Immunotherapy Combination Shows Promise in Advanced Ovarian Cancer

Jeffrey Wasser, MD

Jeffrey Wasser, MD

Marcia Goglia was given a laxative and sent home from the emergency department after doctors told her that the extreme stomach pain she was feeling was likely constipation. But knowing that something was indeed wrong, Goglia followed-up with a gastroenterologist. It turns out, she was right. Goglia had been misdiagnosed and the pain she was experiencing was ovarian cancer. The news was not something she expected to hear. Even less so that it was already stage III and beginning to spread.

Goglia, 64, of Middletown, Connecticut, had no family history or genetic predisposition to ovarian cancer. She attributes the disease to just “plain old bad luck.”

Ovarian cancer, in its early stages, often has no symptoms or they may not be obvious to the disease. Women many experience symptoms such as bloating, frequent urination, loss of appetite, abdominal pain, fatigue, heartburn or constipation. When caught early and treated, the 5-year survival rate is greater than 90%. However, in advanced stages or recurrence of the disease the odds are worse: the 5-year survival rate at stage III is 39%.

Goglia underwent the standard surgery, followed by chemotherapy at The Carole and Ray Neag Comprehensive Cancer Center at UConn Health in Farmington. When the chemotherapy stopped working, her doctors attempted different chemotherapy combinations. They tried this unsuccessfully for more than a year. That’s when Goglia’s gynecologic oncologist at UConn Health mentioned a clinical trial.

This clinical trial was evaluating the combination of two immunotherapies, pembrolizumab and the experimental agent epacadostat, an orally available hydroxyamidine and inhibitor of indoleamine 2,3-dioxygenase (IDO1), with potential immunomodulating and antineoplastic activities that targets and binds to IDO1.

A few months into the trial, Goglia’s tumors had all shrunk, and the tumor on her liver was gone. Additionally, the cancer markers in her blood were low.

Goglia calls the trial “a miracle” and says if it weren’t for the team at UConn Health, she “might not be here right now.” There is still a long way to go for Goglia, but the trial and its therapy have given her hope.

This ECHO-202 clinical trial is showing positive results of Keytruda plus epacadostat: the combination is well tolerated and has promising clinical activity. The regimen will be further evaluated in a phase III trial (NCT02752074) that is currently recruiting patients with unresectable or metastatic melanoma.

Goglia recommends that patients with advanced cancers should consider clinical trials. “If your traditional cancer treatment isn’t working, don’t be afraid to pursue your clinical trial options,” she says.

“By enrolling in a clinical trial, a person may be helping their own health,” says Jeffrey Wasser, MD, principal clinical investigator at Neag Cancer Center. “But they are also helping others by contributing to the advancement of potential and promising cures going forward.”