Frontline Maintenance Therapy in Ovarian Cancer


A panel of expert gynecologic oncologists introduce themselves and review frontline maintenance treatment options in ovarian cancer.


Ritu Salani, MD, MBA: Welcome to OncLive® Peer Exchange®: “Updates and Treatment Approaches for Ovarian and Endometrial Cancer.” I’m Dr Ritu Salani, and I’m the UCLA Gynecologic Oncology Division director. Joining me today in this discussion are my colleagues.

Ursula A. Matulonis, MD: My name is Ursula Matulonis. I’m a medical oncologist at the Dana-Farber Cancer Institute [in Boston, Massachusetts,] and lead our Division of Gynecologic Oncology there.

Shannon N. Westin, MD, MPH, FACOG: I’m Shannon Westin. I am also a [gynecologic] oncologist, and I am at The University of Texas MD Anderson Cancer Center [in Houston], and I am the center medical director there.

Matthew A. Powell, MD: I’m Matthew Powell. I’m a gynecologic oncologist at Siteman Cancer Center [at Washington University in St Louis School of Medicine in Missouri]. I direct the Division of Gynecologic Oncology and am excited to be here today.

Bhavana Pothuri, MD: I’m Bhavana Pothuri. I’m a [gynecologic] oncologist at NYU [New York University] Langone [in New York]. I am also the Clinical Trials Office medical director for the Perlmutter Cancer Center [in New York City, New York]. I’m excited to be here with you all today.

Ritu Salani, MD, MBA: I’m excited because this is an expert panel, and today, we are going to discuss a number of topics, specifically the most recent updates in ovarian and endometrial cancer. We’ll discuss the latest research in the field and the impact of [findings from] recent clinical trials on making decisions [about] treatment selections.

I’d like to get started by talking about frontline maintenance therapy in ovarian cancer. There’s been a lot of exciting updates, some old and some new, that are building upon this. I’d love to hear about what the standard of care is currently. Ursula, do you mind starting us off with the standard-of-care, first-line maintenance setting in ovarian cancer?

Ursula A. Matulonis, MD: There have been [findings from] 3 clinical trials that have led to FDA approvals in the up-front setting. SOLO-1 [NCT01844986] has been a very important trial, testing the use of olaparib in the maintenance setting post carboplatin-paclitaxel response in patients with underlying germline [mutation] or tumor, but all deleterious mutations [are] showing fantastic practice-changing improvements in PFS [progression-free survival] and trends toward overall survival, which have held up [in] multiple iterations. So that represents a significant standard of care. There’s the PAOLA-1 trial [NCT02477644], which has looked at the addition of olaparib to bevacizumab. So you start off with carboplatin-paclitaxel-bevacizumab, so any use of bevacizumab, then continue the [bevacizumab] as maintenance, then add olaparib to this. That has really shown the most striking results in patients with underlying deleterious BRCA mutations. Also, there has not been a benefit of adding olaparib in cancers that are HRD, or homologous combination deficient. In the HRP, [or] homologous recombination proficient, setting, there has not been a benefit of adding olaparib to bevacizumab, so that does not contain an FDA approval because of trends toward worsening progression-free survival as well as overall survival.

Thirdly, there’s the PRIMA study [NCT02655016] that has looked at niraparib. So, olaparib has [been] looked at 2 years in SOLO-1 and PAOLA-1. The PRIMA trial has looked at 3 years of niraparib, and we’re waiting for overall survival results. But in terms of progression-free survival, the use of niraparib compared [with] placebo has shown improvements in progression-free survival in all the different groups [with] BRCA-mutated HRD [disease], BRCA wild-type [disease], and HRP [disease], but with lessening levels of benefit. All [results from] these trials have shown acceptable levels. Obviously, no risk of MDS [myelodysplastic syndrome] and AML [acute myeloid leukemia] is acceptable, but from a risk-benefit standpoint, the incidence of AML/MDS is about 1%. That’s another reason that we have moved to the use of PARP inhibitors into the up-front setting.

Transcript edited for clarity.

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