ESMO Preceptorship Programme
A case of anti-PD1 treatment in platinum-resistant ovarian
cancer
ELEONORA GHISONIESMO Clinical Unit Visit Fellow Division of Medical Oncology-1 The Royal Marsden NHS Foundation Trust IRCCS Candiolo
London, UK Torino, Italy
Immuno-Oncology - Zurich, Switzerland – 02-03 November 2018
ESMO PRECEPTORSHIP PROGRAMME
Disclosures
• ESMO Clinical Unit Visit Fellowship 2017 supported by Roche
ESMO PRECEPTORSHIP PROGRAMME
S.K. 48 years old� Nov 2013: diagnosed with FIGO stage IIIC clear cell ovarian carcinoma, CA-125
secretor
� Dec 2013 – Apr 2014: primary debulking surgery (R=0) and adjuvant chemotherapy with3wCarboplatin-Taxol + Bevacizumab
� Apr 2014 – Dec 2014: completed Bevacizumab manteinance
� Sept 2015: first recurrence in retroperitoneal and left supraclavicular lymphnodes,platinum-sensitive (PFI 17 months)
� Oct 2015 – Jan 2016: II line CT Carboplatin-Gemcitabine (6 cycles) withradiological PR
� Apr 2016: PD (para-aortic and supra-diaphragm lymphnodes)
Second platinum-resistant recurrence (PFI 3 months)
Genetic analysis: BRCA1-2 wt, RAD51C mut, MSS
ESMO PRECEPTORSHIP PROGRAMME
� 15 Jun 2016: started anti-PD1 treatment in a phase 1 clinical trialwith PR after 3 cycles
� Nov 2016 (5° cycle): skin toxicity G2
patient started topical steroids with promptly resolution to G1and continued on anti-PD1 treatment
� 10 Apr 2017 (12° cycle): DM type 1 onset
withold ICPi treatment and started insulin substitution therapy
Anti-PD1 treatment: chapter I
Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
Annals of Oncology 28 (Supplement 4): iv119–iv142, 2017.
ESMO PRECEPTORSHIP PROGRAMME
Anti-PD1 treatment: chapter II� 2 May 2017: lab results evidenced ALT 301, AST 200, GGT 144
autoimmune hepatitis G3: discontinued treatment
patient was admitted and started steroids 1mg/kg i.v. for 3 days (65mg tot),
then started tapering but promptly needed re-escalation
26 Jun 2017: added mycofenolate 1,5 mg x2/day as steroid-spairing agent
and gradually reduced oral steroids
Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
Annals of Oncology 28 (Supplement 4): iv119–iv142, 2017.
negative
ESMO PRECEPTORSHIP PROGRAMME
Anti-PD1 treatment: chapter III
� 12 Dec 2017: patient in good general condition, ECOG 0
Skin toxicity G1, DM type 1 still insulin-dependent, autoimmune hepatitis
G1 still on treatment with steroids 5 mg/day.
RECIST 1.1 evaluation:
PR (-60% target lesions)
at 7 months since study-treatment discontinuation in
platinum-resistance EOC setting…
ESMO PRECEPTORSHIP PROGRAMME
� Should clear cell OC considered a separate entity?
� Do a big toxicity correlate with a big response?
� What about adding PARP inhibition (combination ormanteinance)?
Discussion
ESMO Preceptorship Programme
Thank you for your attention!