Abstract：
Standard treatment of newly diagnosed, advanced ovarian carcinoma (OC) consists of cytoreductive surgery followed by platinum-based chemotherapy with or without bevacizumab. Maintenance therapy with PARP inhibitors and olaparib-bevacizumab has recently shown to significantly improve progression-free survival in the first-line setting. Some practical aspects of maintenance therapy, however, are still poorly defined.
To provide guidance to clinicians in the selection of maintenance therapy for newly diagnosed, advanced ovarian carcinoma.
A board of six gynecologic oncologists with expertise in the treatment of OC in Italy convened to address issues related to the new options for maintenance treatment. Based on scientific evidences, the board produced practice-oriented statements. Consensus was reached via a modified Delphi study that involved a panel of 22 experts from across Italy.
Twenty-seven evidence- and consensus-based statements are presented, covering the following areas of interest: use of biomarkers (BRCA mutations and presence of homologous recombination deficiency); timing and outcomes of surgery; selection of patients eligible for bevacizumab; definition of response to treatment; toxicity and contraindications; evidence of synergy of bevacizumab plus PARP inhibitor. Two treatment algorithms are also included, for selecting maintenance therapy based on timing and outcomes of surgery, response to platinum-based chemotherapy and biomarker status. A score for the assessment of response to chemotherapy is proposed, but its validation is ongoing.
We provide here consensus statements and treatment algorithms to guide clinicians in the selection of appropriate and personalized maintenance therapy in the first-line setting of advanced OC management.
To provide guidance to clinicians in the selection of maintenance therapy for newly diagnosed, advanced ovarian carcinoma.
A board of six gynecologic oncologists with expertise in the treatment of OC in Italy convened to address issues related to the new options for maintenance treatment. Based on scientific evidences, the board produced practice-oriented statements. Consensus was reached via a modified Delphi study that involved a panel of 22 experts from across Italy.
Twenty-seven evidence- and consensus-based statements are presented, covering the following areas of interest: use of biomarkers (BRCA mutations and presence of homologous recombination deficiency); timing and outcomes of surgery; selection of patients eligible for bevacizumab; definition of response to treatment; toxicity and contraindications; evidence of synergy of bevacizumab plus PARP inhibitor. Two treatment algorithms are also included, for selecting maintenance therapy based on timing and outcomes of surgery, response to platinum-based chemotherapy and biomarker status. A score for the assessment of response to chemotherapy is proposed, but its validation is ongoing.
We provide here consensus statements and treatment algorithms to guide clinicians in the selection of appropriate and personalized maintenance therapy in the first-line setting of advanced OC management.
摘要：
背景：新诊断的标准治疗，晚期卵巢癌(OC)包括细胞减灭术,然后是铂类化疗联合或不联合贝伐单抗.PARP抑制剂和奥拉帕尼-贝伐单抗的维持治疗最近显示在一线治疗中显著改善无进展生存期。维持治疗的一些实际方面，然而,仍然定义不清。
目的：为临床医生选择新诊断的维持治疗提供指导，晚期卵巢癌.
方法：意大利有6名在OC治疗方面具有专长的妇科肿瘤学家委员会召开会议，讨论与新的维持治疗方案有关的问题。根据科学证据,董事会制作了以实践为导向的声明。通过修改后的Delphi研究达成了共识，该研究涉及来自意大利各地的22名专家。
结果：提出了27项基于证据和共识的声明，涵盖以下关注领域:生物标志物的使用(BRCA突变和同源重组缺陷的存在);手术时机和结果;符合贝伐单抗治疗条件的患者的选择;治疗反应的定义;毒性和禁忌症;贝伐单抗与PARP抑制剂协同作用的证据.还包括两种治疗算法，根据手术时机和结果选择维持治疗，对铂类化疗的反应和生物标志物状态。提出了评估化疗反应的评分，但它的验证正在进行中。
结论：我们在此提供共识声明和治疗算法，以指导临床医生在高级OC管理的一线环境中选择适当和个性化的维持治疗。
目的：为临床医生选择新诊断的维持治疗提供指导，晚期卵巢癌.
方法：意大利有6名在OC治疗方面具有专长的妇科肿瘤学家委员会召开会议，讨论与新的维持治疗方案有关的问题。根据科学证据,董事会制作了以实践为导向的声明。通过修改后的Delphi研究达成了共识，该研究涉及来自意大利各地的22名专家。
结果：提出了27项基于证据和共识的声明，涵盖以下关注领域:生物标志物的使用(BRCA突变和同源重组缺陷的存在);手术时机和结果;符合贝伐单抗治疗条件的患者的选择;治疗反应的定义;毒性和禁忌症;贝伐单抗与PARP抑制剂协同作用的证据.还包括两种治疗算法，根据手术时机和结果选择维持治疗，对铂类化疗的反应和生物标志物状态。提出了评估化疗反应的评分，但它的验证正在进行中。
结论：我们在此提供共识声明和治疗算法，以指导临床医生在高级OC管理的一线环境中选择适当和个性化的维持治疗。
