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Evaluating the Angiogenetic Properties of Ovarian Cancer Stem-Like Cells using the Three-Dimensional Co-Culture System, NICO-1
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Systemic therapy de-escalation in advanced ovarian cancer: a new era on the horizon?

Giuseppe Caruso1,2, Robert L Coleman3, Giovanni Aletti4

  • 1Department of Maternal and Child Health and Urological Sciences, Department of Experimental Medicine, University of Rome La Sapienza, Rome, Italy g.caruso@uniroma1.it.

International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society
|August 19, 2023
PubMed

Insights

Poly(ADP-ribose) polymerase inhibitors (PARPi) offer improved survival in advanced ovarian cancer. De-escalating treatment, particularly for BRCA-mutated patients, may enhance quality of life without worsening outcomes.

Area of Science:

  • Oncology
  • Pharmacology

Background:

  • Poly(ADP-ribose) polymerase inhibitors (PARPi) have significantly improved outcomes in advanced ovarian cancer.
  • Increased survival necessitates exploring de-intensified treatment strategies to enhance patient quality of life.
  • Systemic treatment de-escalation represents a personalized approach to ovarian cancer therapy.

Purpose of the Study:

  • To review current trends, challenges, and future directions in systemic treatment de-escalation for advanced ovarian cancer.
  • To discuss the potential for reducing chemotherapy intensity in patients receiving PARPi.
  • To identify patient subpopulations who may benefit from de-escalated treatment strategies.

Main Methods:

  • Review of current literature on PARPi in ovarian cancer treatment.
  • Analysis of de-escalation strategies, including neoadjuvant PARPi, reduced adjuvant chemotherapy, and modified maintenance therapy.
  • Discussion of ongoing clinical trials investigating de-escalation approaches.

Main Results:

  • PARPi effectiveness suggests potential for reduced chemotherapy in selected patients.
  • Favorable prognostic factors (e.g., BRCA mutation, homologous recombination deficiency, no residual disease) are key for de-escalation.
  • Various de-escalation strategies are being investigated, including neoadjuvant PARPi and modified maintenance durations.

Conclusions:

  • Selected advanced ovarian cancer patients, particularly those with BRCA mutations, may tolerate de-intensified treatment.
  • De-escalation strategies aim to maintain oncologic control while improving quality of life.
  • Ongoing trials will clarify the safety and efficacy of de-escalating systemic therapy in ovarian cancer.
Keywords:
BRCA1 ProteinBRCA2 ProteinHomologous recombinationOvarian CancerQuality of Life (PRO)/Palliative Care

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