Gynecologic Cancer -- Clinical Research Program

Our gynecologic research team is working to develop the latest treatments for cancers of the ovaries, cervix, uterus, vulva, and vagina. We are also at the forefront of research on gestational trophoblastic disease and uterine leiomyosarcoma.

Our surgeons have pioneered many techniques for gynecologic cancers, including minimally invasive surgery and radical debulking techniques. We are also leaders in developing targeted therapies, immunotherapies, and techniques that combine chemotherapy and radiation therapy, including treatments for recurrent disease.

Among our recent research accomplishments:

Imaging

  • We have found that imaging by computed tomography (CT) is useful for detecting perihepatic metastases in patients with ovarian cancer. The method facilitates the distinction between metastases that have invaded the liver and those that have not, and could guide the selection of surgical treatment approaches. Radiology. 2008 Aug; 248(2):511-7 [PubMed Abstract]
  • In patients with advanced ovarian cancer who have undergone optimal primary cytoreduction (debulking) surgery, we have compared our surgeons’ initial assessments of residual disease to evaluations based on CT scans obtained after the surgery. The two detection methods were found to correlate in only 52 percent of patients. Future studies will explore the underlying reason(s) and clinical implications of this discrepancy. J Clin Oncol. 2007 Nov 1;25(31):4946-51 [PubMed Abstract]
  • In comparing the utility of CT and magnetic resonance imaging (MRI) for preoperative evaluation of patients with early stages of invasive cervical cancer, our investigators have found that MRI is significantly better than CT for tumor visualization and for the detection of parametrial invasion. Radiology. 2007 Nov;245(2):491-8 [PubMed Abstract]

Surgery

  • Our physicians have demonstrated that lymph node dissection improves the outcomes of patients who are treated for endometrial cancer. We found that the procedure is essential for accurate surgical staging, which is an important prognostic factor for the disease. The removal of ten or more regional lymph nodes was associated with improved overall survival in lower-stage, older patients who received no adjuvant therapy or brachytherapy only. Am J Obstet Gynecol. 2008 Apr;198(4):457. [PubMed Abstract]
  • In reviewing our experience in treating patients for endometrial cancer, we observed that the use of laparoscopy and comprehensive surgical staging has increased over a 12-year period, while the use of postoperative adjuvant whole pelvic radiation therapy has decreased. These changes have not caused any negative effects on the patients’ overall survival. Gynecol Oncol. 2007 Apr;105(1):150-6. [PubMed Abstract]
  • We have observed that risk-reducing salpingo-oophorectomy — a procedure chosen by many women who carry BRCA gene mutations to reduce their risk of breast and gynecologic cancer — may provide different degrees of protection in patients who carry BRCA1 mutations versus those who carry BRCA2 mutations. J Clin Oncol. 2008 Mar 10;26(8):1331-7. [PubMed Abstract]
  • Our physicians have recommended that radical vaginal trachelectomy be incorporated into gynecologic oncology practices as a treatment option for women with early-stage cervical cancer who wish to maintain their fertility. Since 2001, we have offered the operation as a fertility-preserving option to patients who would otherwise be treated with radical hysterectomy or pelvic radiation therapy. Gynecol Oncol. 2008 Jan;108(1):214-9 [PubMed Abstract]

Targeted Therapies

  • We have examined the safety and efficacy of combining the chemotherapy drugs paclitaxel and carboplatin with the targeted therapy cetuximab as first-line treatment of patients with advanced ovarian, peritoneal, or fallopian tube cancer. Our investigators found that the combination was well tolerated in ovarian cancer patients. However, it did not prolong progression-free survival when compared with historical data. Gynecol Oncol. 2008 Aug;110(2):140-5. [PubMed Abstract]

