Consensus on drivers of maintenance treatment choice and patterns of care in advanced ovarian cancer.

Objectives: Maintenance therapies, including poly (ADP-ribose) polymerase (PARP) inhibitors and/or bevacizumab, have substantially improved the prognosis of patients with advanced ovarian cancer. Owing to the variability in treatment strategies across Europe, a Delphi study was conducted among European experts to understand the heterogeneity of clinical practice and identify key factors driving maintenance treatment decisions for advanced ovarian cancer.
Methods: A pragmatic literature review was conducted to identify key questions regarding maintenance treatment strategies in patients with advanced ovarian cancer. Utilizing a Delphi methodology, consensus was assessed among a panel of 16 experts using a questionnaire based on results of the pragmatic literature review.
Results: Panelists agreed that BRCA mutation and homologous recombination status should be assessed in parallel at diagnosis, and that first-line platinum chemotherapy may be initiated concurrently. There was a consensus that alternative homologous recombination deficiency tests are acceptable provided they are clinically validated. Panelists agreed that Response Evaluation Criteria in Solid Tumors (RECIST) and CA-125 elimination rate constant K (KELIM) scores can help assess tumor chemosensitivity and guide treatment-related decisions. Panelists defined high-risk disease as International Federation of Gynecology and Obstetrics (FIGO) stage IV disease or stage III with residual disease after initial/interval cytoreduction. Risk of disease progression was a key determinant of choice between PARP inhibitor, bevacizumab, or both in combination, as maintenance therapy in advanced ovarian cancer.
Conclusions: Key drivers for selecting advanced ovarian cancer maintenance treatments include tumor mutational status as a key biomarker and clinician perception of the risk for early disease progression.
Competing Interests: Competing interests: BY has had consulting positions for MSD, AstraZeneca, GSK-TESARO, Bayer, Roche-Genentech, ECS Progastrin, Novartis, LEK, Amgen, Clovis Oncology, Merck Serono, BMS, Seagen, Myriad, Menarini, Gilead, and Eisai. APF has had advisory roles for AstraZeneca, GSK-Tesaro, Clovis, PharmaMar, Abilify Pharma, and Eisai; has been a speaker for AstraZeneca, GSK-Tesaro, Clovis, PharmaMar, Karyopharm and Seagen; and has received research grants to their institution from GSK, PharmaMar, AstraZeneca, and Novartis. BS has received grants/research support from AstraZeneca, Roche, MSD, and GSK; honoraria or consultation fees from AstraZeneca, Roche, MSD, GSK, and Eisai; and has participated in company-sponsored speakers bureaus for AstraZeneca, Roche, MSD, GSK, and Eisai. AG has received honoraria from AstraZeneca, GSK, Merck, Roche, and Clovis; and has been a speaker for AstraZeneca, GSK, Merck, and Clovis. CG has received grants from AstraZeneca, MSD, Novartis, GSK, BerGen Bio, Merdannex, Roche, and Verastem; and has received honoraria from AstraZeneca, MSD, GSK, Clovis, Verastrem, Takeda, Eisai, Cor2Ed, and Peer Voice. SP has received honoraria from AstraZeneca, MSD, GSK, Roche, Clovis, Immunogen and AbbVie; and research/funding from AstraZeneca, Roche, MSD, and GSK. DL has had consulting or advisory roles for AstraZeneca, Corcept, Clovis Oncology, Daiichi Sankyo, Genmab, GSK, Immunogen, MSD, Novartis, Oncoinvest, Novocure, Seagen, Sutro; has received research funding to their institution from AstraZeneca, Clovis Oncology, Pharma & Genmab, GSK, Immunogen, Incyte, MSD, Novartis, Pharmamar, Roche, Seagen, alkermes and Corcept; has received travel accommodation/expenses from AstraZeneca, GSK and MSD. MPBG has had advisory roles for AstraZeneca, MSD, GSK, Clovis, PharmaMar, and Eisai; has been a speaker for AstraZeneca, MSD, GSK, Clovis, and PharmaMar; and has received travel accommodation and expenses from AstraZeneca, MSD, GSK, and PharmaMar. IR has had advisory roles for Roche, AstraZeneca, GSK, and Clovis; has received grants/research support from Roche, AstraZeneca, and GSK; has received honoraria from PharmaMar, Roche, AstraZeneca, GSK, MSD, Eisai, and Seagen; and has been a sponsored speaker for PharmaMar, Roche, AstraZeneca, GSK, and MSD. CGr has received funding from AstraZeneca, Meda Pharma, and Roche Diagnostics; honoraria or consultation fees from AstraZeneca, Celgene, Clovis, Eisai, GSK, MSD, PharmaMar, Roche, and Vifor Pharma; and has participated in company-sponsored speakers bureaus for Amgen, AstraZeneca, Eisai, GSK, MSD, PharmaMar, and Roche. TVG has consulted/advised for AstraZeneca, BioNTech, Eisai, GSK, ImmunoGen, Incyte, Karyopharm, MSD/Merck, OncXerna Therapeutics, Seagen, Tubulis, Zentalis; travel, accommodations, and/or expenses paid by AstraZeneca, ImmunoGen, MSD/Merck, PharmaMar; research funding from Amgen, AstraZeneca, and Roche; all payments are institutional. MR has received grants/research support from Neye Foundation, Novo Nordisk Foundation, and AstraZeneca; and has received honoraria or consultation fees from Laegeforeningen/Danish Medical Association, AstraZeneca, and GSK. DCC has received honoraria from Amgen, AZD, GSK, Janssen, Pfizer, and MSD Oncology; has had consulting or advisory roles with Seagen, Genmab, MSD Oncology, and GSK; and has received research funding from Roche and Pfizer. JF has received honoraria from AstraZeneca and GSK. LB has received funding from AstraZeneca, Helse Vest, and the University of Bergen; has been a sponsored speaker for GSK and MSD. AL has received funding from Sanofi, Roche, GSK, BMS, AstraZeneca, Ose Immuno, Lovance, Agenus, Arcagy Gineco, Ability Pharma, Apmonia, Blueprint Medicines Corporation, MSD, Clovis, Merck Serono, Onko+, Zentalis, Kephren, and Medscape. TdlMR has received grants/research support from Seagen, MSD, and Pfizer; honoraria or consultation fees from AstraZeneca, Pfizer, MSD, GSK, Gilead, Clovis Oncology, and Esai; and has participated in company-sponsored speakers bureaus for AstraZeneca, GSK, and MSD. PH has received honoraria from Amgen, AstraZeneca, GSK, Roche, Sotio, Stryker, Zai Lab, MSD, Clovis, Eisai, Mersana, and Exscientia; has participated in advisory boards for AstraZeneca, Roche, GSK, Clovis, Immunogen, MSD, Miltenyi, Novartis, and Eisai; and has received research funding to their institution from AstraZeneca, Roche, GSK, Genmab, DFG, European Union, DKH, Immunogen, Seagen, Clovis, and Novartis. CK has received honoraria or consultation fees from GSK, AstraZeneca, Novartis, PharmaMar, Genomic Health, Roche, Eli Lilly, Merck MSD, Pfizer, and Daiichi Sankyo; has participated in company-sponsored speakers bureaus for GSK, AstraZeneca, Novartis, and Roche; and has received travel support from GSK, AstraZeneca, and Roche. JS-B has received honoraria or consultation fees from AstraZeneca, GSK, and MSD; and has received grants/research support from AstraZeneca, Novartis, Pfizer, and Roche.
(© IGCS and ESGO 2024. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.)