Paradigm change in urological, gynaecological and breast cancer management: A new practice-changing data from ASCO 2022 annual meeting

Changing medical practice has been a constant process based on many scientific findings for years. In the oncology community, the American Society of Clinical Oncology (ASCO), one of the major annual conferences, presented the latest updates on practice-changing in cancer. At the recent meeting of 2022, held this year on June 2-6, researchers presented essential findings in urological, gynecological, and breast cancer management. In urological cancer, olaparib + abiraterone was demonstrated thru the PROpel trial to benefit in first-line treatment mCRPC regardless of the HRR stratification factor, along with the adjuvant therapy everolimus, for fully resected RCC in the EVEREST trial. In gynecological cancer, tisotumab vedotin demonstrated a potential role in improving clinical outcomes in 1st line r/mCC thru InnovaTV-205. In breast cancer, trastuzumab deruxtecan showed significant benefit for redefined human epidermal growth factors receptor 2 status in HER2 low BC patients, where current targeted-HER2 therapies are ineffective in the DESTINY-BREAST 04 study. The use of Immuno-based combinations in the medical management of TNBC patients has been supported thru several recent studies, showing positive results and outcomes, as demonstrated by the expert's opinions in Rizzo et al. research papers. In this article, we resumed the different renowned and what we considered intriguing to review studies presented during these three long sessions at the ASCO 2022 meeting.

Antibody-Drug Conjugate Targets, Drugs and Linkers

Antibody-drug conjugates offer the possibility of directing powerful cytotoxic agents to a malignant tumor while sparing normal tissue. The challenge is to select an antibody target expressed exclusively or at highly elevated levels on the surface of tumor cells and either not all or at low levels on normal cells. The current review explores 78 targets that have been explored as antibody-drug conjugate targets. Some of these targets have been abandoned, 9 or more are the targets of FDA-approved drugs, and most remain active clinical interest. Antibody-drug conjugates require potent cytotoxic drug payloads, several of these small molecules are discussed, as are the linkers between the protein component and small molecule components of the conjugates. Finally, conclusions regarding the elements for the successful antibody-drug conjugate are discussed.

Tisotumab Vedotin: First Approval

Tisotumab vedotin (Tivdak™) is an antibody-drug conjugate comprising a fully human monoclonal antibody specific for tissue factor (TF-011) conjugated to monomethyl auristatin E (MMAE) that has been engineered to target tissue factor expressing tumours. Based on the results of a phase II trial, tisotumab vedotin has been granted accelerated approval in the USA for the treatment of adult patients with recurrent or metastatic cervical cancer with disease progression on or after chemotherapy. This article summarizes the milestones in the development of tisotumab vedotin leading to this first approval.

Exploiting somatic alterations as therapeutic targets in advanced and metastatic cervical cancer

It is estimated that 604,127 patients were diagnosed with cervical cancer worldwide in 2020. While a small percentage of patients will have metastatic disease at diagnosis, a large percentage (15-61%) later develop advanced disease. For this cohort, treatment with systemic chemotherapy remains the standard of care, with a static 5-year survival rate over the last thirty years. Data on targetable molecular alterations in cervical cancer have lagged behind other more common tumor types thus stunting the development of targeted agents. In recent years, tumor genomic testing has been increasingly incorporated into our clinical practice, opening the door for a potential new era of personalized treatment for advanced cervical cancer. The interim results from the NCI-MATCH study reported an actionability rate of 28.4% for the cervical cancer cohort, suggesting a subset of patients may harbor mutations which that are targetable. This review sets out to summarize the key targeted agents currently under exploration either alone or in combination with existing treatments for cervical cancer.

Immunotherapy in gynecological cancers

Immunotherapy has changed the natural history of several malignancies that, a decade ago, had a very poor prognosis, such as lung cancer and melanoma. Consequently, many attempts have been done to expand the indications of immunotherapy agents, predominantly immune checkpoint inhibitors (ICIs), in other cancers, including gynecological malignancies. Alongside promising results in cervical and endometrial neoplasms, there are not clear data on the benefit of ICIs as single agent or in combination with antiangiogenic agents in ovarian cancer (OC) and ongoing trials are focusing on combining ICIs with standard chemotherapy or PARP inhibitors. This chapter summarized the evidences of ICIs in gynecological malignancies and report the ongoing trials in cervical, endometrial and OC.