During a Targeted Oncology Case Based Peer Perspectives event, John K. Chan, MD, reviewed the case of a 49-year-old African American woman with high-grade epithelial ovarian cancer.
John K. Chan, MD
During a Targeted Oncology Case Based Peer Perspectives event, John K. Chan, MD, director, Gynecologic Cancer Research and associate clinical professor, Obstetrics/Gynecology, Reproductive Sciences, UCSF Helen Diller Family Comprehensive Cancer Center, reviewed the case of a 49-year-old African American woman with high-grade epithelial ovarian cancer.
Targeted Oncology™: Would you order additional molecular testing for this patient?
CHAN: If the patient is germline positive, I wouldn’t order another molecular test. I know how to treat this patient. I’ve got a piece of the tumor saved, and I can always reorder Foundation [Medicine testing] when the patient recurs.
What are the options for therapy in this patient?
If you use olaparib [Lynparza] alone, the median progression-free survival [PFS] benefit is 56 months.1 Maybe I won’t even need to worry about testing that tumor. She already has the ability to receive olaparib, so I generally don’t do additional molecular tests on these patients.
What do you think of the poll results?
Adding bevacizumab [Avastin] is a primary therapy for ovarian cancer. This needle is moving a lot as we speak, with all these combinations [incorporating bevacizumab] starting to come up. We are understanding more and more that ovarian cancer [therapy] is a maintenance strategy. This is very important.
What would you recommend at this point for this patient?
[Most physicians] would go for olaparib because of the SOLO-1 trial [NCT01844986] and because she had germline-positive BRCA gene mutation.2 She was treated with chemotherapy and had a great response, resulting in NED. [This patient is similar to those] that ended up getting the PFS benefit of 50-plus months.
What factors influenced your decision to treat a patient such as this with a PARP inhibitor?
The toxicities. The magnitude of benefits associated with these PARP inhibitors have rocked our world and changed what we do.
1. Banerjee S, Moore KN, Colombo G, et al. Maintenance Olaparib for patients (pts) with newly diagnosed, advanced ovarian cancer (OC) and a BRCA mutation (BRCAm): 5-year (y) follow-up (f/u) from SOLO1. Ann Oncol. 2020;31(suppl 4):S613. Abstract 811MO. doi:10.1016/j.annonc.2020.08.950
2. Moore K, Colombo N, Scambia G, et al. Maintenance olaparib in patients with newly diagnosed advanced ovarian cancer. N Engl J Med. 2018;379(26):2495-2505. doi:10.1056/NEJMoa1810858