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Expert Interviews
Gynaecological Cancers, Immunotherapy CE/CME accredited

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Experts answer questions with in-depth advice on the current clinical landscape and how new therapies and guidance might impact regional clinical practice. Useful tips below will show how to navigate the activity. Close

Guideline-based treatment of recurrent/metastatic cervical cancer

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Dr David O’Malley is director of the Division of Gynecologic Oncology within the Department of Obstetrics and Gynecology at the James Cancer Hospital and Solove Research Institute in Columbus, OH, USA, and professor in the Department of Obstetrics and Gynecology at The Ohio State University College of Medicine. read more

Dr O’Malley has over 600 peer-reviewed citations and over 220 published articles, including in the New England Journal of Medicine, Lancet, Lancet Oncology, JAMA Oncology, Nature Genetics, Nature Communications and the Journal of Clinical Oncology. He serves on multiple editorial boards and has served as a committee member for the Society of Gynecologic Oncology, a member of the Developmental Therapeutics Working Group for NRG Oncology and a panel member of the National Comprehensive Cancer Network Guidelines for Ovarian Cancer (2008–2021). He currently serves as a member of the Ovarian Cancer Working Group for NRG Oncology, on the National Cancer Institute’s Gynecologic Cancer Steering Committee’s Ovarian Task Force, and as an ovarian cancer clinical trial lead at GOG Partners. 

Dr O’Malley has been recognized as a Top Doctor since 2010. At Ohio State University, he has developed the gynaecologic oncology division into one of the premier clinical research and phase I gynaecologic oncology programmes in the country. He has led numerous clinical trials, including serving as principal investigator for multiple national and international trials.

Disclosures

Dr David O’Malley discloses: Advisory board or panel fees from AbbVie, Adaptimmune, Agenus, Arcus Biosciences, Arquer Diagnostics, AstraZeneca, Atossa Therapeutics, Boston Biomedical, Cardiff Oncology, Celcuity, Clovis Oncology, Corcept Therapeutics, DualityBio, Eisai, Elevar Therapeutics, Exelixis, Genelux, Genentech, GSK, lmmunoGen, Inc, lmvax, lnterVenn Biosciences, InxMed, Iovance Biotherapeutics, Janssen, Jazz Pharmaceuticals, Laekna, Leap Therapeutics, Luzsana Biotechology, Merck & Co, Mersana Therapeutics, MSD, Myriad Genetics, Novartis, Novocure, OncoC4, Onconova Therapeutics, Regeneron Pharmaceuticals, Replmmune, R-Pharm, Roche, Roche Diagnostics, Seagen, Sorrento Therapeutics, Sutro Biopharma, Tarveda Therapeutics, Toray, Trillium Therapeutics, Umoja Biopharma, VBL Therapeutics, Verastem Oncology, Vincerx Pharma, Xencor and Zentalis Pharmaceuticals. Grants/research support from AbbVie, Advaxis, Agenus, Alkermes, Aravive, Arcus Biosciences, Inc., AstraZeneca, BeiGene, Boston Biomedical, Bristol Myers Squibb, Clovis Oncology, Deciphera Pharmaceuticals, Eisai, EMD Serono, Exelixis, Genentech, Genmab, GSK, lmmunoGen, lncyte, Iovance Biotherapeutics, Karyopharm, Leap Therapeutics, Merck & Co, Mersana Therapeutics, MSD, Novartis, NovoCure, OncoC4, OncoQuest Pharmaceuticals, Pfizer, Precision Therapeutics, Prelude Therapeutics, Regeneron Pharmaceuticals, Roche, Rubius Therapeutics, Seagen, Sutro Biopharma, TESARO and Verastem Oncology.

