune disorder.

IMMUNOTHERAPY AT FOX CHASE

The specialists at Fox Chase Cancer Center have the knowledge and expertise to treat gynecologic cancers with immunotherapy effectively for the most successful outcome. “We can typically get responses for three to six months, and other patients do remarkably well for years,” Smith said. Our proactive approach identifies patients who may benefit from immunotherapy early on, so even those starting primary treatment have a preparedness plan for recurrences.

Patients at Fox Chase also gain access to advice from multiple leading gynecologic cancer experts, who meet weekly to discuss treatment decisions for both primary and recurring cancers. “Our multidisciplinary board includes physicians, fellows, pathologists, radiologists, radiation oncology, social workers, and palliative care,” Smith explained. “A patient is getting six or seven experts working on their case at one time.”

Should a patient develop side effects, our physicians and nurses are uniquely qualified to identify and manage potential issues and collaboratively coordinate a patient’s care—all possible because Fox Chase is a leading research and clinical institution.

“We care for these people in clinical trials, so we’ve seen the side effects. And we have the ability to manage them in a comprehensive way,” Smith said.