Immunotherapy in ovarian cancer: we are not there yet

With the disappointment brought by modest results of trials testing single-agent immune checkpoint inhibitors in recurrent ovarian cancer, 1 Disis ML Taylor MH Kelly K et al. Efficacy and safety of avelumab for patients with recurrent or refractory ovarian cancer: phase 1b results from the JAVELIN solid tumor trial. JAMA Oncol. 2019; 5: 393-401 Crossref PubMed Scopus (149) Google Scholar , 2 Varga A Piha-Paul S Ott PA et al. Pembrolizumab in patients with programmed death ligand 1-positive advanced ovarian cancer: analysis of KEYNOTE-028. Gynecol Oncol. 2019; 152: 243-250 Summary Full Text Full Text PDF PubMed Scopus (91) Google Scholar renewed optimism arose around the possibility that combination treatments would deliver the positive results the community was waiting for. Surely, there would be a way to enhance the activity of immunotherapy in recurrent ovarian cancer, a setting in which progress had remained elusive. In other tumour types, chemotherapy had been shown to induce antigen presentation, priming tumour cells to become receptive to the immune attack triggered by PD-L1 inhibitors and yielding improved clinical outcomes. 3 Shu CA Gainor JF Awad MM et al. Neoadjuvant atezolizumab and chemotherapy in patients with resectable non-small-cell lung cancer: an open-label, multicentre, single-arm, phase 2 trial. Lancet Oncol. 2020; 21: 786-795 Summary Full Text Full Text PDF PubMed Scopus (106) Google Scholar , 4 Gandhi L Rodríguez-Abreu D Gadgeel S et al. Pembrolizumab plus chemotherapy in metastatic non-small-cell lung cancer. N Engl J Med. 2018; 378: 2078-2092 Crossref PubMed Scopus (2528) Google Scholar Those data revitalising the field of immunotherapy in solid tumours provided the rationale for also testing immune checkpoint inhibitors with chemotherapy in ovarian cancer. Avelumab alone or in combination with chemotherapy versus chemotherapy alone in platinum-resistant or platinum-refractory ovarian cancer (JAVELIN Ovarian 200): an open-label, three-arm, randomised, phase 3 studyNeither avelumab plus PLD nor avelumab alone significantly improved progression-free survival or overall survival versus PLD. These results provide insights for patient selection in future studies of immune checkpoint inhibitors in platinum-resistant or platinum-refractory ovarian cancer. Full-Text PDF