Radiopharmaceutical Switch Maintenance for Relapsed Ovarian Carcinoma.

Charles Kunos,Jacek Capala

doi:10.3390/ph13100287

Abstract

Switch maintenance, or using alternative therapeutic agents that were not administered during a prior course of cancer treatment, has emerged as an active clinical research and regulatory agency-approvable path in the National Cancer Institute (NCI) Cancer Therapy Evaluation Program (CTEP) drug-development sequence. To better inform the design of therapeutic radiopharmaceutical trials, we reviewed academic scholarship discussing the clinical use of maintenance approaches to cancer treatment. Women with advanced-stage primary platinum-refractory or platinum-resistant ovarian carcinoma and their courses of treatment provide context for our discussion. Twenty-four (10%) out of 244 trials for women with ovarian carcinoma fit our search terms for maintenance trials. Five (2%) trials studied radiopharmaceuticals as switch maintenance. In our opinion, radiopharmaceutical switch maintenance merits further testing in prospective trials for women with advanced-stage primary platinum recurrent or refractory ovarian carcinoma.

Highlights

In 2020, one percent (21,750 women) of all new cancer cases in the United States are women newly diagnosed with ovarian carcinomas [1]
A switch maintenance approach for primary platinum-refractory ovarian carcinoma has gained interest and recent regulatory approval [5,6]. Such an approach largely fits into one of two therapeutic strategies—(i) a switch maintenance strategy, whereby after conventional first-line therapy patients are switched to an alternative agent or combination of agents until disease progression, or (ii) a continuation maintenance strategy, whereby one treatment of the first-line is continued past its standard duration alone or in a new combination until disease progression [7]
Radioimmunotherapy trials establish a foundation upon which generation therapeutic radiopharmaceutical maintenance trials can be designed

Summary

Introduction

In 2020, one percent (21,750 women) of all new cancer cases in the United States are women newly diagnosed with ovarian carcinomas [1]. There is an unmet therapeutic need for safe and effective treatment for an estimated 5438 (25% [4]) newly diagnosed American women each year whose ovarian carcinoma falls into the primary platinum-refractory disease category. A switch maintenance approach for primary platinum-refractory ovarian carcinoma has gained interest and recent regulatory approval [5,6] Such an approach largely fits into one of two therapeutic strategies—(i) a switch maintenance strategy, whereby after conventional first-line therapy patients are switched to an alternative agent or combination of agents until disease progression, or (ii) a continuation maintenance strategy, whereby one treatment of the first-line is continued past its standard duration alone or in a new combination until disease progression [7]. A maintenance strategy might more broadly squeeze between prior-line and next-line treatment, such that radiopharmaceuticals are not necessarily boxed-in by first-line and second-line therapies (Figure 1)

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Discussion

Conclusion