Until recently, an ovarian cancer diagnosis came with little hope. About 21,010 women are expected to be diagnosed with ovarian cancer in 2026, and about 12,450 are expected to die from the disease, the American Cancer Society estimates.

Now, however, advances in precision medicine are beginning to change that outlook for some patients, offering new, more targeted treatment options at diagnosis.

Targeted therapies are improving outcomes for some women newly diagnosed with ovarian and other gynecologic cancers, said gynecologic oncologist Dr. Jennifer Haag (rhymes with “vague”) with Novant Health Cancer Institute - New Hanover in Wilmington. Those include endometrial (the most common form of uterine cancer — so common that the terms are often used interchangeably), cervical and vaginal/vulvar cancer.

“It used to be that there were just two standard chemotherapy medicines we treated everything with,” she said. “But there’s so much more available now.”

We asked Haag about these treatments and how they’re changing cancer care.

What exactly are targeted cancer therapies?

It’s a very broad category, and there are different targeted therapies for each type of gynecologic cancer.

What we historically treat cancer with — general chemotherapy — is broadly toxic to all cells and causes effects all over the body. But targeted therapy is a little bit smarter than that. It’s able to deliver the treatment specifically to tumor cells, usually based on some kind of molecular target, a unique feature of the cancer cell that doctors can lock onto.

Can chemotherapy be used as a targeted therapy?

It can. The antibody-drug conjugates (ADCs) are targeted cancer therapies that combine antibodies with chemotherapy drugs via a linker that can selectively kill cancer cells but spare healthy tissue.

The antibody is usually specific to a marker in the tissue that makes it more likely to attach to tumor cells than normal tissue. Then, the chemotherapy can be delivered more directly to that tumor cell. These ADCs are being used in ovarian, endometrial and cervical cancer patients with certain genetic markers.

Traditional chemotherapy goes everywhere and affects all different types of cells without regard to whether they’re normal or abnormal. These antibody drugs are better able to target abnormal tumor cells.

Are all targeted therapies given through an IV?

Most are, but some come in pill form.

What targeted therapy is used in ovarian cancer?

There’s a PARP inhibitor (a class of drugs that block a certain enzyme and help repair DNA damage in cells) that can work well for patients who have a specific mutation — the BRCA mutation. It comes in pill form rather than an infusion.

We’ve been using PARP inhibitors for a little over 10 years, and they have very good survival data. They can extend survival in ovarian cancer patients by years.

The prognosis for ovarian cancer used to be grim, but many cases of it are now more like a chronic disease we can treat a lot of different ways. Targeted therapies are offering hope that hadn’t been part of the picture previously.

Are targeted therapies still considered experimental?

As we’re starting to get really good long-term data from big studies, targeted therapies are starting to be more of a standard of care.

Most often, these drugs start out as experimental in randomized trials, which is why they’re frequently used in a metastatic or recurrent setting. Most patients in these trials have already tried traditional therapies that didn’t work.

Are targeted therapies only used for late-stage gynecologic cancers?

They’re evolving rapidly. Even during the course of my fellowship training, the focus on where we used targeted therapies shifted. Early on, we were using them in patients with recurrent or very advanced disease.

Now, particularly with immunotherapy, it’s being used in the upfront setting, meaning the first rounds of chemotherapy. Putting these targeted therapies a little more upfront helps patients respond better to them.

OK, you’ve covered cervical and ovarian cancers. What about endometrial cancer?

We’ve been having success with immunotherapies like Keytruda and Jemperli — drugs that basically use the immune system to help fight tumor cells. Just as PARP inhibitors are effective in women with the BRCA gene, these are effective in patients with specific markers: PD-L1 and deficiencies in mismatch repair proteins. It’s not a therapy we can use in everyone.

Are targeted therapies used in place of, or in conjunction with, traditional cancer medicines?

Both. They may be used alone or in combination with traditional therapies.

When using targeted therapy in conjunction with something else, does it happen concurrently or at a different time?

Usually concurrently. For instance, in patients with endometrial cancer who qualify for immunotherapy either before or after they have a hysterectomy, they get two different types of chemotherapy and immunotherapy — either Keytruda or Jemperli. The immunotherapy is given with the chemo at the beginning. The immunotherapy then continues by itself for several years as a maintenance medication.

Can targeted therapies treat other types of cancers?

They’re used in many cancers. We see Keytruda used a lot with lung, breast, melanoma, stomach and colorectal cancers. Actually, gynecological cancers are a little late to use targeted therapies.

What are the side effects of targeted therapy?

That’s tough to answer given how broad targeted therapies are. I think the important thing to know is that, because some of these targeted therapies are more focused, they can cause some specific side effects.

Side effects with traditional chemotherapy are well-known — things like nausea, fatigue and hair loss. Those are less common in targeted therapies.

Some of the immunotherapies can cause inflammation in different parts of the body — the thyroid, liver, colon. The antibody-drug conjugates I mentioned earlier can be toxic to the eyes and lungs. Those side effects can range from benign things like dry eye to serious ones like vision loss.

So, patients on these medications need very close follow-up and sometimes consultation with specialists to help manage side effects.

Is radiation ever used in combination with targeted therapies?

We’re starting to use Keytruda in combination with radiation for cervical cancer that has spread to other parts of the pelvis. However, a lot of our data about radiation is in older trials where targeted therapies weren’t being used. We just don’t know where some of these things fit together in the treatment landscape, but as we start to use targeted therapies more, we will likely see many types of combination therapy.

These therapies are so new — and evolving. Should cancer patients try to see a young doctor like you who’s more likely to be familiar with them?

No. Cancer treatment guidelines are put forth by our national organizations, and the targeted therapies are included there. So, as long as clinicians are following guidelines for treatment, they should be knowledgeable about targeted therapies.

Any final thoughts about targeted therapies?

I would encourage anybody who has a gynecologic cancer to inquire about targeted therapies. Because we have so many new drugs coming out all the time, it’s worth a discussion with your provider about whether or not you qualify for them.

And if you do, ask about the benefits and the side effects so you have the full picture.

Targeted therapies have revolutionized the treatment landscape — particularly PARP inhibitors for ovarian cancer and immunotherapy for endometrial cancer. They have brought new hope to many women diagnosed with gynecologic cancer.