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Dr Domenica Lorusso is an associate professor of obstetrics and gynecology at Fondazione Policlinico Universitario A Gemelli in Rome, Italy. read more

Dr Lorusso has been involved in gynaecological oncology research for more than 25 years and has conducted or participated in approximately 200 phase I to IV clinical trials in gynaecological malignancies. At present, she is the principal investigator of more than 60 studies. Dr Lorusso is responsible for the Clinical Trials Committee of the MITO (Multicentre Italian Trials in Ovarian Cancer and Gynaecological Malignancies) Group, which includes more than 150 Italian centres involved in gynaecological oncology research. She is member of the Board of Directors of the Gynaecological Cancer Intergroup, which includes 23 international research groups involved in the promotion and implementation of high-quality clinical trials to improve outcomes for women with gynaecological cancers. Dr Lorusso is also an active member of ENGOT (European Network of Gynaecological Oncological Trial groups), where she chairs the Gynecological Cancer Academy.

Dr Lorusso has co-authored approximately 300 international oncology publications. She is an author of national and international guidelines on the treatment of ovarian, cervical and endometrial cancer. Dr Lorusso’s key goals are to promote clinical research, international trial collaborations and education.

Dr Domenica Lorusso discloses: Advisory board or panel fees from AstraZeneca, Clovis Oncology, Corcept, Genmab, GSK, ImmunoGen, MSD, Oncoinvest, Pharmamar, Seagen and Sutro. Consultancy fees from AstraZeneca, Clovis Oncology, Corcept, Genmab, GSK, ImmunoGen, MSD, Novartis, Oncoinvent, Pharmamar, Seagen and Sutro. Grants/research support from AstraZeneca, Clovis Oncology, Genmab, GSK, ImmunoGen, Incyte, MSD, Novartis, Pharmamar, Roche and Seagen. Speakers’ bureau fees from AstraZeneca, Clovis Oncology, Genmab, GSK, ImmunoGen, MDS, Pharmamar and Seagen.

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Ms. Courtney Arn is a women’s health nurse practitioner in the Division of Gynecologic Oncology at The Ohio State University (OSU), Columbus, OH, USA. read more

After graduating from the OSU College of Nursing, Ms. Arn undertook the Women’s Health Care Nurse Practitioner Core Board Certification. Ms. Arn specializes in the treatment of women with gynaecological cancers, covering ovarian, uterine, peritoneal, endometrial, cervical, vaginal and vulval cancer.

Ms. Courtney Arn discloses: Speakers’ Bureau fees from AstraZeneca, Eisai, Genmab, GSK, Merck and Seagen.

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  • Downloads including slides are available for this activity in the Toolkit
Learning Objectives

After watching this activity, participants should be better able to:

  • Identify the most appropriate treatment for patients with recurrent/metastatic cervical cancer in line with current US guidelines
  • Discuss the treatment of recurrent/metastatic cervical cancer according to current European guidelines
  • Evaluate the safety considerations associated with immunotherapy and targeted treatments for recurrent/metastatic cervical cancer
Overview

