Understanding the Pembrolizumab Treatment Combo in Platinum-Resistant Ovarian Cancers

Following the FDA’s approval of pembrolizumab (Keytruda) or pembrolizumab and berahyaluronidase alfa-pmph (Keytruda Qlex) plus paclitaxel with or without bevacizumab (Avastin) for the treatment of patients with platinum-resistant ovarian cancers (PROC), Emese Zsiros, MD, PhD, FACOG, shared that patients struggling with paclitaxel-related toxicities may have to switch to pembrolizumab/bevacizumab maintenance.

Zsiros noted that while the weekly paclitaxel backbone in this combination therapy for patients with PROC presents expected toxicities such as neuropathy and fatigue, patients can successfully transition to maintenance with pembrolizumab and bevacizumab after significant paclitaxel exposure to achieve favorable clinical outcomes.

As the chair of the Department of Gynecologic Oncology at Roswell Park Comprehensive Cancer Center in Buffalo, New York, Zsiros shared her clinical experience with the trial, highlighting the cumulative nature of adverse effects such as hair loss and fatigue associated with standard-of-care paclitaxel.

She emphasized that the trial allowed for the discontinuation of the chemotherapy component if toxicities became significant, typically after the first 3 to 5 months. According to Zsiros, patients who transitioned to the maintenance phase, consisting of pembrolizumab with or without bevacizumab, demonstrated positive responses even after the paclitaxel was stopped.

This flexibility in treatment management is crucial for oncology nurses and advanced practice providers as they navigate the balance between therapeutic efficacy and patient quality of life. By monitoring these expected cumulative adverse effects, providers can help ensure patients remain on effective maintenance therapies longer.

Transcript

This is a weekly paclitaxel backbone, so patients will experience additional [adverse] effects from the Taxol, such as neuropathy, fatigue, and hair loss, which [accumulate] over time. This is expected as part of the standard-of-care regimen; even patients in the control arm receiving weekly Taxol plus or minus bevacizumab similarly experienced these [adverse] effects. Unfortunately, these [adverse] effects do not go away with the combination.

However, in the clinical trial, if a patient had [adverse] effects from the weekly Taxol, the Taxol was allowed to be discontinued. There were several patients who used Taxol for the induction phase in combination with pembrolizumab, weekly Taxol, and bevacizumab. Once they had significant toxicity from the Taxol exposure, they were allowed to continue on the pembrolizumab plus or minus bevacizumab. In my clinical practice, I enrolled many patients in this trial. There were many who only received weekly Taxol for the first 3 to 5 months before stopping that regimen and were able to continue with pembrolizumab plus or minus bevacizumab as maintenance. I have seen really favorable outcomes in those cohorts of patients.

This transcript has been edited for clarity and conciseness.