Dr. Miller on Approaching Frontline Maintenance Therapy in Ovarian Cancer

Eirwen M. Miller, MD, gynecologic oncologist, Allegheny Health Network, West Penn Hospital, discusses her approach to frontline maintenance therapy in ovarian cancer.

Prior to implementing frontline maintenance therapy, patient factors, such as whether patients have ascites and plural effusions despite paracentesis or thoracentesis, whether they are candidates for primary debulking surgery, and whether debulking surgery would be optimal or suboptimal, need to be considered, says Miller. These factors can inform whether a patient should receive bevacizumab (Avastin), whereas the results of germline and somatic molecular testing can inform if a patient should receive a PARP inhibitor, Miller says.

Patients who are homologous recombination deficient (HRD) who are started on bevacizumab should have olaparib (Lynparza) added to their maintenance plan based on the results of the phase 3 PAOLA-1 trial, Miller says. Patients who are homologous recombination proficient (HRP) should continue on bevacizumab alone if it was already started, Miller says.

Patients who are not started on bevacizumab and are HRD should receive a PARP inhibitor, whereas patients who have not started on bevacizumab and are HRP could be considered for niraparib (Zejula) based on the results of the phase 3 PRIMA trial, concludes Miller.