Ovarian Cancer: Future Directions in Care

Closing out her discussion on ovarian cancer, Leslie Randall, MD, shares closing advice for community physicians on optimal treatment strategies.


Leslie M. Randall, MD: I’ve always been a proponent of maintenance therapy, even from a long time ago when we first had maintenance therapy approved for platinum-sensitive recurrence. But I can tell you, as we get more and more data about not only the benefit but also the relative toxicity of maintenance therapy as we get better at managing the side effects, we’re really starting to see interesting results. Our quality of life data is showing that the original trial showed no detriment in quality of life to giving maintenance therapy in a disease setting where patients don’t have active disease, so that maintenance setting. There’s no detriment to the quality of life but we’re coming up with more sophisticated ways of looking at the quality of life. You may have heard of the time without symptoms or toxicity analyses that really are TWiST [time without symptoms or toxicity] analyses that really account for the symptoms that are related to the maintenance therapy but also the symptoms that are related to the early progression of disease. And when you look at a TWiST analysis, that’s where you really start to see a very significant benefit of continuing patients on maintenance therapy. This has been most pronounced with the PARP inhibitors, and this TWiST analysis has been presented pretty much all of the PARP trials at this point in time and has shown very favorable results. This was really interesting data because the most common argument I hear is contradictory to maintenance therapy or reasons not to give maintenance therapies, a patient has no disease. Why should you give them therapy or subject them to the side effects of treatment when they really just need a break from treatment? And these TWiST analyses really put those comments into perspective because not only is the therapy symptomatic, but the early recurrences are symptomatic as well, so I love this data. I think that this has been really informative to help us work through that barrier to maintenance therapy.

It's been great to spend time with you all as community oncologists. I think that you’re an important part of our patient care system and I would just encourage you if you don’t know the data surrounding ovarian cancer maintenance therapy that you get very familiar with it. To me, this is clearly the standard of care for patients and they should all be offered maintenance therapy if they’re the correct candidates for maintenance therapy. If it’s something that you’re not interested in doing in your practice, that is fine, I think that you could find GYN [gynecologic]-oncologists. Many of us have knowledge of this data and are happy to see these patients, and happy to help comanage these patients with you. I have several patients that I help community oncologists manage in this setting and it’s actually a really nice relationship. Those patients also see us for clinical trials as they become available so it's a very beneficial relationship for the community providers, for us, and for the patients. We really enjoy that here in our catchment area.

Transcript edited for clarity.

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