Dr Graham on Advancements in the Management of Ovarian Cancer

"Relatively recent data suggest that neoadjuvant therapy is as good as adjuvant therapy, so we are giving a bit more neoadjuvant chemotherapy. Now that we have those data, it’s important for our patients because it leads to equal outcomes. We can consider not just aspects of… the tumor, but also what’s going on with the patient."

Deena M. Atieh Graham, MD, medical oncologist at John Theurer Cancer Center at Hackensack Meridian Health, discussed recent treatment developments and the current therapeutic landscape for patients with advanced ovarian cancer.

The majority of patients with ovarian cancer continue to present with stage III or IV disease, which underscores the need for effective systemic strategies, Graham began. Recent data suggest that neoadjuvant chemotherapy offers outcomes comparable to primary cytoreductive surgery, leading to increased use of this approach, particularly for patients who may not be optimal surgical candidates at presentation. This shift allows oncologists to consider not only tumor burden and resectability but also patient-specific factors, such as overall health and surgical fitness, when determining initial management strategies, Graham explained.

Another key area of evolution is the use of maintenance therapy following initial treatment. In patients with BRCA wild-type tumors who are also homologous recombination deficiency (HRD) negative based on germline or somatic testing, maintenance therapy with bevacizumab (Avastin) remains a commonly used option. This approach is generally reserved for patients who are less likely to derive benefit from receiving PARP inhibitors, Graham noted.

Conversely, in patients with BRCA-mutated disease, the use of maintenance PARP inhibitors has become a standard of care and is now widely integrated into frontline disease management. These therapies have been shown to prolong progression-free survival, reinforcing their value in biomarker-selected populations. The broader use of PARP inhibitors has fundamentally changed the treatment paradigm for BRCA-mutated ovarian cancer and has highlighted the importance of timely and comprehensive biomarker testing early in the disease course, Graham concluded.