Chan JK, Liang SY, Kapp DS, Chan JE, Herzog TJ, Coleman RL, Monk BJ, Richardson MT., Gynecol Oncol. S0090-8258(20)33910-X. doi: 10.1016/j.ygyno.2020.09.017. Online ahead of print., 2020 Sep 26
We have evaluated three clinical decision points withbiomarker guidance that must be made in the upfront treatment of ovariancancer.Our discussion provides a clinical pathway to guide clinicians on the selectionof new upfront regimens for ovarian cancer incorporating bevacizumab and/orpoly-adenosine diphosphate-ribose polymerase (PARP) inhibitors.
It is also important to recognize that the selection of upfront agentsmay influence treatment options at recurrence. For example, the addition ofthese novel agents may have marginal median progression-free survival (mPFS) benefit of only3–6months; however, this clinical benefit may extend mPFS and categorizepatients as “platinum-sensitive,” allow them to be eligible for there-treatment of platinum combinations, or become eligible for more clinicaltrials.
Sinceclinicians have access to three PARPi (olaparib, niraparib, and rucaparib) inthe platinum sensitive setting, they may choose to alternate the sequential useof these biologic agents from bevacizumab to PARPi or vice-versa depending onthe initial response to these agents. Genetic and genomic testing serve as animportant tool to triage patients towards maintenance therapy with biologicagents.
Furtherdecision tree analysis with economic considerations are also warranted toevaluate sequential therapies beyond the upfront setting to reflect the overallovarian cancer patient's treatment journey.