Consensus statements and treatment algorithm to guide clinicians in the selection of maintenance therapy for patients with newly diagnosed, advanced ovarian carcinoma: Results of a Delphi study

• Published in: Gynecologic oncology 2023-08, Vol.175, p.182-189
• Main Authors: Colombo, Nicoletta, Gadducci, Angiolo, Landoni, Fabio, Lorusso, Domenica, Sabbatini, Roberto, Artioli, Grazia, Berardi, Rossana, Ceccherini, Rita, Cecere, Sabrina Chiara, Cormio, Gennaro, De Angelis, Carmine, Legge, Francesco, Lissoni, Andrea, Mammoliti, Serafina, Mangili, Giorgia, Naglieri, Emanuele, Petrella, Maria Cristina, Ricciardi, Giuseppina Rosaria Rita, Ronzino, Graziana, Salutari, Vanda, Sambataro, Daniela, Savarese, Antonella, Scandurra, Giuseppa, Tasca, Giulia, Tomao, Federica, Valabrega, Giorgio, Zavallone, Laura, Pignata, Sandro
• Format: Article
• Language: English
• Subjects: Advanced ovarian cancer; Antineoplastic Agents - therapeutic use; Bevacizumab; BRCA; Carcinoma, Ovarian Epithelial - drug therapy; Delphi Technique; Female; HRD; Humans; Maintenance Chemotherapy; Maintenance therapy; Niraparib; Olaparib; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - genetics; PARP inhibitor; Poly(ADP-ribose) Polymerase Inhibitors
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2023.05.065

•Several treatment options for ovarian carcinoma are available beyond chemotherapy (83).•Maintenance therapy with bevacizumab and/or PARPi can prolong survival (72).•The present consensus-statements are meant to assist clinicians in decision-making (84).•Based on the consensus-statements, two practical treatment algorithms are provided (84).•A novel tool for the assessment and definition of response to treatment is proposed (85). Standard treatment of newly diagnosed, advanced ovarian carcinoma (OC) consists of cytoreductive surgery followed by platinum-based chemotherapy with or without bevacizumab. Maintenance therapy with PARP inhibitors and olaparib-bevacizumab has recently shown to significantly improve progression-free survival in the first-line setting. Some practical aspects of maintenance therapy, however, are still poorly defined. To provide guidance to clinicians in the selection of maintenance therapy for newly diagnosed, advanced ovarian carcinoma. A board of six gynecologic oncologists with expertise in the treatment of OC in Italy convened to address issues related to the new options for maintenance treatment. Based on scientific evidences, the board produced practice-oriented statements. Consensus was reached via a modified Delphi study that involved a panel of 22 experts from across Italy. Twenty-seven evidence- and consensus-based statements are presented, covering the following areas of interest: use of biomarkers (BRCA mutations and presence of homologous recombination deficiency); timing and outcomes of surgery; selection of patients eligible for bevacizumab; definition of response to treatment; toxicity and contraindications; evidence of synergy of bevacizumab plus PARP inhibitor. Two treatment algorithms are also included, for selecting maintenance therapy based on timing and outcomes of surgery, response to platinum-based chemotherapy and biomarker status. A score for the assessment of response to chemotherapy is proposed, but its validation is ongoing. We provide here consensus statements and treatment algorithms to guide clinicians in the selection of appropriate and personalized maintenance therapy in the first-line setting of advanced OC management.