Consensus on drivers of maintenance treatment choice and patterns of care in advanced ovarian cancer
Year: 2024
Type: article
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.
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
Institutions: Instituto de Salud Carlos III, Hospital Clínico Universitario de Valencia, INCLIVA Health Research Institute, University Medical Center Hamburg-Eppendorf, Royal Marsden Hospital, Edinburgh Cancer Research, Institute of Genetics and Cancer, University of Edinburgh, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Humanitas University, IRCCS Humanitas Research Hospital, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Girona, Fundación Instituto Valenciano de Oncología, Medical University of Vienna, Universitair Ziekenhuis Leuven, Rigshospitalet, Cork University Hospital, Karolinska University Hospital, Haukeland University Hospital, University of Bergen, Institut Gustave Roussy, Centre Eugène Marquis, Kliniken Essen-Mitte, University Hospital of Basel, IPO Porto, Hospices Civils de Lyon, Centre pour l'innovation en cancérologie de Lyon
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,800
Award: G8890405749
OpenAlex ID: W4403746293