Transforming Gynecologic Cancer Care for Georgia Women

After Dianne Sacks was diagnosed with ovarian cancer at her local hospital in late 2021, she proceeded through standard treatments, surgery and chemotherapy.

“I seemed to respond pretty quickly to the chemotherapy,” she says. But after six months, her tumor markers began to rise again, signaling the need for something beyond the standard of care.

“My doctors didn't have much confidence in the next step and thought that I might benefit from joining a clinical trial,” Sacks, now 78, recalls. “That’s how we ended up at Emory. My brother, who’s at the University of Texas at Houston, found out about Dr. Modesitt from folks at MD Anderson, and he referred me to her.” Winship gynecologic oncologist Susan C. Modesitt is professor and chair in the Department of Gynecology and Obstetrics at Emory University School of Medicine.

Since entering Modesitt’s care, Sacks has enrolled in two nationwide Phase 3 clinical trials seeking to discover treatments for “platinum-resistant” ovarian cancer, which evades standard interventions. Both trials initially showed promise for Sacks, but after her disease progressed, her trial therapies ended.

“It feels good to have access to clinical trials, especially under wise eyes like Dr. Modesitt’s,” Sacks says. “Winship has more tools in the tool chest.”

Tasked with growing Winship’s gynecologic cancer program

Modesitt, who is also the editor-in-chief of the journal Gynecologic Oncology Reports, joined Winship Cancer Institute of Emory University in 2022. Her task: turn a small gynecologic cancer program into a regional research powerhouse. She is well on her way, with an expanded faculty, multiple clinical trials and a high-risk comprehensive care center all newly—or nearly—at fruition.

“We started off with four faculty. We are up to seven. We started with one clinical trial. We are up to 15 or 20,” Modesitt says. Some of those trials are led by in-house faculty; others are nationwide studies with enrollment sites at Winship, like the two that Sacks was able to join.

Modesitt also oversaw the start of a fellowship program accredited by the American College of Obstetricians and Gynecologists. Now in its second year, the fellowship program attracts young gynecologic oncologists looking to bolster their research and clinical skills under the leadership of Winship gynecologic oncologist Sarah Dilley, an assistant professor in the Division of Gynecologic Oncology at Emory University School of Medicine.

“I’m collaborating with a lot of other physicians, pharmacists and other training programs to make sure my fellows are getting exposed to all different aspects of oncology,” Dilley says. The first accepted fellow developed a study, now funded and enrolling patients, looking at preventing neuropathy, the painful nerve damage that’s a common chemotherapy side effect.

Modesitt says her goal is to make Winship the national leader in gynecologic cancer treatments and innovation, while bolstering the care available to the diverse, historically underserved population in the Atlanta metro area and the southeast more broadly.

“It’s all kind of coming together,” she says.

Clinical trials

Building up Winship as a prominent site for gynecologic cancer clinical trials enables more patients to easily and conveniently participate in potentially lifesaving studies, without the disruption of traveling to major research hubs.

“There’s a real energy and excitement around bringing that innovation to a different patient population, to people who are not necessarily in Boston or New York,” says Winship gynecologic oncologist Beryl Manning-Geist, an Emory medical school Woodruff Scholar alumna whom Modesitt recruited back after Manning-Geist's advanced training at Harvard and Memorial Sloan Kettering. Manning-Geist, an assistant professor in the Division of Gynecologic Oncology within the medical school’s Department of Gynecology and Obstetrics, is now working on opening a secondary site for a clinical trial she helped start at Sloan Kettering, bringing her work home to Winship.

The trial takes a precision medicine approach to low-grade serous ovarian cancer, a rare, mostly chemo-resistant form of the disease that tends to occur disproportionately in younger patients. Although researchers know the standard treatment lacks clinical efficacy, patients are often subjected to multiple rounds of chemotherapy before becoming eligible to enroll in clinical trials for other options. That is, patients are subjected to punishing rounds of chemo even though doctors know it’s unlikely to help them. Manning-Geist’s trial skips right to the experimental therapies.

“We used these sledgehammers when maybe we could use scalpels,” she says of using chemotherapy versus more targeted interventions.

For platinum-resistant ovarian cancers—cases where multiple ‘sledgehammers’ have failed—researchers are exploring new strategies. Namita Khanna, an associate professor and director of the pelvic surgery fellowship in the Department of Gynecology and Obstetrics at Emory University School of Medicine, is running a pilot study repurposing an antifungal medication, atovaquone, to see if it helps inhibit disease progression. She notes a similar ongoing study using metformin, a commonly used type 2 diabetes medication, to treat endometrial cancer.

“Therapies for patients with platinum-resistant ovarian cancer tend to perform poorly, and these patients really need something that can produce some positive results,” says Khanna. She adds that her study uses an existing drug known to be well-tolerated. Khanna collaborates on both studies with Winship hematologist-oncologist David A. Frank, director of the Winship Innovation Initiative, director of the Division of Hematology and a professor in Emory University School of Medicine's Department of Hematology and Medical Oncology.

