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Targeted drug therapy is directed at proteins on vulvar cancer cells that help them grow, spread, or live longer. Targeted drugs work to destroy cancer cells or slow their growth.  They have side effects different from chemotherapy and some are taken as pills.

Some targeted therapy drugs, for example, monoclonal antibodies, work in more than one way to control cancer cells and may also be considered immunotherapy because they boost the immune system. Different types of targeted drug therapy can be used to treat vulvar cancer.

Antibody-drug conjugates for vulvar cancers

An antibody-drug conjugate (ADC) is a monoclonal antibody linked to a chemotherapy drug. The antibody attaches to a target protein on cancer cells, so the chemo can be brought directly to the cancer cells.

Fam-trastuzumab deruxtecan, T-DXd (Enhertu)

This ADC connects the anti-HER2 antibody to the chemo drug deruxtecan. T-DXd can be used by itself to treat late-stage, HER2-positive vulvar cancer that has recurred after the first systemic treatment . This drug is given in a vein (IV) typically once every 3 weeks.

Common side effects include:

• Low blood cell counts
• Nausea and vomiting
• Diarrhea
• Fatigue
• Hair loss
• Decreased appetite
• Low potassium level
• Changes in liver function test results,
• Cough

A less common, but serious side effect is decreased heart muscle strength, a condition called left ventricular dysfunction.

NTRK inhibitors for vulvar cancers

A very small number of vulvar cancers have changes in one of the NTRK genes, called NTRK gene fusions. Cells with these gene changes make abnormal TRK proteins, which can lead to abnormal cell growth and cancer.

Larotrectinib (Vitrakvi), entrectinib (Rozlytrek), or repotrectinib (Augtyro)

 TRK inhibitors target and disable the proteins made by the NTRK genes. These drugs are taken as pills, once or twice daily.

Common side effects can include:

• Abnormal liver test results
• Decreased white blood cell and red blood cells
• Muscle and joint pain
• Tiredness (fatigue)
• Diarrhea or constipation
• Nausea and vomiting
• Stomach pain

Less common but more serious side effects can include:

• Mental changes, such as confusion, changes in mood, and changes in sleep
• Liver damage
• Changes in heart rhythm and/or function
• Vision changes
• Harm to a fetus