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Bevacizumab plus PARP inhibitor
from Section III - Ovarian Cancer
Published online by Cambridge University Press: 20 July 2023
Two classes of targeted therapies have revealed a progression-free survival prolongation in front-line maintenance in epithelial high-grade ovarian carcinomas: bevacizumab and poly(ADP-ribose) polymerases inhibitors (PARPi). PARPi have demonstrated particular efficacy in patients having BRCA1/2 mutations, or other homologous-recombination repair deficiency (HRD). To date, the question of single maintenance with PARPi versus double maintenance with PARPi + bevacizumab has not been specifically addressed. Three trials (SOLO-1, PRIMA, VELIA) compared PARPi versus placebo without any bevacizumab, and a fourth (PAOLA-1) utilized bevacizumab plus placebo as the control arm comparing it to bevacizumab plus PARPi. In the following article, we support a double maintenance approach with PARPi + bevacizumab in the HRD-positive subgroup based on (i) a never-reached efficiency in this subgroup with bevacizumab+olaparib,better than olaparib alone in a patient-adjusted indirect comparison (ii) a rationale for additive effected (iii) a good safety and cost-effective profile. The FDA and EMA indeed approved double maintenance for HRD-positive patients in 2020.
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