Prognosis and Therapy of Ovarian Cancer, Part 2: the shifting landscape of medical treatment in ovarian cancer.

Background: Ovarian cancer (OC) remains the most common cause of death among all gynecological cancer. For early-stage disease (FIGO stages I and II), staging surgery followed by chemotherapy (CT) with Carboplatin ± Paclitaxel often results in high rates of progression-free survival (PFS) and overall survival (OS). However, this is not the case for advanced-stage disease (stages III and IV), where recurrence rates are significantly higher. Consequently, additional therapeutic strategies, such as maintenance treatment, are essential to improve outcomes in these patients.

Summary: Several randomized controlled trials (RCT) have proven the benefit of Bevacizumab, an anti-vascular endothelial growth factor antibody (anti-VEGF) as 1st line maintenance treatment. Molecular testing led to the introduction of Poly (ADP-ribose) polymerase inhibitors (PARPi), with outstanding results in BRCA-mutated (BRCAmt) and homologous recombination deficient without BRCAmt (HRd) tumors, but not as ideal in HR-proficient (HRp) tumors, which make up the majority of the OC tumors, therefore, further research in this category of tumors is urgently warranted. Immunotherapy, both with chemotherapy and as maintenance failed to improve survival in advanced OC.

Key messages: Combining multiple drug classes (immune checkpoint inhibitors, anti-VEGF and PARPi) was able to improve survival, results in HRp tumors are however still pending. Phase 2 and 3 trials are underway to investigate more innovative treatment of OC.