Thomas J. Herzog, MD

Panelists discuss how frontline maintenance therapy options for advanced ovarian cancer are influenced by key factors, such as a patient’s HRD status, and when a combination approach with PARP inhibitors and bevacizumab might be preferred over monotherapy.

Panelists discuss how genomic instability scores, including HRD vs HRP profiles, influence treatment selection and sequencing in ovarian cancer, particularly in guiding the use of PARP inhibitors and other targeted therapies in the maintenance setting, and how these scores may prompt adjustments to standard treatment approaches.

Panelists discuss how biomarker testing for advanced ovarian cancer, including when and which biomarkers to test (such as HRD), plays a crucial role in guiding treatment decisions and personalizing patient care.

Thomas J. Herzog, MD, examines the PAOLA-1 trial results, focusing on the primary endpoint of progression-free survival (PFS) and key secondary endpoint of overall survival for olaparib in combination with bevacizumab for the treatment of advanced ovarian cancer. He discusses the 5-year overall survival data in relation to the PFS data and reviews the safety profile of the combination therapy with over 5 years of median follow-up. Dr. Herzog also considers the impact of these data on clinical decision-making and patient counseling from the perspective of a practicing gynecologic oncologist.

Panelists discuss clinical guidelines recommendations for HRD testing in ovarian cancer and how they inform their practice.

Discussion centered around data from the PAOLA-1 trial, highlighting the prevalence of BRCA1/2 mutations and HRD status in ovarian cancer, and how patients with these alterations may benefit from PARP inhibitor treatment.

The panel reviews commercially available HRD tests and expand upon factors that may influence test choice, such as clinical performance, institutional availability, turnaround time, and cost.

Dr Hagemann explains how loss of heterozygosity (LOH), large-scale state transitions (LSTs), and telomeric allelic imbalance (TAI) can also contribute to HRD.

Experienced clinicians explain the role of the homologous recombination repair (HRR) pathway in DNA repair and how mutations in HRR-related genes, including BRCA1 and BRCA2, can cause homologous recombination deficiency (HRD) and contribute to the development and progression of ovarian cancer (OC).

Thomas Herzog, MD, Thomas Krivak, MD, and Ian Hagemann, MD, PhD open their discussion by introducing themselves and the objectives of the program.

Thomas Herzog, MD, discusses the data that led to the FDA approval of the combination of olaparib and bevacizumab for the maintenance treatment of patients with advanced ovarian cancer who are in complete or partial response to first-line platinum-based chemotherapy with bevacizumab and whose cancer is associated with homologous recombination deficiency–positive status defined by either a deleterious or suspected deleterious BRCA mutation, and/or genomic instability.

Thomas Herzog, MD, professor of obstetrics and gynecology, deputy director, University of Cincinnati Cancer Institute, discusses the use of hyperthermic intraperitoneal chemotherapy (HIPEC) in ovarian cancer.