Dr. Jackson on VEGF Versus PARP Inhibitors in Recurrent Ovarian Cancer

Amanda L. Jackson, MD, an associate professor of Obstetrics & Gynecology and division director of the University of Cincinnati Health, discusses choosing between VEGF inhibitors and PARP inhibitors in the treatment of patients with recurrent platinum-sensitive ovarian cancer.

When deciding between a VEGF inhibitor and PARP inhibitor, a lot of the decision making has to do with the previous treatments a patient received and how their disease presents, says Jackson. With the emergence of PARP inhibitors in the frontline maintenance setting, the field is going to see an increasing number of patients coming into their recurrence having already received a PARP inhibitor, according to Jackson. For those who have not been given 1, a PARP inhibitor should be considered—especially if the patient has homologous recombination deficiency or harbors a BRCA mutation, adds Jackson; these patient subgroups will experience significant benefit with this approach. However, benefit with these agents has been seen across the board, according to Jackson.

How a patient’s disease presents is another important factor to consider, as well as whether or not they present with many ascites or carcinomatosis. If they do, then bevacizumab (Avastin) should be considered, says Jackson. Treatment decision making involves looking at what a patient received in the frontline setting and then ensuring that benefit is maximized by exposing them to maintenance medications that they have not already received, concludes Jackson.