In this activity, two oncologists specializing in cervical cancer provide an update on the latest US and European guidelines on the treatment of recurrent or metastatic disease, including the supporting clinical trial data and insights into how to select treatments in clinical practice. A women’s health nurse practitioner summarizes the key safety considerations when using immunotherapy and targeted treatments for cervical cancer.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of oncologists, gynaecologists and oncology nurses involved in the management of patients with cervical cancer.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Dr David O’Malley discloses: Advisory board or panel fees from AbbVie, Adaptimmune, Agenus, Arcus Biosciences, Arquer Diagnostics, AstraZeneca, Atossa Therapeutics, Boston Biomedical, Cardiff Oncology, Celcuity, Clovis Oncology, Corcept Therapeutics, DualityBio, Eisai, Elevar Therapeutics, Exelixis, Genelux, Genentech, GSK, lmmunoGen, Inc, lmvax, lnterVenn Biosciences, InxMed, Iovance Biotherapeutics, Janssen, Jazz Pharmaceuticals, Laekna, Leap Therapeutics, Luzsana Biotechology, Merck & Co, Mersana Therapeutics, MSD, Myriad Genetics, Novartis, Novocure, OncoC4, Onconova Therapeutics, Regeneron Pharmaceuticals, Replmmune, R-Pharm, Roche, Roche Diagnostics, Seagen, Sorrento Therapeutics, Sutro Biopharma, Tarveda Therapeutics, Toray, Trillium Therapeutics, Umoja Biopharma, VBL Therapeutics, Verastem Oncology, Vincerx Pharma, Xencor and Zentalis Pharmaceuticals. Grants/research support from AbbVie, Advaxis, Agenus, Alkermes, Aravive, Arcus Biosciences, Inc., AstraZeneca, BeiGene, Boston Biomedical, Bristol Myers Squibb, Clovis Oncology, Deciphera Pharmaceuticals, Eisai, EMD Serono, Exelixis, Genentech, Genmab, GSK, lmmunoGen, lncyte, Iovance Biotherapeutics, Karyopharm, Leap Therapeutics, Merck & Co, Mersana Therapeutics, MSD, Novartis, NovoCure, OncoC4, OncoQuest Pharmaceuticals, Pfizer, Precision Therapeutics, Prelude Therapeutics, Regeneron Pharmaceuticals, Roche, Rubius Therapeutics, Seagen, Sutro Biopharma, TESARO and Verastem Oncology.

Ms. Courtney Arn discloses: Speakers’ Bureau fees fromAstraZeneca, Eisai, Genmab, GSK, Merck and Seagen.

Dr Domenica Lorusso discloses: Advisory board or panel fees from AstraZeneca, Clovis Oncology, Corcept, Genmab, GSK, ImmunoGen, MSD, Oncoinvent, Pharmamar, Seagen and Sutro. Consultancy fees from AstraZeneca, Clovis Oncology, Corcept, Genmab, GSK, ImmunoGen, MSD, Novartis, Oncoinvent, Pharmamar, Seagen and Sutro. Grants/research support from AstraZeneca, Clovis Oncology, Genmab, GSK, ImmunoGen, Incyte, MSD, Novartis, Pharmamar, Roche and Seagen. Speakers’ bureau fees from AstraZeneca, Clovis Oncology, Genmab, GSK, ImmunoGen, MDS, Pharmamar and Seagen.

Content reviewer

Alicia Canalejo, APRN, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Contributor

Hannah Fisher has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Nurses

USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

A maximum of 0.75 contact hours may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

This activity is awarded 0.75 ANCC pharmacotherapeutic contact hour.

Date of original release: 14 December 2023. Date credits expire: 14 December 2024.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

This activity is CE/CME accredited

To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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Topics covered in this activity

Gynaecological Cancers / Immunotherapy
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touchEXPERT OPINIONS
Guideline-based treatment of recurrent/metastatic cervical cancer
0.75 CE/CME credit

Question 1/5
Based on the current NCCN and ESGO/ESTRO/ESP guidelines, what would be the preferred first-line systemic therapy for a patient with PD-L1–positive recurrent/metastatic cervical cancer with a risk of GI perforation?

ESGO, European Society of Gynaecological Oncology; ESP, European Society of Pathology; ESTRO, European Society for Radiotherapy and Oncology; NCCN, National Comprehensive Cancer Network; GI, gastrointestinal; PD-L1, programmed death-ligand 1.

The preferred first-line systemic regimen for patients with PD-L1–positive recurrent/metastatic cervical cancer recommended by the current NCCN and ESGO/ESTRO/ESP guidelines is a combination of either cisplatin/paclitaxel or carboplatin/paclitaxel + pembrolizumab ± bevacizumab.1,2 However, patients may be at an increased risk for the development of GI perforation and gall bladder perforation when treated with bevacizumab; therefore, caution should be exercised when treating these patients with bevacizumab.3

Abbreviations:

ESGO, European Society of Gynaecological Oncology; ESP, European Society of Pathology; ESTRO, European Society for Radiotherapy and Oncology; GI, gastrointestinal; NCCN, National Comprehensive Cancer Network; PD-L1, programmed death-ligand 1.

