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- Title
The role of maintenance therapy in ovarian cancer – updated literature review.
- Authors
Stănculeanu, Dana Lucia
- Abstract
The purpose of this review is to summarize the most recent data supporting the use of maintenance therapy in advanced epithelial ovarian cancer (OC) treatment, which has been developed to prevent disease recurrence after primary therapy. Poly (ADPribose) polymerase inhibitors (PARPi) and antiangiogenic agents dominate the landscape of maintenance treatment. PARPi therapy has been approved in the treatment of highgrade serous OC in the settings of platinumsensitive recurrence, as maintenance single agent treatment after standard firstline chemotherapy, based on the results of: Study 19, SOLO3 and SOLO2 (Olaparib), QUADRA and NOVA (Niraparib), ARIEL2 and ARIEL3 (Rucaparib). At the molecular basis, PARPi eliminate the remaining tumor cells before they go subclonal or increase clonality index, therefore it is best to start the administration at the time of best response. Recent practicechanging randomized clinical trials (SOLO1, PAOLA1, VELIA and PRIMA) demonstrated significant improvements in progressionfree survival (PFS) driven by the incorporation of PARPi (olaparib, olaparib+bevacizumab, veliparib and niraparib) as standard frontline maintenance therapy. The benefit was not only observed in women with BRCA mutations and homologous recombination deficiency (HRD), but also in those with BRCA wild type and even non‐HRD. Biomarker testing is extremely important, but the selection of maintenance is based also on clinical and financial factors. Regarding the antiVEGF antibody bevacizumab, the final analysis of the GOG218 trial did not reveal overall survival differences for patients who received antiangiogenic maintenance therapy compared with chemotherapy alone, despite the improvement in PFS. However, olaparib+bevacizumab represents an option for BRCA mutant or HRDpositive patients in frontline therapy. Although PARPi are currently established as maintenance therapies in recurrence settings and front line, there are still unanswered questions that further trials will address, such as the role of maintenance in PARPiexposed patients and possible PARPi combinations. There is also a need for the development of more specific and sensitive predictive biomarkers for PARPi maintenance therapy and also to investigate their response in other molecular phenotypes of OC.
- Subjects
OVARIAN cancer; OVARIAN epithelial cancer; CANCER treatment; OVERALL survival; LITERATURE reviews; PHENOTYPES
- Publication
Oncolog-Hematolog, 2021, Issue 55, p48
- ISSN
2066-8716
- Publication type
Article