Eirwen M. Miller, MD, a gynecologic oncologist at Allegheny Health Network, West Penn Hospital, discusses the current treatment landscape of ovarian cancer.

The treatment landscape of ovarian cancer has evolved rapidly in recent years, specifically with ongoing clinical trials examining the role of immunotherapy with or without a PARP inhibitor in the up-front maintenance setting, Miller explains. Results from these trials are highly anticipated, as they could help refine up-front maintenance therapy in the platinum-resistant setting before potentially moving treatments to the frontline setting, Miller says. 

Trials are also examining antibody-drug conjugates and monoclonal antibodies, Miller notes. Overall, ovarian cancer has new data that continues to provide more options and is pushing the treatment landscape forward, Miller concludes.

Videos

Eirwen M. Miller, MD, discusses the current treatment landscape of ovarian cancer.


Dr. Miller on the Current Treatment Landscape of Ovarian Cancer

Eirwen M. Miller, MD, a gynecologic oncologist at Allegheny Health Network, West Penn Hospital, discusses the safety and efficacy of veliparib (ABT-888) vs other PARP inhibitors usedin the treatment of patients with ovarian cancer.

There are other indications for PARP inhibitors other than veliparib in a treatment setting, according to Miller. Olaparib (Lynparza) is approved in a treatment setting, as well as niraparib (Zejula) in conjunction with immunotherapy, Miller explains. As such, PARP inhibitors are not only best served in the maintenance setting, Miller explains.

Although the addition of veliparib to chemotherapy was tolerated, there is not substantial evidence to suggest that the agent is as active as other PARP inhibitors that have received regulatory approval, Miller notes. However, other PARP inhibitors were not found to be as well tolerated as veliparib when combined with cytotoxic chemotherapy, Miller concludes.

Eirwen M. Miller, MD, discusses the safety and efficacy of veliparib vs other PARP inhibitors used in the treatment of patients with ovarian cancer.

Dr. Miller on the Safety, Efficacy of Veliparib Vs Other PARP Inhibitors in Ovarian Cancer

Eirwen M. Miller, MD, gynecologic oncologist, Allegheny Health Network, West Penn Hospital, discusses the potential utility of sequential PARP inhibition in ovarian cancer.

Retreatment with a PARP inhibitor after a patient has progressed on a prior PARP inhibitor has been done anecdotally in ovarian cancer, says Miller. However, it is not yet understood whether sequential PARP inhibition is effective for patients in this setting, Miller explains. Moreover, whether PARP inhibitor selection effects efficacy is unknown, Miller adds. Additionally, safety remains a concern with this treatment approach, Miller says. 

However, retreatment with PARP inhibitors may be considered for patients with ovarian cancer who harbor germline or somatic 

 mutations and have progressed on frontline maintenance therapy, Miller concludes. 

Eirwen M. Miller, MD, discusses the potential utility of sequential PARP inhibition in ovarian cancer.  



Dr. Miller on the Potential Utility of Sequential PARP Inhibition in Ovarian Cancer 

Eirwen M. Miller, MD, gynecologic oncologist, Allegheny Health Network, West Penn Hospital, discusses her approach to frontline maintenance therapy in ovarian cancer.

Prior to implementing frontline maintenance therapy, patient factors, such as whether patients have ascites and plural effusions despite paracentesis or thoracentesis, whether they are candidates for primary debulking surgery, and whether debulking surgery would be optimal or suboptimal, need to be considered, says Miller. These factors can inform whether a patient should receive bevacizumab (Avastin), whereas the results of germline and somatic molecular testing can inform if a patient should receive a PARP inhibitor, Miller says. 

Patients who are homologous recombination deficient (HRD) who are started on bevacizumab should have olaparib (Lynparza) added to their maintenance plan based on the results of the phase 3 PAOLA-1 trial, Miller says. Patients who are homologous recombination proficient (HRP) should continue on bevacizumab alone if it was already started, Miller says. 

Patients who are not started on bevacizumab and are HRD should receive a PARP inhibitor, whereas patients who have not started on bevacizumab and are HRP could be considered for niraparib (Zejula) based on the results of the phase 3 PRIMA trial, concludes Miller. 

Eirwen M. Miller, MD, discusses her approach to frontline maintenance therapy in ovarian cancer.  



Eirwen M. Miller, MD

Articles

Dr. Miller on the Current Treatment Landscape of Ovarian Cancer

Dr. Miller on the Safety, Efficacy of Veliparib Vs Other PARP Inhibitors in Ovarian Cancer

Dr. Miller on the Potential Utility of Sequential PARP Inhibition in Ovarian Cancer

Dr. Miller on Approaching Frontline Maintenance Therapy in Ovarian Cancer