--- title: "Select upfront regimens in ovarian cancer with biomarkers. | Sutter Health" description: "We have evaluated three clinical decision points with biomarker guidance that must be made in the upfront treatment of ovarian cancer." url: "https://www.sutterhealth.org/research/publications/select-upfront-regimens-in-ovarian-cancer-with-biomarkers-1055312825" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Select upfront regimens in ovarian cancer with biomarkers. # Selecting new upfront regimens for advanced ovarian cancer with biomarker guidance. 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._ 2020-09-26 ## Abstract We have evaluated three clinical decision points with biomarker guidance that must be made in the upfront treatment of ovarian cancer. Our discussion provides a clinical pathway to guide clinicians on the selection of new upfront regimens for ovarian cancer incorporating bevacizumab and/or poly-adenosine diphosphate-ribose polymerase (PARP) inhibitors. It is also important to recognize that the selection of upfront agents may influence treatment options at recurrence. For example, the addition of these novel agents may have marginal median progression-free survival (mPFS) benefit of only 3–6months; however, this clinical benefit may extend mPFS and categorize patients as “platinum-sensitive,” allow them to be eligible for the re-treatment of platinum combinations, or become eligible for more clinical trials. Since clinicians have access to three PARPi (olaparib, niraparib, and rucaparib) in the platinum sensitive setting, they may choose to alternate the sequential use of these biologic agents from bevacizumab to PARPi or vice-versa depending on the initial response to these agents. Genetic and genomic testing serve as an important tool to triage patients towards maintenance therapy with biologic agents. Further decision tree analysis with economic considerations are also warranted to evaluate sequential therapies beyond the upfront setting to reflect the overall ovarian cancer patient's treatment journey. [PubMed abstract](https://pubmed.ncbi.nlm.nih.gov/32994055/) ![Su-Ying Liang, Ph.D.](https://dyn.mktgcdn.com/p/cRIUee_GK3HEL1Wq8svqoUApvABjlwVVA-KUHVGzuNw/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Su-Ying Liang, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/su-ying-liang-phd-1049681030) ## Research topics - [All Cancer](https://www.sutterhealth.org/research-search-results?query=%22%5C%22All+Cancer%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Genetics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Genetics%5C%22%22) - [Ovarian Cancer](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Ovarian+Cancer%5C%22%22) - [Women's Health](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Women%27s+Health%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Use of gene expression profiling and chemotherapy in early-stage breast cancer: a study of linked electronic medical records, cancer registry data, and genomic data across two health care systems.](https://www.sutterhealth.org/research/publications/gene-expression-profile-chemotx-breast-ca-1055312292) Afghahi A, Mathur M, Thompson CA, Mitani A, Rigdon J, Desai M, Yu PP, de Bruin MA, Seto T, Olson C, Kenkare P, Gomez SL, Das AK, Luft HS, Sledge GW Jr, Sing AP, Kurian AW. J Oncol Pract. pii: JOPR009803. \[Epub ahead of print\] 2016 May 24 - Publication ### [The Healthcare Systems Research Network (HCSRN) as an environment for dissemination and implementation research: a case study of developing a multi-site research study in precision medicine.](https://www.sutterhealth.org/research/publications/hcsrn-as-environment-for-implementation-research-1055312447) Rahm AK, Ladd I, Burnett-Hartman AN, Epstein MM, Lowery JT, Lu CY, Pawloski PA, Sharaf RN, Liang SY, Hunter JE. EGEMS (Wash DC). 7(1):16. doi: 10.5334/egems.283. 2019 Apr 12 - Publication ### [Beyond barriers: fundamental 'disconnects' underlying the treatment of breast cancer patients' sexual health.](https://www.sutterhealth.org/research/publications/disconnects-in-breast-cancer-tx-and-sexual-health-1055312906) Halley MC, May SG, Rendle KA, Frosch DL, Kurian AW. Cult Health Sex. 1-12. \[Epub ahead of print\] 2014 Aug 20 - Publication ### [Does the diagnosis of breast or ovarian cancer trigger referral to genetic counseling?](https://www.sutterhealth.org/research/publications/breast-ovarian-cancer-dx-trigger-genetic-counseling-referral-1055312651) Powell CB, Littell R, Hoodfar E, Sinclair F, Pressman A. Int J Gynecol Cancer. 23(3):431-6. doi: 10.1097/IGC.0b013e318280f2b4. 2013 Mar 01 - Publication ### [Mapping the decision-making process for adjuvant endocrine therapy for breast cancer: the role of decisional resolve.](https://www.sutterhealth.org/research/publications/decision-making-adjuvant-endocr-tx-breast-ca-1055312417) Beryl LL, Rendle KA, Halley MC, Gillespie KA, May SG, Glover J, Yu P, Chattopadhyay R, Frosch DL. Med Decis Making. pii: 0272989X16640488. \[Epub ahead of print\] 2016 Apr 06 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/select-upfront-regimens-in-ovarian-cancer-with-biomarkers-1055312825#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Select upfront regimens in ovarian cancer with biomarkers."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/select-upfront-regimens-in-ovarian-cancer-with-biomarkers-1055312825#medicalscholarlyarticle","name":"Selecting new upfront regimens for advanced ovarian cancer with biomarker guidance.","headline":"Select upfront regimens in ovarian cancer with biomarkers.","abstract":"We have evaluated three clinical decision points with biomarker guidance that must be made in the upfront treatment of ovarian cancer. Our discussion provides a clinical pathway to guide clinicians on the selection of new upfront regimens for ovarian cancer incorporating bevacizumab and/or poly-adenosine diphosphate-ribose polymerase (PARP) inhibitors. It is also important to recognize that the selection of upfront agents may influence treatment options at recurrence. For example, the addition of these novel agents may have marginal median progression-free survival (mPFS) benefit of only 3–6months; however, this clinical benefit may extend mPFS and categorize patients as “platinum-sensitive,” allow them to be eligible for the re-treatment of platinum combinations, or become eligible for more clinical trials. Since clinicians have access to three PARPi (olaparib, niraparib, and rucaparib) in the platinum sensitive setting, they may choose to alternate the sequential use of these biologic agents from bevacizumab to PARPi or vice-versa depending on the initial response to these agents. 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