Jason A. Konner, MD, medical oncologist, Memorial Sloan Kettering Cancer, discusses preferred platinum doublet chemotherapies in the treatment of patients with recurrent ovarian cancer.

The choice of which platinum doublet to give really needs to be individualized to the patient, says Konner. If a physician prefers to use bevacizumab (Avastin), it has to be incorporated into the patient’s course of treatment from the start. If a physician plans to use a PARP inhibitor for switch maintenance, the platinum doublet can be selected independent of that based on schedule and toxicity, prior treatments, and patient preference, he adds.

The first platinum doublet that showed a benefit was carboplatin and paclitaxel. It was encouraging to see something better than single-agent carboplatin, says Konner. However, patients had just grown their hair back. Their nerves were just recovering from frontline treatment with paclitaxel, so losing their hair again and getting more neuropathy was not desirable. Gemcitabine ushered in a welcome change, he adds. Moreover, the data from the phase III CALYPSO trial, showed that carboplatin and liposomal doxorubicin is as good as, and potentially better than, carboplatin/paclitaxel in that setting, which was very encouraging. As such, that has become one of Konner’s preferred regimens with regard to schedule, toxicity, and efficacy.

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Dr. Konner on Preferred Platinum Doublets in Recurrent Ovarian Cancer

Jason A. Konner, MD, Gynecologic Medical Oncology Service, Memorial Sloan-Kettering Cancer Center, discusses the uncertain path of PARP inhibitors for the treatment of ovarian cancer.

In a study evaluating maintenance therapy with olaparib in platinum-sensitive, relapsed, high-grade serous ovarian cancer, median progression-free survival (PFS) improved to 8.4 months from 4.8 months. In December 2011, AstraZeneca announced that it would not be moving forward into phase III trials because interim analysis of the phase II data suggested that PFS benefit would not translate into an overall survival benefit. Konner also notes that AstraZeneca changed the drug from a capsule to a tablet and that it may need to start over completely.

Veliparib is currently involved in multiple studies, mostly in feasibility combinations with cytotoxic chemotherapy. Though veliparib's singe agent efficacy is still unknown, the oncology community awaits data from a Gynecologic Oncology Group phase II study.

Konner concludes by mentioning that several other PARP inhibitors have failed and been discontinued, casting further doubt on the future of PARP inhibitors.

Dr. Konner Discusses PARP Inhibitors in Ovarian Cancer

Jason A. Konner, MD, Gynecologic Medical Oncology Service, Memorial Sloan-Kettering Cancer Center, explains that one of the main drivers behind research into bevacizumab (Avastin) for patients with ovarian cancer is to identify which patients will benefit the most from the treatment.

Konner believes that a clear benefit is evident to physicians who are currently using bevacizumab in recurrent ovarian cancer. However, at this point biomarkers are not available to identify which patients will benefit the most before initiating treatment.

In addition to a need for biomarkers, subgroups should be identified to help select appropriate patients. As an example, Konner describes that a high-risk group of patients with ovarian cancer from the European ICON7 trial seemed to show a greater survival benefit from treatment with bevacizumab. At this point, however, data from the ICON7 trial is still premature.

Finally, Konner notes that combinations of novel emerging antiangiogenic agents with bevacizumab may also result in a more efficacious treatment.

Jason A. Konner, MD, from Memorial Sloan-Kettering Cancer Center, explains that one of the main drivers behind research into bevacizumab in ovarian cancer is to identify which patients will benefit the most from the treatment.

Jason A. Konner, MD

Articles

Dr. Konner on Preferred Platinum Doublets in Recurrent Ovarian Cancer

Dr. Konner Discusses PARP Inhibitors in Ovarian Cancer

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