Maintenance Treatment of Newly Diagnosed Advanced Ovarian Cancer: Time for a Paradigm Shift?

Abstract

Recent data have demonstrated substantial efficacy with poly (ADP-ribose) polymerase (PARP) inhibitors as treatment and/or maintenance therapy in patients with newly diagnosed advanced epithelial ovarian cancer (EOC). Here, we review efficacy and safety results from four recent Phase III trials in newly diagnosed EOC: SOLO1 (olaparib), PAOLA-1 (olaparib in combination with bevacizumab), PRIMA (niraparib), and VELIA (veliparib). The implications of these data for current clinical practice and areas for future research are discussed, including ongoing studies of targeted agents in the newly diagnosed setting. Data from SOLO1, PAOLA-1, PRIMA, and VELIA confirm the benefit of PARP inhibitors (olaparib, niraparib, veliparib) for women with newly diagnosed EOC. The greatest benefit was seen in patients with a BRCA1 and/or BRCA2 mutation or in the homologous recombination deficiency (HRD)-test positive subgroup. These four well-conducted studies have generated practice-changing data. However, deciding how to apply these results in clinical practice is challenging, and substantial differences in trial design impede cross-trial comparisons. Recent PARP inhibitor approvals (olaparib, niraparib) in the newly diagnosed EOC setting have provided new maintenance treatment options for a broader patient population. The results of these studies call for personalized medicine based on biomarker profile and other factors, including tolerability, cost considerations, and physician and patient preference. Important areas for future research include appropriate use of both BRCA mutation and HRD testing to inform magnitude of PARP inhibitor benefit as well as exploring further options for patients who are HRD-test negative and for those who become PARP inhibitor resistant.

Machine Learning-Based Risk Prediction of Critical Care Unit Admission for Advanced Stage High Grade Serous Ovarian Cancer Patients Undergoing Cytoreductive Surgery: The Leeds-Natal Score

“…Although primary chemotherapy is associated with lower peri-operative morbidity and post-surgical mortality [ 31 ], this was not correlated to CCU admission. New systemic treatment algorithms for newly diagnosed advanced EOC could serve as tools to help with clinical decision making and patient stratification on a daily basis [ 32 ].…”

Noncoding RNAs in the Glycolysis of Ovarian Cancer

“…Ovarian cancer (OC) is currently the most deadly gynecologic malignancy with insidious and rapidly progressive onset. Most patients have advanced pelvic and abdominal metastases by the time of diagnosis, and the 5-years survival rate is only 20–30% worldwide ( Vafadar et al, 2020 ; DiSilvestro et al, 2021 ; Vergote et al, 2021 ). OC account for 5% of all cancer deaths in women ( Yang et al, 2021 ; Youssef et al, 2021 ) due to the low survival rates resulting from late diagnosis.…”

Towards Personalized Management of Ovarian Cancer

“…The standard management approach in the treatment of epithelial ovarian cancer includes cytoreductive surgery and platinumbased chemotherapy. [1][2][3][4][5][6] Cytoreductive surgery aims to remove cancerous tissue from the ovaries and adjacent tissues to achieve optimal debulking. Chemotherapy is usually employed either in the neoadjuvant setting (to downstage cancer) or after cytoreductive surgery (to treat microscopic seedling in optimally debulked tumors or reduce tumor burden in suboptimally debulked cancer).…”

“…Chemotherapy is usually employed either in the neoadjuvant setting (to downstage cancer) or after cytoreductive surgery (to treat microscopic seedling in optimally debulked tumors or reduce tumor burden in suboptimally debulked cancer). [1][2][3][4][5][6] Despite advances in these treatment modalities, the overall outcomes for patients with epithelial ovarian cancer remain poor with over 4000 patients dying from the condition each year in the UK. However, recent advances in ovarian cancer therapeutics have had a positive impact in improving survival outcomes.…”