Why progress on ovarian cancer treatments is slow

We hear the safety instructions every time we fly – secure your own oxygen mask before assisting your children. This advice serves as a powerful metaphor for women's health. Just as an oxygen mask is vital for survival in an emergency, proactive health monitoring is essential for a woman’s long-term wellbeing.

In the case of ovarian cancer, early detection is critical to survival, yet, it is not as prominently publicised as breast cancer awareness. The numbers put into perspective the desperate need to advance research in this field, patient advocacy, early detection methods, and education. In the US, about 20,000 women are diagnosed with ovarian cancer each year and it is the leading cause of death from gynaecologic cancers, according to the Centers for Disease Control.

Although ovarian cancer accounts for only about 3% of all cancers in women, it ranks fifth for cancer deaths among women.

Early detection and diagnosis of ovarian cancer are crucial because, when it is caught early, the five-year survival rate is about 93%. However, according to the American Cancer Society, 75% of ovarian cancer is diagnosed at a late stage where the five-year survival rate is only 20-30%. Research needs to be directed toward developing effective screening methods, and patients and physicians should understand the early signs and symptoms of ovarian cancer. This is particularly important in women who are at a higher risk, including women over 50, those with a family history of ovarian cancer, carriers of genetic mutations such as BRCA1 and BRCA2, and women who have had other cancers. Effective screening and vigilance in these groups are paramount to improving early detection rates.

Market dynamics and treatment advances

Platinum-based therapy is commonly used to treat advanced cases of ovarian cancer. In fact, the global market size for platinum-based ovarian cancer treatment was about $618 million in 2021 and is estimated to grow to almost $1 billion by 2030. This growth is primarily driven by the increasing prevalence of ovarian cancer, but also the rising demand for platinum-based therapy in combination with targeted treatments that aim to address the disease's heterogenous nature, including tumor genetics and disease stage. Developing novel therapies is expected to continue to grow the market over the coming years.

While research and development has resulted in better treatment options for women with ovarian cancer, there are still many women who do not have suitable options. This means there is an opportunity to develop alternate, potentially more effective, treatments for ovarian cancer within the current landscape.

Ovarian cancer treatment hinges on disease stage and subtype. Typically, debulking surgery plus platinum-based chemotherapy is the frontline treatment. While not curative, this strategy offers symptom relief and modest survival benefits. In recent years, there have been exciting advancements in ovarian cancer treatment, particularly in targeted therapies. Notable targeted drugs include Avastin (bevacizumab, anti-VEGF mAb) and poly-ADP ribose polymerase (PARP) inhibitors, which have been demonstrated to significantly improve survival rates when used with chemotherapy.

Emerging treatment options, such as antibody-drug conjugates (ADCs) like AbbVie's Elahere (mirvetuximab, FRα targeting ADC), offer hope for patients with previously limited treatment options. With multiple companies following suit and investing significantly into ADC development, it is likely that the ovarian cancer treatment landscape will continue to expand in the coming years.

Individualised therapies are also gaining traction. Genelux Corp’s oncolytic virus, olvi-vec, which targets and replicates within tumor cells, is currently in the Phase 3 OnPrime trial. Despite the challenges faced by cell and gene therapies in solid tumours, this innovative approach holds promise.

Ongoing clinical trials

Merck is conducting the Phase 3 Keylynk-001 trial investigating the efficacy of its leading oncology drug, Keytruda (pembrolizumab, anti-PD-L1) plus chemotherapy followed by maintenance treatment with Merck/AstraZeneca’s Lynparza (olaparib, PARP inhibitor), as a primary treatment for women with advanced epithelial, platinum-sensitive, ovarian cancer lacking BRCA mutations. Participants with platinum-sensitive ovarian cancer are expected to respond well to treatment, and thus will be monitored for progression-free survival for 57 months. However, concerns around the possibility of high-grade AEs remain, given that Lynparza’s label details the possibility of myelodysplastic syndrome or acute myeloid lymphoma.

Another critical area of focus is platinum-resistant ovarian cancer. Corcept Therapeutics is conducting the Phase 3 Rosella trial, which evaluates the combination of relacorilant, an oral selective glucocorticoid receptor modulator, with nab-paclitaxel. This combination aims to enhance efficacy without increasing toxicity, with results anticipated in the latter half of 2024.

Disparities and challenges in clinical trials

Despite significant efforts in developing novel and effective treatments, last year alone 11 ovarian cancer-focused clinical trials were halted, including five Phase 3 trials. This represents a considerable setback, as Phase 3 trials are typically the final step before a new treatment can receive approval for public use.

The benefits and insights gained from clinical trials are not equally shared among all cancer patients. Recent research shows, for instance, that Latino and African American patients are less likely to participate in ovarian cancer clinical trials. Medicaid and Medicare patients have also historically been underrepresented. The same research shows that only 5% of women with ovarian cancer are participating in trials. Understanding potential disparities in enrolment is essential for designing interventions to improve participation and survival rates in ovarian cancer.

The need for innovation

Early detection is as important as innovation to help women “put their oxygen mask on first” when it comes to fighting ovarian cancer. While advancements in therapeutic approaches highlight significant progress, better diagnostic tools and patient advocacy must be part of combating ovarian cancer and addressing the substantial unmet needs within the field.

These are the early days of innovations expected to transform the treatment landscape. With a growing market for personalised medicine, adaptability and foresight can help companies navigate the swiftly evolving ovarian cancer space.

About the authors

Stylianos Sarrigiannidis is a senior business analyst with Lifescience Dynamics, a company focused on helping optimise clinical and commercial strategies in the biopharma industry. Before joining Lifescience Dynamics, Sarrigiannidis completed a PhD in Biomedical Engineering at the University of Glasgow where he investigated drug delivery mechanisms, tissue regeneration, and biomaterials. While working at Lifescience Dynamics, he has been growing his subject matter expertise in various therapeutic areas, including oncology.

Mallory Wiggans is a business analyst with Lifescience Dynamics, a company focused on helping optimise clinical and commercial strategies in the biopharma industry. Wiggans aims to understand and provide insights on the dynamic treatment landscapes of various therapeutic areas, including gynaecological cancers. Before joining Lifescience Dynamics, Wiggans completed a PhD in Molecular Genetics at the University of Toronto where she investigated stem cell involvement in cancer.