Maintenance Consensus Statement: Advancing Patient Care in Ovarian Cancer With Maintenance Therapy
In a recent commentary in The Oncologist, Drs. Randall, Birrer, and Herzog published a call-to-action to incorporate maintenance therapy into standard practice in ovarian cancer care.1 In "Ovarian Cancer Maintenance: Practice-Changing Data Calls for Changing Practice," the authors urge their fellow clinicians to counsel all eligible patients with ovarian cancer about maintenance therapy.
Rationale for maintenance therapy—With optimization of cytotoxic treatment regimens, ovarian cancer has become a relapsing and remitting disease, and most patients remain sensitive to multiple lines of treatment. However, with each successive line of treatment, the duration of remission becomes shorter. Effective maintenance therapies address an important need in ovarian cancer by prolonging the intervals between cytotoxic treatments, while maintaining quality of life for patients.
Based on these practice-changing data, it’s time to change practice! All eligible patients with ovarian cancer deserve informed counseling regarding the pros and cons of maintenance therapy, and the option of maintenance treatment in these regulatory approved settings.
Maintenance therapy options—Recent advances in maintenance therapy have changed the ovarian cancer treatment landscape. Data from clinical trials have demonstrated that maintenance therapies targeting poly ADP ribose polymerase (PARP) or vascular endothelial growth factor (VEGF) can extend progression-free survival (PFS) relative to placebo/observation without detriment to quality of life in patients with ovarian cancer. Based on these exciting results, there have been multiple FDA approvals for PARP inhibitor or anti-VEGF maintenance therapies across the front-line and recurrent settings.
Despite robust data demonstrating the significant benefits of maintenance, real-world data suggest that a substantial proportion of eligible patients currently do not receive maintenance therapy. Indeed, data presented at the 2019 Society of Gynecologic Oncology Annual Meeting highlight this disconnect by showing that nearly half of eligible patients did not receive maintenance in the recurrent setting.2 According to the authors of the commentary in The Oncologist, key barriers that may be hampering widespread adoption of maintenance therapy into clinical practice include lack of awareness, cost considerations, quality-of-life concerns, and logistical issues related to prolonged therapy.
Given the strong body of evidence supporting the superiority of maintenance treatment over observation, the authors recommend that clinicians counsel all eligible patients about the risks and benefits of maintenance therapy and offer them the option of maintenance therapy.