Dr DeBernardo on an Ovarian Cancer Patient Case Study

Robert DeBernardo, MD, section head, Department of Obstetrics and Gynecology, Women’s Health Institute, Cleveland Clinic, discusses a case study seen in a patient with ovarian cancer. 

DeBernardo begins by saying that he often finds case presentations intriguing because they apply real-life scenarios and incorporate data from clinical studies into practice. The case that was presented at a 2023 

® State of the Science Summit™ on gynecologic cancers was particularly compelling because it highlighted how ovarian cancer treatment approaches have evolved over time, he explains. For instance, the patient featured in the case would be treated differently today than they were in reality, as they received treatment approximately a decade ago, DeBernardo explains.

-positive disease, contemporary treatment protocols would likely include a combination of surgery, chemotherapy, and PARP inhibition, options that weren't available when she was initially diagnosed, he expands. What's fascinating about this case presentation is the diverse array of interventions employed throughout this patient’s treatment, he states. Instead of solely relying on chemotherapy for recurrences, investigators integrated focal radiation therapy, PARP inhibitors, and maintenance bevacizumab (Avastin), DeBernardo notes. As the ovarian cancer field transitions into an era of folate receptor α–targeted drugs, this patient is now benefiting from such therapy, he emphasizes.

Despite experiencing multiple recurrences, this patient’s emphasis on maintaining quality of life has been a guiding principle in her treatment decisions, he explains. It's remarkable how well this patient is living with her disease, enjoying life despite the challenges she's faced, DeBernardo continues. The case also prompts reflection on the evolving ovarian cancer treatment paradigm, especially with the increasing use of PARP inhibitors in the frontline setting, he says. Although the impact of these agents on overall survival may be limited, they still hold value as therapeutic agents, particularly in homologous recombination deficient–positive patients, DeBernardo states. Questions arise about the role of these agents upon disease recurrence and whether they should be viewed more akin to chemotherapy rather than solely as maintenance therapy, DeBernardo says. This perspective underscores the ongoing relevance of PARP inhibitors in the ovarian cancer therapeutic arena, concludes.

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Robert DeBernardo, MD, discusses a case study seen in a patient with ovarian cancer.  

Dr DeBernardo on the Use of Later-Line Maintenance Therapy in Ovarian Cancer

Robert DeBernardo, MD, section head, Obstetrics and Gynecology, Women’s Health Institute, Cleveland Clinic, discusses the use of maintenance therapy in the second- and later-line settings for patients with ovarian cancer.

Ovarian cancer recurrence is common, and recurrent disease is not currently believed to be curable, DeBernardo says, adding that he considers patients with recurrent ovarian cancer to have a terminal illness. Therefore, the role of maintenance therapy at the time of ovarian cancer recurrence differs from that of upfront maintenance therapy in this patient population, DeBernardo emphasizes. In the second-line setting and beyond, maintenance therapy can be considered if it has the potential to provide benefit to patients, DeBernardo notes.

Although maintenance therapies in this setting may extend progression-free survival, including the time patients can survive without chemotherapy, current data do not support the use of this treatment strategy to extend overall survival (OS), DeBernardo explains. Some patients with recurrent ovarian cancer may experience an OS benefit with maintenance therapy, but this benefit must be considered within the context of safety and quality of life (QOL), according to DeBernardo. For instance, oncologists need to determine whether patients are willing to risk developing treatment-associated adverse effects and commit to a treatment schedule that requires them to receive infusions every few weeks.

 State of the Science Summit™ on gynecologic oncology, which DeBernardo chaired, Lisa Rauh-Benoit, MD, of Cleveland Clinic, gave a presentation on the use of maintenance therapy upon ovarian cancer recurrence, in which she discussed the use of bevacizumab (Avastin) maintenance therapy in patients with recurrent ovarian cancer. DeBernardo, who uses maintenance therapy in the recurrent setting in his clinical practice, notes that bevacizumab is relatively well tolerated and beneficial for certain patient subgroups. Overall, maintenance therapy may help patients with recurrent ovarian cancer prolong the time before they require chemotherapy, which can elevate their QOL for a longer period than they would experience with chemotherapy alone, DeBernardo concludes.

Robert DeBernardo, MD, discusses the use of maintenance therapy in the second- and later-line settings for patients with ovarian cancer.

Dr DeBernardo on the Role of PARP Inhibitors in Frontline Ovarian Cancer

Robert DeBernardo, MD, section head, Department of Gynecologic Oncology, leader, Section of Gynecologic Oncology, director, Peritoneal Surface Malignancy Program, Laura J. Fogarty Endowed Chair in Uterine Cancer Research, Cleveland Clinic, discusses the current role of PARP inhibitors in the frontline treatment landscape in ovarian cancer, and the importance of discussing the risk/benefit profile of these agents with patients when determining a treatment approach.

PARP inhibition has emerged as a pivotal therapeutic approach in the management of ovarian cancer, DeBernardo begins. Although research with PARP inhibitors primarily focuses on assessing progression-free survival benefit, this measure may not have accurately captured the efficacy of this drug class in recurrent disease. Accordingly, DeBernardo asserts that there still may be a crucial role for these agents in the up-front setting. Specifically, PARP inhibitors have demonstrated significant benefit in a subset of patients with ovarian cancer, including those with 

 and other homologous recombination deficient mutations, DeBernardo explains.

It's imperative for clinicians to engage in candid discussions with their patients regarding the risks and benefits associated with PARP inhibition, DeBernardo continues. These agents can offer potential advantages, such as improved outcomes, he says. However, they also come with a risk of adverse effects, including the potential development of myelodysplastic syndrome (MDS). Addressing these considerations comprehensively ensures that patients are informed about the potential long-term implications of treatment, DeBernardo states.

Moreover, the practical aspects of PARP inhibition should not be overlooked, DeBernardo notes. Following surgery and chemotherapy, patients may experience fatigue and a desire to conclude treatment. Therefore, the decision to proceed with PARP inhibition should be weighed carefully, taking into account the patient's preferences and overall quality of life, DeBernardo says.

Ultimately, the goal should be to provide personalized care that aligns with the patient's values and preferences, DeBernardo emphasizes. By engaging in open communication and considering the broader context of the patient's journey, clinicians can make well-informed decisions that prioritize the patient's well-being while effectively managing their ovarian cancer, DeBernardo concludes.

Robert DeBernardo, MD, discusses the current role of PARP inhibitors in the frontline treatment landscape in ovarian cancer. 

Robert DeBernardo, MD

Articles

Dr DeBernardo on an Ovarian Cancer Patient Case Study

Dr DeBernardo on the Use of Later-Line Maintenance Therapy in Ovarian Cancer

Dr DeBernardo on the Role of PARP Inhibitors in Frontline Ovarian Cancer