Informing Ovarian Cancer Treatment Approach With Clinical Trial Data


Chad A. Hamilton, MD, discusses how clinical trial data inform treatment selection for patients with ovarian cancer.

Case: A 49-Year-Old Woman with BRCA-WT Ovarian Cancer

  • A 49-year-old presented to her primary care physician complaining of abdominal bloating and nausea
  • PMH: mild HTN
  • FH: mother died of breast cancer at age 59; cousin on mother’s side died of ovarian cancer at age 65
  • Imaging: CT reveals small-volume ascites, bilateral 8-cm adnexal masses
  • Labs: CA 125, 285 U/mL
  • Surgical intervention: she underwent exploratory laparotomy followed by omentectomy, bilateral salpingo-oophorectomy, and resection of peritoneal nodules; optimal cytoreduction with < 1 cm of residual disease after surgery
  • Diagnosis: stage IIIC HGSC
  • Treatment: She was treated with IV carboplatin and paclitaxel w/ NK1, 5HT3, and dexamethasone CINV prophylaxis
  • TRAEs: She experienced persistent daily nausea with vomiting on day 1 after chemotherapy
  • Follow-up: After completion of chemotherapy, CA 125, 14.2; clinically NED; patient reports continuing daily nausea


Chad A. Hamilton, MD: These 4 trials that I just discussed have really been practice changing and have shaped all of our practices in GYN oncology. And we all interpret the data a little bit differently and integrate them into our practices a little bit differently. To make it easy on myself, I try to stick to FDA indications and NCCN [National Comprehensive Cancer Network] guidelines as much as possible. For me, my decision depends largely on whether I use bevacizumab in the frontline setting, and then what the patient’s BRCA and HRD [homologous recombination deficiency] status is.

In the case we presented, this patient was treated with carboplatin and paclitaxel without bevacizumab. In that population, if this patient is HRD positive, then niraparib would be the FDA-indicated treatment for this patient. If I had used bevacizumab in the frontline setting, used it along with the carboplatin-paclitaxel, then in those patients, the choice then is olaparib plus bevacizumab. It really comes down to whether I used bevacizumab in the front line. If I did, then often I’m going to go with the olaparib plus bevacizumab maintenance, as in the PAOLA-1 study [NCT02477644]. And of course that’s in my HRD-positive population. If I did not use bevacizumab in the frontline setting, then niraparib is the FDA-indicated PARP inhibitor in that setting for HRD-positive patients. If the [patient’s disease] is also BRCA mutated, then that gives you an option of whether to use olaparib or niraparib. And in that setting, then I’ll base my choice between those 2 on patient factors.

In this case, for instance, the patient had a lot of challenges with nausea. In that case, I would lean towards niraparib where it’s a once-daily dosing and I can give the niraparib in the evening. And oftentimes I treat patients with something like Zofran [ondansetron] or some other antiemetic a half an hour before they go to bed and take their niraparib. And it seems to be relatively well tolerated and abrogates some of the nausea issues they’ve had. Now on the flip side, if it’s a patient who perhaps had their platelets or bone marrow pretty banged up during primary chemotherapy, then that’s a group that I may lean toward olaparib rather than niraparib.

Transcript is AI-generated and edited for clarity and readability.

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