Biomarkers Predict Response to Treatment in Cervical and Endometrial Cancers

PTCE would like to acknowledge Merck Sharp & Dohme Corp. and Eisai Inc. for their generous support of pharmacist education.

In a live virtual symposium presented at the 2020 ASHP Midyear Clinical Meeting and Exhibition, the dynamic duo Allison Baxley, PharmD, BCOP, and Laura Alwan, PharmD, BCOP, engaged pharmacists in learning about the role of biomarkers in cervical and endometrial cancers in their presentation titled Advanced or Metastatic Cervical and Endometrial Cancers: The Pharmacist’s Role in Caring for Patients on Targeted and Immunotherapies.

Dr Baxley kicked off the session with a review of the incidence, pathophysiology, risk factors, and prognosis of cervical and endometrial cancers. She described the role of surgery, radiation, and systemic therapy in the management of both cancers. Dr Baxley noted biomarker analysis is not necessary in treatment of early-stage, curative-intent cervical cancer; however, it should be considered for patients with recurrent, progressive, or metastatic cervical and endometrial cancers. Programmed cell death-ligand 1 (PD-L1) is an important biomarker in cervical cancer, whereas human epidermal growth factor 2 (HER2) is a poor prognostic factor in endometrial cancer. Other relevant biomarkers in both cervical and endometrial cancer include:

• Microsatellite instability (MSI-H)/deficient mismatch repair (dMMR)
• Tumor mutational burden (TMB)
• Neurotrophic tyrosine receptor kinase (NTRK) gene fusion

Dr Baxley explained that patients with cervical and endometrial cancers and an NTRK mutation may benefit from entrectinib or larotrectinib in the second-line treatment setting. Patients with PD-L1, MSI-H/ dMMR or TMB-high expression may benefit from pembrolizumab in the second-line setting. She also highlighted the role of pembrolizumab plus lenvatinib in endometrial cancer. Additionally, vascular endothelial growth factor (VEGF) is often overexpressed in endometrial cancer, and though testing is not generally done, the VEGF inhibitor bevacizumab is often used either with chemotherapy or as monotherapy after disease progression on prior therapy. Dr Baxley explained that trastuzumab is not beneficial as a single agent; however, the National Comprehensive Cancer Network (NCCN) Guidelines recommend addition of trastuzumab to combination chemotherapy in patients with HER2+ stage III/IV endometrial cancer.

Dr Alwan shifted gears to focus on the role of pharmacists in cervical and endometrial cancers. She emphasized the need for educating patients on risk reduction and prevention strategies, recognizing common and rare adverse effects (AEs) of therapy, providing patient education on cancer therapy, and communicating with the multidisciplinary team to ensure patients have appropriate care and monitoring plans. She highlighted updates to human papillomavirus (HPV) vaccination recommendations in 2019 and changes to cervical cancer screening in 2020 before focusing on treatment-associated AEs. Dr Alwan thoroughly reviewed immune-related adverse events as well as management strategies for AEs associated with specific agents, including bevacizumab and trastuzumab. She wrapped up the session with a final discussion of multikinase inhibitor AEs and appropriate management.