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Stage 4 Cancer

Stage 4, Stage IV metastatic cancer

“Metastases cancer” or stage 4 cancer, is the medical term for describing a condition where a tumor originating in a certain organ, “primary tumor”, is identified in another organ or in a distant location from the original organ, e.g., metastases of breast cancer can be found in the lungs, brain, bones and liver.

It is important to note, metastases are the same type of the original primary tumor, even if its location is in distant organs and so are the treatments regarded as such, for example, a treatment for a metastatic lung cancer that has spread to the liver, is determined by the treatment for metastatic lung cancer and not by the treatment for liver cancer.

Metastases formation

Cancer cells of the primary tumor can be released into the bloodstream and lymphatic system and circulate to distant organs or adjacent organs and tissues to the primary tumor and “settle” in them and grow.

There are different types of cancer which is known where metastases can be formed, for example,

  • Breast cancer can spread to the bones, brain, liver and lungs
  • Lung cancer can spread to the brain, bones, liver and kidney
  • Prostate cancer can spread to the bones
  • Colon cancer, rectal cancer, colorectal cancer can spread to the liver and lungs
Breast cancer can spread to the bones, brain, liver and lungs
Breast cancer can spread to the bones, brain, liver and lungs

Stage IV metastatic cancer and recovery

In the vast majority of the metastatic cases, the treatments do not cure. Treatment goals are slowing tumor growth rate, prolonging life and reducing the symptoms of the disease, improving the quality of life of the patient.

The efficacy of the treatments is affected by many factors, among them are the type of cancer, number of metastases (also called “lesions”) and their location, how much cancer the patient has in his or her body, growth rate of the tumor lesions, medical history of the patient, background diseases, microenvironment between the tumor cells themselves, resistance the tumor has developed to previous treatments and other.

Advanced treatments and clinical trials for stage 4

The National Cancer Institute (NCI) highlights the fact that for a certain group of metastatic cancer patients, the best treatment option is to join one of the many clinical trials existing worldwide aiming to increase their chances of therapeutic success.

This is also recommended by the USA national comprehensive cancer network, NCCN,  (USA national comprehensive cancer network)

“Patients with cancer should be encouraged to participate in clinical trials during all aspects of their diagnosis and treatment”

Currently, every patient will be offered the standard protocols described above. Sometimes the oncologist may suggest integrating these therapies with trials carried out in the Institute.

Advances in cancer therapies may be found in clinical trials prescribing cutting edge, interesting drugs, some of which have already been recognized by the FDA (US Food & Drug Administration) as “breakthrough treatments” and require further information input before being finally and fully approved.

An entire world of clinical trials and compassionate drugs and treatments are open and available worldwide. It is important to know which cutting edge treatments exist which patients can gain far more from them than the standard care offered.

For most patients with stage 4 metastatic cancer, current treatments are insufficiently effective. This gives rise to the need for innovative strategies with greater efficacy in fighting the disease.

Read our publications on innovative treatments for stage 4 metastatic cancer:

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Ovarian Cancer – Mirvetuximab Soravtansine Yields Benefit

Background

Patients with platinum-resistant ovarian cancer have limited therapeutic options available to them. Treatment is largely comprised of chemotherapy, which is known to have limited efficacy where just 4% and 13% will benefit and substantial toxicity.

No biomarker-driven approaches have been indicated for this population.

Clinically meaningful antitumor activity and an acceptable safety profile were seen with the use of Mirvetuximab Soravtansine in patients with platinum-resistant ovarian cancer harboring high folate receptor–alpha (FRα) expression, according to the results of the phase 3 SORAYA trial (NCT04296890) presented during the The Society of Gynecologic Oncology (SGO) 2022 Annual Meeting on Women’s Cancer.

About the Study in ovarian cancer

The global, single-arm, phase 3 SORAYA trial enrolled patients with platinum-resistant ovarian cancer who were treated with 1 to 3 prior regimens and experienced recurrence within 6 months after the last platinum dose they had received.

To be eligible for enrollment, patients needed to have high-grade serous histology and have received prior Avastin.

Patients needed to have tumors that demonstrated FRα-high with immunohistochemistry PS2+ scoring.

Study Results – Patients with Platinum-Resistant Ovarian Cancer Harboring High Folate Receptor–Alpha (FRα) Expression

This antibody-drug conjugate (ADC) elicited a response rate (percentage of patients whose tumors decreased) of 32.4% in the patient population (n = 105).

  • Among the 34 responders, 5 patients achieved a complete remission
  • 29 patients experienced a partial response (percentage of patients whose tumors decreased between 30-50%)
  • 7% of patients achieved stable disease
  • 0% experienced disease progression
  • The median duration of response was 6.9 months with the drug
  • Moreover, the median progression-free survival (The time it took until the disease progressed under the treatment) with Mirvetuximab Soravtansine was 4.3 months.

What is Mirvetuximab Soravtansine?

Mirvetuximab Soravtansine is an antibody-drug conjugate (ADC) comprised of an FRα-binding antibody, a cleavable linker, and maytansinoid DM4.

Findings from a pooled analysis of prior studies that examined the ADC in 70 patients with FRα-high, platinum-resistant ovarian cancer who previously received 1 to 3 therapies, which included Avastin showed:

  • Response Rate of 31.4%
  • Median Duration of Response of 7.8 months
  • Median Time Until Disease Progression of 4.4 months

Side Effects

Most side effects were low-grade, reversible ocular and gastrointestinal events.

Serious treatment-related side effects were experienced by 8% of patients.

A total of 7 patients discontinued treatment with the ADC because of toxicity.

Takeaway Message for ovarian cancer patients

Phase 3 SOROYA trial revealed promising response rates with Mirvetuximab Soravtansine in patients with platinum-resistant ovarian cancer and high folate receptor–alpha (FRα) expression.

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Improving therapeutic success, extending life and quality of life are our main business. We extend to metastatic cancer patients and patients with brain tumors, the most advanced treatment options in the world and the best experts in Israel and abroad.

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