Targeted therapy for vulvar cancer

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells and limit harm to normal cells. Targeted therapy may also be called molecular targeted therapy.

Targeted therapy is sometimes used to treat vulvar cancer. If you have targeted therapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules.

You may have targeted therapy to treat metastatic or recurrent vulvar cancer.

Targeted therapy drugs used for vulvar cancer may not be covered by all provincial and territorial health plans. Your healthcare team will talk to you about your options if they think you may benefit from these drugs.

Different types of targeted therapy are used for vulvar cancer.

Monoclonal antibodies have been designed in a lab to recognize and lock onto particular protein markers on the surface of some cancer cells.

Bevacizumab (Avastin and biosimilars) is a monoclonal antibody that may be given in combination with chemotherapy drugs, such as cisplatin and paclitaxel, to treat metastatic vulvar cancer. It targets the vascular endothelial growth factor (VEGF). VEGF is a protein that helps a tumour build a blood supply, which it needs to grow larger. Bevacizumab attaches to VEGF so the tumour can’t use it to build a blood supply and grow.

Bevacizumab is given through a needle into a vein (intravenously, or by IV).

Tyrosine kinase inhibitors (TKIs) block chemicals called tyrosine kinases. These chemicals are part of the signalling process within cells. When this process is blocked, the cell stops growing and dividing.

Erlotinib (Tarceva) is a TKI that may be used to treat metastatic vulvar cancer. It works on cancer cells that have the epidermal growth factor receptor (EGFR) protein. A mutation in the EGFR gene can cause cancer cells to grow and divide more than normal. Erlotinib targets the tyrosine kinase part of EGFR and blocks the protein from working, which stops or slows the growth of cancer cells.

Erlotinib is taken daily as a pill by mouth (orally).

Side effects of targeted therapy will depend mainly on the type of drug or combination of drugs, the dose, how it’s given and your overall health. Tell your healthcare team if you have side effects that you think are from targeted therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Bevacizumab may cause these side effects:

• fatigue
• high blood pressure (hypertension)
• diarrhea
• constipation
• abdominal pain
• nausea and vomiting
• bleeding
• protein in the urine (proteinuria)

Erlotinib may cause these side effects:

• skin problems, including rashes
• loss of appetite
• fatigue
• diarrhea
• constipation
• abdominal pain
• nausea and vomiting
• hair loss