Immunotherapy

  • We have evaluated the hormonal drugs goserelin and bicalutamide in patients with epithelial ovarian cancer. Our phase II study indicated that the treatment is safe but does not prolong progression-free survival in patients who are in second or greater complete disease remission. Cancer. 2007 Dec 1;110(11):2448-56. [PubMed Abstract]
  • Vaccine-based immunological approaches are being explored for the treatment of gynecologic cancers at Memorial Sloan Kettering. In patients with advanced epithelial ovarian cancers, we are investigating a vaccine formulation of NY-ESO-1b peptide and Montanide ISA-51 adjuvant. The target of this vaccine, the protein NY-ESO-1, is present only in cells of the germline and in cancer cells of some tumors, including about 45 percent of ovarian tumors. Our initial study in patients who are in high-risk first remission has shown that the vaccine is safe and induces specific T cell immunity, regardless of whether the patient’s tumor expresses NY-ESO-1. Clin Cancer Res. 2008 May 1;14(9):2740-8. [PubMed Abstract]
  • We are also investigating a vaccine for gynecologic cancers composed of seven ovarian cancer antigens conjugated to keyhole limpet hemocyanin (KLH), an immunogenic carrier protein, in the presence of the adjuvant QS21. The vaccine safely induced antibody responses against five of the seven antigens in patients with epithelial ovarian, fallopian tube, or peritoneal cancer who are in second or greater complete clinical remission. Clin Cancer Res. 2007 Jul 15;13(14):4170-7. [PubMed Abstract]

Chemotherapy

  • Our physicians have demonstrated that chemotherapy with fixed-dose-rate gemcitabine plus docetaxel is a reasonable primary treatment option for women with metastatic uterine leiomyosarcoma. In a Gynecologic Oncology Group study, we found that this regimen achieved high response rates as first-line therapy in patients with advanced, unresectable disease who had not received any prior cytotoxic drugs. Gynecol Oncol. 2008 Jun;109(3):329-34. [PubMed Abstract] ; Gynecol Oncol. 2008 Jun;109(3):313-5. [PubMed Abstract]
  • In a randomized, multicenter study of patients with metastatic soft tissue sarcomas, we found that the chemotherapy regimens gemcitabine and docetaxel given together via fixed-dose-rate infusion yielded superior progression-free and overall survival when compared with a higher dose of gemcitabine alone. J Clin Oncol. 2007 Jul 1;25(19):2755-63. [PubMed Abstract]
  • In ovarian cancer patients with residual tumors that are less than 10 mm, we have found that maximal cytoreduction (debulking) surgery improves survival by enhancing the patient’s response to chemotherapy. Our findings support a rationale for making maximal cytoreduction the goal of initial surgery in these patients. Gynecol Oncol. 2008 Feb; 108(2):276-81. [PubMed Abstract]
  • To evaluate our second-remission consolidation strategies, we analyzed a strictly defined population of ovarian cancer patients who were in second or greater complete clinical remission (showing complete response to treatment). We found that the median progression-free survival from second complete remission is short, and that a second response rarely is longer than the first. The number of patients with a second response that is longer than their first one — or the proportion of patients remaining in complete remission at given time points — could be evaluated as an outcome measure in future clinical studies. Gynecol Oncol. 2007 Sep;106(3):469-75. [PubMed Abstract]
  • In comparing responses to combination platinum-taxane chemotherapy in patients with advanced ovarian cancer, we found that the rates of initial response, platinum resistance, progression-free survival, and overall survival in women ages 65 and older are similar to those of younger women. Elderly women who can tolerate primary cytoreductive surgery may therefore be treated with combination platinum-taxane chemotherapy. Gynecol Oncol. 2007 Aug; 106(2):381-7. [PubMed Abstract]
  • In a large, randomized study, we investigated whether prolonged administration of paclitaxel in combination with cisplatin improves overall survival of patients with epithelial ovarian cancer. Extending the paclitaxel treatment from 24 to 96 hours did not significantly improve the results of cisplatin treatment. J Clin Oncol. 2007 Oct 1;25(28):4466-71. [PubMed Abstract]