A drug that gained fame as a treatment for certain types of lung cancer is showing its mettle against cancer of the vulva as well.
In a recent clinical trial, investigators led by Dana-Farber's Neil Horowitz, MD, and Ursula Matulonis, MD, found that the drug Tarceva temporarily stalled or reversed the growth of squamous cell vulvar cancers in some women with the disease. The trial marked the first time a "targeted" therapy, which aims at a specific abnormal protein in cancer cells, has been tested in patients with vulvar cancer.
The results are particularly welcome in a disease which, because of its relative rarity, hasn't received as much research funding as other cancers. Every year, an estimated 4,000 women in the United States are diagnosed with the disease, and 1,000 die of it. While many patients can be cured by a combination of surgery and chemotherapy or radiation therapy, others — particularly those whose cancer has metastasized to other parts of the body — don't fare as well.
The trial sprang from the discovery that vulvar cancer cells often have an increased expression of a protein known as EGFR — the same protein found in excess in non-small cell lung cancers (NSCLCs), and the very protein targeted by Tarceva. When used in certain patients with NSCLC, Tarceva often produces remissions that last well over a year.
"The results in non-small cell lung cancer caused us to ask whether Tarceva could have an effect in vulvar cancer patients as well," Dr. Horowitz says. The trial included patients whose cancer was limited to the vulva as well as those whose cancer had spread. Almost 28 percent of the participants had a “partial response” to Tarceva — meaning their tumors measurably shrank — and 40 percent had no worsening of the disease.
Although these benefits generally lasted only a few months, they demonstrate the promise of targeted drugs for a disease which remains very difficult to treat once it has spread beyond its site of origin, Dr. Horowitz remarks. Encouragingly, all the participants whose tumor cells had surplus EGFR had a partial response or stable disease when treated with Tarceva.
Pending additional funding, Dr. Horowitz hopes to test Tarceva in combination with drugs that can starve tumors of an adequate blood supply.
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