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!