Considerations for high-risk disease and advanced ovarian cancer first-line treatment
| Question | Variables | Agreement (%) | Disagreement (%) |
| Statements that achieved consensus | |||
| What characteristics are you considering when defining a patient of high-risk in your practice? | Chemotherapy response should be assessed after neoadjuvant chemotherapy to define further systemic treatment decisions | 81.0 | 19.0 |
| Regarding adding bevacizumab to first-line platinum-based regimen in patients with high-grade serous or high-grade endometrioid carcinomas with no previous bowel obstruction/sub-occlusion or extensive bowel resection, how do you agree or disagree with the following statements? | Patients with homologous recombination deficiency tumors do not need to automatically receive bevacizumab first line | 82.0 | 18.0 |
| Patients with BRCA mutation and/or homologous recombination deficiency tumors should receive bevacizumab first line, regardless of being ‘high-risk’ | 12.0 | 88.0 | |
| Patients with BRCA wild-type/unknown and/or homologous recombination proficient/homologous recombination unknown tumors should receive bevacizumab upfront, regardless of being ‘high-risk’ | 18.7 | 81.3 | |
| If an early good response (cycle 1–3) is achieved in platinum-based chemotherapy with bevacizumab, it is accepted that bevacizumab can be discontinued after terminating the chemotherapy, so that PARP inhibitor could be used as monotherapy maintenance treatment | 18.7 | 81.3 | |
| What characteristics are you considering when defining a patient of high-risk in your practice? | High-risk advanced ovarian cancer is defined as FIGO III with residual disease after initial/interval cytoreduction or FIGO IV | 87.5 | 12.5 |
| Worse chemotherapy response after neoadjuvant chemotherapy may be considered a high-risk characteristic | 81.3 | 18.7 | |
| Tumor primary chemosensitivity measured by worse KELIM scores may indicate a high-risk characteristic | 81.3 | 18.7 | |
| Regarding adding bevacizumab to first-line platinum-based regimen in patients with high-grade serous or high-grade endometrioid carcinomas and previous bowel obstruction/sub-occlusion or extensive bowel resection, how do you agree or disagree with the following statements? | If an early good response (cycle 1–3) is achieved in platinum-based chemotherapy (ie, RECIST or KELIM score), it is accepted that bevacizumab is not added to chemotherapy, so that PARP inhibitor could be | 87.5 | 12.5 |
| Patients with high-risk disease should receive bevacizumab upfront, regardless of BRCA/homologous recombination deficiency status | 12.5 | 87.5 | |
| Statements that did not achieve consensus | |||
| Regarding adding bevacizumab to first-line platinum-based regimen in patients with high-grade serous or high-grade endometrioid carcinomas with no previous bowel obstruction/sub-occlusion or extensive bowel resection, how do you agree or disagree with the following statements? | Patients with high-risk disease should receive bevacizumab upfront, regardless of BRCA/homologous recombination deficiency status | 25.0 | 75.0 |
| Regarding adding bevacizumab to first-line platinum-based regimen in patients with high-grade serous or high-grade endometrioid carcinomas and previous bowel obstruction/sub-occlusion or extensive bowel resection, how do you agree or disagree with the following statements? | Patients with BRCA wild-type/unknown and/or homologous recombination proficient/homologous recombination unknown tumors should receive bevacizumab upfront, regardless of being ‘high-risk’ | 25.0 | 75.0 |
| Poor chemosensitivity after 1–3 cycles of initial chemotherapy (eg, determined by RECIST or KELIM score) should be an indication for adding bevacizumab | 75.0 | 25.0 | |
Bold values indicate the achieved (≥80% agreement or disagreement) or nearest-to-consensus across each statement. Furthermore the bold statements help indicate the differences among the patient characteristics.
FIGO, International Federation of Gynecology and Obstetrics; KELIM, CA-125 elimination rate constant K; PARP, poly(ADP-ribose) polymerase; RECIST, Response Evaluation Criteria in Solid Tumors.