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.

In an OncLive^® 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.