Ovarian Cancer

In the treatment of patients with platinum-sensitive, recurrent ovarian cancer, a lower starting dose of niraparib in patients with a low body weight (77 kg) or low platelet count (150,000/μL) had similar efficacy as the fixed 300-mg starting dose versus placebo on the end point of progression-free survival, confirming a previous observation.
A review of the National Cancer Database reveals that use of neoadjuvant chemotherapy for advanced epithelial ovarian cancer increased markedly between 2004 and 2016. At the same time, median survival improved by more than 6 months. Study authors found no association between the 2 trends.
Data from a real-world setting show that a platinum-free interval >12 months was associated with the best outcomes after progression on PARP inhibitor maintenance in patients with high-grade serous ovarian cancer.
ASCO guidelines cite significant improvement in progression-free survival when PARP inhibitors are used as maintenance therapy or in the setting of recurrent disease in women with advanced ovarian cancer who have responded to platinum-based chemotherapy in the first line.
In an analysis of the phase 3 PRIMA study, niraparib monotherapy as first-line maintenance after platinum-based chemotherapy improved progression-free survival in women with newly diagnosed advanced ovarian cancer regardless of BRCA mutation status or homologous recombination status (deficient or proficient).
In the PAOLA-1 study, women with advanced ovarian cancer, regardless of BRCA mutation status, experienced a 40% reduction in the risk for disease progression or death when randomized to olaparib plus bevacizumab compared with placebo and bevacizumab. The reduction in risk with olaparib was greatest in patients whose tumors were homologous recombination deficient.
In a 4-arm randomized study, providing telephone genetic counseling only to those women who have a pathogenic mutation or who request the counseling is noninferior to mandatory pre- and posttest counseling, which may represent a new paradigm for genetic testing.
In the phase 2 OVARIO study, median progression-free survival has not yet been reached in women with advanced ovarian cancer who are being treated with the combination of niraparib and bevacizumab after response to first-line platinum-based chemotherapy plus bevacizumab. The combination did not appear to cause cumulative toxicities.
An all-oral regimen in women with recurrent platinum-sensitive ovarian cancer did not show superiority to platinum-based regimens on the outcome of progression-free survival.
In a meta-analysis of 7 large randomized clinical trials, PARP inhibitors were not significantly more likely to cause secondary hematologic malignancies compared with control groups.
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