scholarly journals Current Ovarian Cancer Maintenance Strategies and Promising New Developments

2021 ◽  
Vol 12 (1) ◽  
pp. 38-53
Author(s):  
Vinaya Gogineni ◽  
Susan Morand ◽  
Hannah Staats ◽  
Rachel Royfman ◽  
Monika Devanaboyina ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
New Developments ◽  
Maintenance Strategies

scholarly journals Frontline Maintenance Treatment for Ovarian Cancer

2021 ◽  
Vol 23 (8) ◽  
Author(s):  
Osnat Elyashiv ◽  
Yien Ning Sophia Wong ◽  
Jonathan A. Ledermann
Keyword(s):  
Ovarian Cancer ◽  
Drug Resistance ◽  
Dna Repair ◽  
Maintenance Treatment ◽  
Advanced Disease ◽  
Disease Recurrence ◽  
Primary Treatment ◽  
New Paradigm ◽  
Maintenance Strategies ◽  
Advanced Epithelial Ovarian Cancer

Abstract Purpose of Review Advanced epithelial ovarian cancer remains the most lethal gynaecological cancer. Most patients with advanced disease will relapse within 3 years after primary treatment with surgery and chemotherapy. Recurrences become increasing difficult to treat due to the emergence of drug resistance and 5-year survival has changed little over the last decade. Maintenance treatment, here defined as treatment given beyond primary chemotherapy, can both consolidate the response and prolong the control of disease which is an approach to improve survival. Recent Findings Here we review maintenance strategies such as targeting angiogenesis, interference of DNA repair through inhibition of PARP, combinations of targeting agents, and immunotherapy and hormonal therapy. Summary Much has been learnt from the success and challenges of these treatments that have in the last few years which led to significant reduction in disease recurrence, changed the guidelines for treatment, and established a new paradigm for the treatment of ovarian cancer.

Cost-effectiveness of various maintenance therapies based on mutation status following first-line treatment of primary epithelial ovarian cancer in the United States.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19399-e19399
Author(s):  
Courtney Penn ◽  
Melissa Wong ◽  
Christine S. Walsh
Keyword(s):  
Ovarian Cancer ◽  
Cost Effectiveness ◽  
Homologous Recombination ◽  
Maintenance Therapy ◽  
Cost Effective ◽  
The United States ◽  
Base Case ◽  
Mutation Status ◽  
Maintenance Strategies ◽  
The Cost

e19399 Background: The recent SOLO1, PRIMA, and PAOLA trials all reported positive efficacy results, making it difficult to determine optimal upfront maintenance therapy for patients with primary, advanced ovarian cancer. We evaluated the cost-effectiveness of the maintenance strategies outlined in these trials for BRCA-positive patients, homologous-recombination deficient patients without a BRCA mutation (HRD-positive), and homologous-recombination proficient (HRD-negative) patients. Methods: Three decision analysis models were developed, one for each mutation status. We evaluated olaparib (SOLO1), olaparib/bevacizumab (PAOLA), bevacizumab alone (PAOLA), and niraparib (PRIMA) maintenance strategies. Base case 1 assessed olaparib vs olaparib/bevacizumab vs bevacizumab vs niraparib vs no maintenance therapy in BRCA-positive patients. Base cases 2 and 3 assessed olaparib/bevacizumab vs bevacizumab vs niraparib vs no maintenance therapy in HRD-positive and HRD-negative patients, respectively. Time horizon was 24 months. Costs, measured in U.S. dollars, were estimated from Medicare claims, wholesale acquisition prices, and previously published sources. Incremental cost-effectiveness ratios (ICERs) were in dollars per progression-free life-year saved (PF-LYS). One-way sensitivity analyses were performed varying drug cost and progression-free survival. Results: Assuming a willingness-to-pay threshold of $100,000/PF-LYS, none of the drug maintenance strategies could be considered cost effective compared with observation. In BRCA-positive patients (base case 1), olaparib monotherapy was the most cost-effective strategy, yielding an ICER of $181,059/PF-LYS. The third-party payer cost per 28-day supply of olaparib would need to be reduced from approximately $17,000 to $9,200 to be considered cost effective compared with observation. In HRD-positive patients (base case 2) and HRD-negative patients (base case 3), bevacizumab monotherapy was the most cost-effective option, with ICERs of $326,491/PF-LYS and $253,937/PF-LYS respectively. Conclusions: At current costs, maintenance therapy for primary ovarian cancer is not cost effective, regardless of mutation status. In BRCA-positive women, lowering the cost of olaparib may make it cost effective compared with observation.

scholarly journals Role of maintenance strategies in advanced epithelial ovarian cancer: a systematic review, network meta-analysis and cost-effectiveness analysis protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e051037
Author(s):  
Qiancheng Hu ◽  
Wenli Kang ◽  
Qiuji Wu ◽  
Xin Wang ◽  
Qingfeng Wang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cost Effectiveness ◽  
Meta Analysis ◽  
Advanced Ovarian Cancer ◽  
Cost Effectiveness Analysis ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Maintenance Strategies ◽  
Effectiveness Analysis ◽  
Life Years

IntroductionDifferent maintenance strategies have shown efficacy in patients with advanced ovarian cancer, but without drawing any conclusion on which strategy is preferred. Therefore, we will conduct a network meta-analysis and cost-effectiveness analysis to investigate maintenance strategies containing chemotherapy, poly (ADP-ribose) polymerase (PARP) inhibitors and anti-angiogenesis therapy for patients with advanced ovarian cancer.Methods and analysisThe search strategy to identify potentially relevant studies will include hand searches in EMBASE, PubMed, Cochrane library and Web of science. The primary outcome is progression-free survival, defined as the date of randomisation to the date of progression or death. The secondary outcome is overall survival (calculated from the time from randomisation to death from any cause), grade 3–4 haematological and non-haematological toxicities, quality-adjusted life years and incremental cost-effectiveness ratios. Two steps of meta-analysis will be carried out, traditional pair-wise meta-analysis and network meta-analysis. Methodological quality, risk of bias and the strength of evidence from randomised controlled trials (RCTs) will be proposed to assess the quality of RCTs. Heterogeneity, publication bias, subgroup analysis and sensitivity analysis will be explored.Ethics and disseminationThe purpose of our study is to perform a comprehensive efficacy, safety and cost-effectiveness analysis of all maintenance strategies in patients with advanced ovarian cancer. The results will be disseminated through international conference reports and peer-reviewed manuscripts. Ethics approval is not required for network meta-analysis and cost-effectiveness analysis.PROSPERO registration numberCRD42021231814.

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