Joyce F. Liu, MD, MPH
With the emergence of new frontline regimens in ovarian cancer, Joyce F. Liu, MD, MPH, explained that the key for future research is for broader groups of patients to benefit and eventually be cured with systemic therapies.
on Ovarian Cancer, Liu, director of Clinical Research, Division of Gynecologic Oncology, assistant professor of Medicine at Dana-Farber Cancer Institute, highlighted the recent changes in the newly diagnosed ovarian cancer space and what the oncology field could see by the end of 2019.
OncLive: What are the key considerations in the newly diagnosed ovarian cancer space?
: One [consideration] is when to give chemotherapy. Is it after surgery? Do we start chemotherapy before we do surgery, or do surgery and then give chemotherapy?
Looking beyond where we are today to where the clinical trials are taking us, [we need] to understand with the addition of antiangiogenic agents, the addition of PARP inhibitors, and immunotherapies, can we make our backbone therapy better than what it has been?
You brought up bevacizumab. Could you discuss the 2018 FDA approval of bevacizumab in the upfront setting and what impact it has had thus far?
Bevacizumab in upfront treatment of patients with ovarian cancer is an interesting question. The initial studies with bevacizumab were published in 2011, and consistently in the studies, we have seen somewhere between the 2- to 4-month progression-free survival (PFS) benefit but no overall survival (OS) benefit in the overall study populations. When we think about whether we are benefitting our patients, we give bevacizumab with chemotherapy and then maintenance bevacizumab for another year. Trading potential toxicities for a potential 2- to 4- month PFS benefit in everybody may not be the best decision. The question is, “Are there patients who benefit more [from bevacizumab]?”
[There are] subset analyses, but the caution with them is that these are subset analyses. The ICON7 and GOG-0218 study suggest that patients with high-risk disease or stage IV cancer may benefit from bevacizumab, but I don’t think we know that for certain. As we have been looking further into these studies, we have been looking for molecular markers that will tell us whether patients will benefit more. There are potential biomarkers, but nothing that has been validated.
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