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February 20, 2019
Olaparib Maintenance Therapy for Newly Diagnosed Advanced Ovarian Cancer: In December 2018, olaparib (Lynparza®) received FDA approval for maintenance treatment of adult women with deleterious or suspected deleterious germline or somatic BRCA-mutated (gBRCAm or sBRCAm) advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in complete or partial response to first-line platinum-based chemotherapy. Olaparib is a PARP inhibitor initially approved for recurrent, platinum-sensitive BRCA1/2 positive ovarian cancer. In 2017, olaparib received approval for maintenance therapy in patients with recurrent ovarian, fallopian tube, or primary peritoneal cancer who had a complete or partial response to platinum-based chemotherapy. The most recent FDA approval extends the indication for maintenance therapy to newly diagnosed patients. A randomized, double-blind, placebo-controlled, multicenter phase 3 trial demonstrated that olaparib as maintenance therapy for newly diagnosed advanced ovarian cancer patients with BRCA-mutation significantly improves PFS after first-line chemotherapy with platinum-based chemotherapy.
Upon completion of the chapter, the reader will be able to:
Demonstrate understanding of the etiology and risk factors associated with the development of ovarian cancer.
Justify the risk and benefits of the surgical and chemoprevention options available for decreasing the potential risk of developing ovarian cancer.
Interpret and understand the utility of the screening tests and serologic markers for diagnosing ovarian cancer.
Distinguish the nonspecific physical signs and symptoms of ovarian cancer.
Recommend the appropriate surgical and chemotherapy treatment options for newly diagnosed, persistent, and recurrent ovarian cancer patients.
Discuss the role of maintenance treatment for improving overall survival for ovarian cancer patients.
Compare and contrast chemotherapy options for women with recurrent platinum-resistant ovarian cancer.
Ovarian cancer is relatively uncommon but is the most incurable of the gynecologic cancers. Ovarian cancer is often denoted as the “silent killer.” The primary reason for the high mortality rate associated with ovarian cancer is the nonspecific symptoms and difficulty for early detection or screening that result in patients presenting with advanced disease. The majority of ovarian cancers are of epithelial origin. Each time ovulation occurs, the epithelium of the ovary is broken followed by occurrence of cell repair. The incessant ovulation hypothesis proposes that the increasing number of times the ovary epithelium undergoes cell repair is associated with the increasing risk of mutations and ultimately ovarian cancer. Although the majority of patients will achieve a complete response (CR) to primary surgery and chemotherapy, disease recurs in more than 50% of patients in the first 2 years after completion of primary treatment. Ovarian cancers often cause metastasis via the lymphatic and blood systems to the liver, and/or lungs. Common complications of advanced and progressive ovarian cancer include ascites and small bowel obstruction (SBO), which often are associated with the end of life.
EPIDEMIOLOGY AND ETIOLOGY