Mihaela C. Cristea, MD, associate clinical professor in the Department of Medical Oncology and Therapeutics Research at City of Hope, discusses investigational maintenance strategies in advanced ovarian cancer.

There are several ongoing clinical trials looking at maintenance PARP inhibition, such as in the phase III PRIMA study with niraparib (Zejula). Data from that study have not yet been reported but are expected by the end of 2019, says Cristea. The trial is similar to the phase III SOLO-1 trial but is evaluating a different PARP inhibitor. Additionally, the study is not limited to patients with 

 mutations. There are several other studies, including the phase III ATHENA trial with rucaparib (Rubraca), she adds. That trial has a complex study design and is looking at various combinations of PARP inhibitors plus checkpoint inhibitors versus single agents as maintenance therapy.

Moving forward, physicians will have to define the patient population that stands to benefit from these approaches outside of those with 

 mutations, says Cristea. The second challenge is to understand the long-term benefit of maintenance therapy. The goal is to improve the cure rate, but the primary endpoint of most of these maintenance studies is progression-free survival. These questions will have to be addressed if the field is to progress, concludes Cristea.

Mihaela C. Cristea, MD

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Dr. Cristea on Investigational Maintenance Strategies in Ovarian Cancer