Epithelial Ovarian Cancer: Treatment

Epithelial Ovarian Cancer: overview

This algorithm follows epithelial ovarian cancer from frontline treatment through maintenance and recurrence. Frontline therapy is cytoreductive surgery plus carboplatin and paclitaxel, with or without bevacizumab. Maintenance is then selected by biomarker: olaparib for BRCA-mutated disease (SOLO-1), olaparib plus bevacizumab for HRD-positive disease (PAOLA-1), niraparib for all-comers (PRIMA), or continued bevacizumab if it was used frontline (GOG-0218). The site's PAOLA-1 summary describes a large PFS benefit with olaparib plus bevacizumab in HRD-positive or BRCA-mutated patients and minimal benefit in HR-proficient patients.

Recurrence is divided by platinum sensitivity. Platinum-sensitive recurrence is re-treated with a platinum doublet with or without bevacizumab (OCEANS), followed by PARP inhibitor maintenance if not used previously (SOLO-2). Platinum-resistant recurrence is treated with single-agent chemotherapy with or without bevacizumab (AURELIA), which improved PFS without an OS benefit, or with mirvetuximab soravtansine for FRα-positive tumors (MIRASOL), which improved PFS, OS and response rate versus chemotherapy.

Trials behind this algorithm

• SOLO1 Moore KN et al, N Engl J Med, 2018
• PAOLA-1 Ray-Coquard I et al, NEJM, 2019; PMID: 31851799
• PRIMA Gonzalez-Martin A et al, NEJM, 2019; PMID: 31562799
• GOG 218 Burger RA et al, NEJM, 2011; PMID: 22204724
• OCEANS Aghajanian C et al, JCO, 2012; PMID: 22529265
• AURELIA Pujade-Lauraine E et al, JCO, 2014; PMID: 24637997
• MIRASOL Moore KN et al, NEJM, 2023; PMID: 38055253

Background reading: Ovarian cancer board review notes.