“We are expanding our research portfolio pretty quickly,” Khanna says, with the goal of being able to offer every Winship gynecologic oncology patient access to a clinical trial. “As a division, we’re working hard to bring more trials to patients.”

Collaborative care for high-risk patients

Besides expanding access to clinical trials, the department recently launched a collaborative clinic in Decatur for patients at high-risk for breast and gynecologic cancers. Modesitt built a similar program during her tenure at the University of Virginia and was eager to offer the same coordinated patient services at Winship.

The clinic, which soft-opened in mid-February, serves patients with a confirmed or likely genetic mutation that increases their risk of developing breast, ovarian and uterine cancers, according to clinic lead Jennifer M. Scalici, gynecologic oncology program lead at Winship and division director for gynecologic oncology in the Department of Gynecology and Obstetrics at Emory University School of Medicine.

Scalici describes the new clinic as “a place where there is time and space to really counsel patients about the gravity of some of these genetic mutations.” She adds, “I’m very excited about it. It’s a need in the community.”

In addition to leading the new clinic, Scalici is completing a Department of Defense-funded study looking at using chemoprevention to interrupt the development of ovarian cancer in hens, the only other species aside from humans with ovaries in which the disease spontaneously develops. The bulk of the research was conducted at the University of South Alabama, Scalici’s prior institution, and she is now leading the data analysis at Winship.

“The problem in studying ovarian cancer in women is it’s a relatively rare disease and, in a hen model, it’s super common,” Scalici explains, noting that hens ovulate daily, accelerating any potential cancer growth. Its rarity in humans is fortunate, but also means limited data exists to guide care.

Scalici hopes her research will eventually yield better surveillance tools for high-risk patients, like targeted screenings that catch cancers early, or before they even develop. “It really is the bench-to-bedside model,” she says.

Data diversity

Another benefit of expanding trial access and opening a dedicated clinic for high-risk patients is the ability to build out Winship’s in-house research database on gynecologic cancers. This resource, which already contains over a decade of patient data, is essential to advancing research and is a potentially valuable asset due to Winship’s uniquely diverse patient population. Black women, historically and still today, remain vastly underrepresented in cancer research data sets. The Winship team is actively working to change that.

“There are lots of other institutions who want to collaborate with us because of data diversity,” Dilley says. For instance, she notes that half of the patients with endometrial cancer in Winship’s database are Black women, a resource that’s “unheard of.”

Black women with endometrial cancer are more likely to develop more aggressive versions of the disease, making their inclusion in research vital to addressing disparities in this—and other types of—cancer.

“There’s this subset of really aggressive types of cancers that are much more prevalent in African American patients,” Modesitt says.

Dilley adds, “We need to learn more about why this is happening to our patients, and we need to understand the nuances of their particular experiences.”

The growing gynecologic oncology team is united in their commitment to increasing patient care resources and to their role—unique in the oncology field—of caring for patients throughout their course of treatment.

“Gynecologic oncology is unique because we are able to care for our patients throughout their care continuum—from surgery to chemotherapy and beyond,” says Modesitt. “It’s a privilege to care for women who have so often spent their lives caring for others.”

Modesitt has a special tie to the patients in this community. She began her academic career at Emory as an undergraduate Woodruff Scholar, where she met her husband, “a Georgia boy.” Her medical training and career subsequently took her to Virginia, North Carolina, Kentucky and Texas, but she promised him they would return to Georgia one day.

“I have a huge loyalty to Emory,” she says. “Even when I could only give ten bucks because I had no money, I gave back every year.” She continues giving back, by expanding access, increasing resources and leading a team focused on better outcomes for patients with gynecologic cancers.

“I love talking about how much work we have done to really transform the care that’s available to the women of Georgia,” Modesitt says.

For Dianne Sacks and her husband, Alan, who have been married for 40 years and are enjoying retirement after long public service careers before the cancer diagnosis, having cutting-edge care a short drive away has allowed her to continue focusing on living in between treatments and appointments.

“You have to keep going. You can’t just give it up,” Sacks says.

“It's been good to have access to those studies,” Sacks continues. “I would do a trial again if the doctor found one that she’d recommend.” In the meantime, she continues the regular scans and treatment tweaks that bookend the months for someone living with active disease—and occupy the minds of their dedicated care team members. “Dr. Modesitt is thinking about what the next step can be.”

---

Kira Goldenberg is a writer and psychotherapist in San Francisco.

---

Within 24 hours after her life-changing CT scan, Marsha Masten was sitting on an exam table at Winship, meeting with Susan Modesitt, MD, Winship gynecologic oncologist and chair of the Emory Department of Gynecology and Obstetrics. Masten recalls Modesitt saying she was pretty certain it was ovarian cancer and indeed had spread. Masten was able to receive a drug being studied in a clinical trial. After having her third CT scan post-treatment, she says, “I’m doing fantastic. It showed no evidence of disease.”

Read more about it here.