Debate 18A - What is the best front-line maintenance therapy for optimally debulked HRD-negative advanced epithelial ovarian cancer? Bevacizumab

Summary

Overall survival for FIGO stage III–IV epithelial ovarian cancer remains low, with only 10% of women remaining disease-free at 10 years of follow-up. Cytoreductive surgery for newly diagnosed advanced ovarian carcinoma, when performed by high-volume surgeons at high-volume centers, has the potential to place the vast majority of patients (approximately 85%) into sustained clinical remission following completion of adjuvant systemic platinum- and taxane-based chemotherapy. However, because most of these patients are ultimately destined to relapse, there has been great interest in identifying effective and tolerable maintenance therapies that can significantly prolong progression-free survival (PFS) and even possibly improve overall survival (OS) in select subpopulations. The molecular signatures exhibited among patients with germline and/or somatic BRCA mutations, as well as those with homologous recombination deficient BRCA-wild type tumors, characterize distinct patient cohorts that may derive benefit from maintenance therapy using the poly-ADP-ribose polymerase I inhibitor olaparib alone or when combined with the anti-angiogenesis agent bevacizumab, respectively. Patients whose tumors are homologous recombination-proficient should be offered maintenance therapy with bevacizumab which can significantly improve PFS by approximately six months and possibly impact OS among those with FIGO stage IV disease.