References:

  1. NCCN. Cervical cancer. V1.2024. Available at: www.nccn.org/professionals/physician_gls/pdf/cervical.pdf (accessed 21 November 2023).
  2. Cibula D, et al. Int J of Gynecol Cancer 2023;33:649–66.
  3. EMA. Bevacizumab SmPC. Available at: www.ema.europa.eu/en/documents/product-information/avastin-epar-product-information_en.pdf (accessed 21 November 2023).

 

Question 2/5
Your patient has advanced metastatic HER2-negative cervical carcinoma. You initiated first-line treatment with cisplatin/paclitaxel + pembrolizumab + bevacizumab, but their disease has progressed. Based on the 2023 NCCN guidelines, what would you select for their next line of treatment?

HER2, human epidermal growth factor receptor 2; NCCN, National Comprehensive Cancer Network.

The 2023 NCCN guidelines recommend tisotumab vedotin as a preferred regimen for the second-line or subsequent treatment of recurrent or metastatic cervical carcinoma. Trastuzumab deruxtecan is only recommended for HER2-positive tumours.

Abbreviations:

HER2, human epidermal growth factor receptor 2; NCCN, National Comprehensive Cancer Network.

Reference:

NCCN. Cervical cancer. V1.2024. Available at: www.nccn.org/professionals/physician_gls/pdf/cervical.pdf (accessed 21 November 2023).

Question 3/5
What was the median overall survival for patients with persistent, recurrent or metastatic cervical cancer in the phase III Keynote-826 study who were treated with pembrolizumab + chemotherapy + (per investigator discretion) bevacizumab?

In the KEYNOTE-826 trial, pembrolizumab + chemotherapy + (per investigator discretion) bevacizumab was associated with a median overall survival of 28.6 months in patients with PD-L1 CPS ≥1 (n=273), 29.6 months in patients with PD-L1 CPS ≥10 (n=158) and 26.4 months in the all-comer patient population (n=308).

Abbreviations:

CPS, combined positive score; PD-L1, programmed death-ligand 1.

Reference:

Monk B, et al. Presented at: 2023 ASCO Annual Meeting, Chicago, IL, USA. 2–6 June 2023. Abstr 5500.

Question 4/5
A patient with recurrent cervical cancer has disease progression after platinum-based chemotherapy and is receiving treatment with the immune checkpoint inhibitor cemiplimab. She has experienced a grade 2 adverse skin reaction. What would be the best course of action?

For most grade 2 toxicities experienced with immune checkpoint inhibitor therapy, treatment should be withheld and resumed when symptoms and/or laboratory values revert to grade ≤1. Corticosteroids at an initial dose of 0.5–1 mg/kg/d of prednisone or equivalent may be administered.

Reference:

Schneider BJ, et al. J Clin Oncol. 2021;39:4073–126.

Question 5/5
Your patient with metastatic cervical cancer has just started tisotumab vedotin therapy. To reduce the risk of adverse events associated with tisotumab vedotin, which of the following tests should you perform at baseline?

Ocular toxicity (predominantly conjunctival and corneal AEs, dry eye and blepharitis) is an adverse event of special interest with tisotumab vedotin. To help mitigate risk and manage ocular adverse events, patients receiving tisotumab vedotin should undergo ophthalmic exams at baseline, prior to each dose and as clinically indicated.1,2

Abbreviation:

MRI, magnetic resonance imaging.

References:

  1. Arn CR, et al. J Adv Pract Oncol. 2023;14:139–52.
  2. FDA. Tisotumab vedotin PI. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2021/761208Orig1s000lbledt.pdf (accessed November 2023).
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