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Publications

Journal Article Review Ppublish

PubMed: 39448084 DOI: 10.1136/ijgc-2024-005497

Consensus on drivers of maintenance treatment choice and patterns of care in advanced ovarian cancer.

Int J Gynecol Cancer 35(7):101863

Authors: Alejandro Perez-Fidalgo, Barbara Schmalfeldt, Angela George, Charlie Gourley, Sandro Pignata, Domenica Lorusso, Maria Pilar Barretina-Ginesta, Ignacio Romero, Christoph Grimm, Toon Van Gorp, Maria Rossing, Dearbhaile C Collins, Josefin Fernebro, Line Bjørge, Alexandra Leary, Thibault de la Motte Rouge, Philipp Harter, Christian Kurzeder, Joana Savva-Bordalo, Benoit You

Affiliations

  • INCLIVA, Hospital Clinico Universitario de Valencia, Valencia, Spain; Ciberonc, Instituto de Salud Carlos III, Madrid, Spain.
  • Clinic and Polyclinic for Gynaecology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
  • Genomics and Oncology, Royal Marsden Hospital, Sutton, UK.
  • CRUK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
  • Istituto Nazionale Tumori di Napoli IRCCS Fondazione G Pascale, Napoli, Italy.
  • Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy.
  • Catalan Institute of Oncology Girona, IDIBGI-CERCA, Girona, Spain.
  • Instituto Valenciano de Oncología, Valencia, Spain.
  • Gynecologic Cancer Unit, Medical University of Vienna, Vienna, Austria.
  • Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.
  • Center for Genomic Medicine, Diagnostic Center, Rigshospitalet, Copenhagen, Denmark.
  • CUH/UCC Cancer Centre, Cork University Hospital, Cork, Ireland.
  • Section of Gynecological Oncology, Karolinska University Hospital, Stockholm, Sweden.
  • Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Center for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.
  • Department of Adult Medicine, Institut de Cancerologie Gustave Roussy, Villejuif, France.
  • Centre Eugène Marquis, Rennes, France.
  • Kliniken Essen-Mitte, Essen, Germany.
  • University Hospital Basel, Basel, Switzerland.
  • Portuguese Institute of Oncology, Porto, Portugal.
  • Early phase trial unit in oncology (CITOHL- EPSILYON), Centre pour l'lnnovation en Cancérologie de Lyon (CICLY), Lyon University Hospital (HCL), Lyon, France; GINECO, Paris, France.

Abstract

OBJECTIVES

Maintenance therapies, including poly (ADP-ribose) polymerase (PARP) inhibitors and/or bevacizumab, have substantially improved the prognosis of patients with advanced ovarian cancer. Owing to the variability in treatment strategies across Europe, a Delphi study was conducted among European experts to understand the heterogeneity of clinical practice and identify key factors driving maintenance treatment decisions for advanced ovarian cancer.

METHODS

A pragmatic literature review was conducted to identify key questions regarding maintenance treatment strategies in patients with advanced ovarian cancer. Utilizing a Delphi methodology, consensus was assessed among a panel of 16 experts using a questionnaire based on results of the pragmatic literature review.

RESULTS

Panelists agreed that BRCA mutation and homologous recombination status should be assessed in parallel at diagnosis, and that first-line platinum chemotherapy may be initiated concurrently. There was a consensus that alternative homologous recombination deficiency tests are acceptable provided they are clinically validated. Panelists agreed that Response Evaluation Criteria in Solid Tumors (RECIST) and CA-125 elimination rate constant K (KELIM) scores can help assess tumor chemosensitivity and guide treatment-related decisions. Panelists defined high-risk disease as International Federation of Gynecology and Obstetrics (FIGO) stage IV disease or stage III with residual disease after initial/ interval cytoreduction. Risk of disease progression was a key determinant of choice between PARP inhibitor, bevacizumab, or both in combination, as maintenance therapy in advanced ovarian cancer.

CONCLUSIONS

Key drivers for selecting advanced ovarian cancer maintenance treatments include tumor mutational status as a key biomarker and clinician perception of the risk for early disease progression.

MeSH

Recombination, Genetic, Poly(Adp-Ribose) Polymerase Inhibitors, Poly(Adp-Ribose) Polymerases, Homologous Recombination, Genital Neoplasms, Female, Neoplasms, Disease Progression, Bevacizumab, Poly Adenosine Diphosphate Ribose, Maintenance, Ovarian Neoplasms, Response Evaluation Criteria In Solid Tumors, Therapeutics, Mutation