Matthew Borst, MD
Treatment for patients with ovarian cancer, whether newly diagnosed or recurrent, requires an individualized approach—a component which includes patient preferences, explains Matthew Borst, MD.
When evaluating a newly diagnosed patient, a variety of disease characteristics must be considered to decide whether neoadjuvant therapy or debulking surgery is the primary approach. For recurrent disease that previously responded to platinum-based chemotherapy, available options include a re-challenge of chemotherapy, secondary cytroreductive surgery, or molecular profiling to determine if a PARP inhibitor or a clinical trial is the optimal choice.
Borst, director of gynecologic oncology, Banner Good Samaritan Regional Medical Center; clinical assistant professor, University of Arizona College of Medicine; and gynecologic oncologist, Arizona Oncology, discussed varying patient scenarios during the 2018 OncLive®
State of the Science SummitTM
on Ovarian Cancer.
In an interview, he highlighted the need for neoadjuvant therapy versus upfront surgery in newly diagnosed patients, effective treatment management for recurrent platinum-sensitive disease, and what to do in the third-line setting and beyond.
OncLive: You gave an overview of different cases at this meeting. Can you speak to the management of newly diagnosed patients?
: The first 2 cases were newly diagnosed cases, and each started with a very important question: “Should the patient’s treatment begin with surgery upfront— primary debulking surgery—or should she be treated with neoadjuvant chemotherapy?” It’s a very important treatment decision from the get-go—helping patients try to overcome ovarian cancer.
Dr Shana Wingo’s talk was about helping to make that decision of surgery versus neoadjuvant chemotherapy by using CT-scan data, laparoscopy data, and of course looking at the patient’s medical condition. Each of the first 2 cases also featured the potential availability of clinical trials for patients and assessing eligibility and appropriate clinical trials to help the patient with frontline treatment.
In your opinion, what characteristics distinguish whether a person should get neoadjuvant therapy or upfront surgery?
There are 2 categories. First, it starts with the patient’s medical status. Are they healthy enough to potentially tolerate a 4-hour surgery with major procedures being done during the surgery? The second category is based on clinical assessment— CT-scan and perhaps laparoscopy evidence. Do we, as the surgical team, feel there is a high prospect for optimal disease resection status?
Most high-volume centers, doing 20 or more ovarian cancer debulking cases per year, will accomplish between 70% and 80% optimal disease resection status. You put together the assessment of the patient’s medical fitness for surgery and you balance that with the distribution of status. Is it amenable to surgical bulking?
What clinical trials are ongoing in the newly diagnosed setting?
There are trials using upfront checkpoint inhibitors as part of the basic framework for chemotherapy. The JAVELIN OVARIAN 100 trial recently achieved its accrual and we’re looking forward to seeing the data when they are available.
Let’s move on to platinum-sensitive ovarian cancer after a 5-year disease-free interval (DFI). What is the normal treatment of these patients?
The question is, “Do we go directly back to platinum chemotherapy, or should we resect the disease if it is assessed to be resectable?” In the particular case that I presented, it was assessed to be resectable but it was in a difficult part of the body— involving the vagina, bladder, and colon. The patient elected to go back to chemotherapy to shrink the tumor and then go to surgery.