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Debate 18A - What is the best front-line maintenance therapy for optimally debulked HRD-negative advanced epithelial ovarian cancer? Bevacizumab

from Section III - Ovarian Cancer

Published online by Cambridge University Press:  20 July 2023

Dennis S. Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Nisha Lakhi
Affiliation:
Richmond University Medical Center, Staten Island
Nicoletta Colombo
Affiliation:
University of Milan-Bicocca
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Summary

Overall survival for FIGO stage III–IV epithelial ovarian cancer remains low, with only 10% of women remaining disease-free at 10 years of follow-up. Cytoreductive surgery for newly diagnosed advanced ovarian carcinoma, when performed by high-volume surgeons at high-volume centers, has the potential to place the vast majority of patients (approximately 85%) into sustained clinical remission following completion of adjuvant systemic platinum- and taxane-based chemotherapy. However, because most of these patients are ultimately destined to relapse, there has been great interest in identifying effective and tolerable maintenance therapies that can significantly prolong progression-free survival (PFS) and even possibly improve overall survival (OS) in select subpopulations. The molecular signatures exhibited among patients with germline and/or somatic BRCA mutations, as well as those with homologous recombination deficient BRCA-wild type tumors, characterize distinct patient cohorts that may derive benefit from maintenance therapy using the poly-ADP-ribose polymerase I inhibitor olaparib alone or when combined with the anti-angiogenesis agent bevacizumab, respectively. Patients whose tumors are homologous recombination-proficient should be offered maintenance therapy with bevacizumab which can significantly improve PFS by approximately six months and possibly impact OS among those with FIGO stage IV disease.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Tewari, KS, et al. Chapter 77: Ovarian cancer. In: DeVita, VT, Lawrence, TS, Rosenberg, SA (Eds.), DeVita, Hellman , and Rosenberg’s Cancer: Principles & Practice of Oncology (11th edn.). Philadelphia, PA: Lippincott Williams & Wilkins; 2019.Google Scholar
Burger, RA, et al. Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med 2011;365:24732483.CrossRefGoogle ScholarPubMed
Tewari, KS, et al. Final overall survival of a randomized trial of bevacizumab for primary treatment of ovarian cancer. J Clin Oncol 2019;37:23172328.CrossRefGoogle ScholarPubMed
González-Martín, A, et al. Niraparib in patients with newly diagnosed advanced ovarian cancer. N Engl J Med 2019;381:23912402.CrossRefGoogle ScholarPubMed
Yi, M, et al. Synergistic effect of immune checkpoint blockade and anti-angiogenesis in cancer treatment. Mol Cancer 2019;18:60.CrossRefGoogle ScholarPubMed

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