Treating Gynecologic Cancers With Immunotherapy
Gynecologic cancers are often difficult to diagnose and many times challenging to treat. Physicians and researchers at Moffitt Cancer Center are combining efforts to explore ways to harness the body’s immune system to better fight gynecologic cancers.
"There’s a limit to how far we can advance the treatment of cancer with chemotherapy, but with immunotherapy there isn’t a limit," said Dr. Robert Wenham, chair of the Gynecologic Oncology Program at Moffitt. "Instead of drugs that target a specific defect that may not be present in every cancer cell, or nonspecifically targeting the DNA of only quickly-growing cancer cells, immunotherapies can unleash an army of immune cells to constantly seek out and destroy cancer cells."
The Gynecologic Oncology Program is actively participating in immunotherapy trials involving:
- checkpoint inhibitors
- vaccine therapy
- and cellular therapy
A checkpoint inhibitor is a type of drug that blocks certain proteins made by some types of immune system cells, such as T cells, and some cancer cells. These proteins help keep immune responses in check and can keep T cells from killing cancer cells. When these proteins are blocked, the “brakes” on the immune system are released and T cells are able to kill cancer cells better.
Cervical Cancer Treatment
Doctors at Moffitt are investigating how to combine checkpoint inhibitors with other methods to treat cancer. Dr. Wenham is collaborating with radiation oncologist Dr. Kamran Ahmed on an investigator-initiated trial for cervical cancer patients with metastatic disease. The goal is to combine stimulating a patient’s immune system via checkpoint inhibitors with radiating the tumor.
Moffitt also had the first patient on an ongoing cellular therapy against cervical cancer using an enriched infusion of the patients own cancer cells that were found attacking the cancer cells within the patient’s tumor.
Ovarian Cancer Treatment
Dr. Robert Wenham
To help fight ovarian cancer, doctors and researchers at Moffitt are currently involved in investigator-initiated drug trials and vaccine trials. Dr. Wenham is leading a phase II trial which is testing the combination of checkpoint inhibitor Pembrolizumab with chemotherapy drug Paclitaxel to learn if it improves the time patients have without their tumor growing.
Dr. Wenham is also leading a large multi-institutional randomized phase II trial for a vaccine against a common protein on ovarian cancer cells called Folate Receptor Alpha. The goal is to help a patient’s body recognize ovarian cancer and keep it from coming back by building immunity against the target protein that is rarely found in healthy adult tissues, but is common in ovarian cancer tissue.
Moreover, early clinical trials are using patient T-cells that have been extracted and then engineered to recognize other specific cancer proteins.
Endometrial Cancer Treatment
Checkpoint inhibitors can be used for cancers that have a genetic abnormality called mismatch repair (MMR) deficiency. This prevents cells from fixing mistakes that occur when DNA copies itself. Checkpoint inhibitors may be an effective strategy since about a third of endometrial tumors are MMR-deficient.
Dr. Jeannie Chern and Dr. Hye Sook Chon are both leading trials testing checkpoint inhibitors in people with endometrial tumors to try and reactivate the immune system to kill the cancer.
Though immunotherapy for gynecological cancers is currently lagging behind immune-based treatments for other cancers, such as melanoma and lung cancer, Dr. Wenham says he is confident immunotherapy will play a big role in the future.
"I am actually optimistic for the first time that we may see entire groups of cancer wiped out in my lifetime," said Dr. Wenham.
