Considerations for advanced ovarian cancer maintenance therapy
| Question | Variables | Agreement (%) | Disagreement (%) |
| Statements that achieved consensus | |||
| The decision to use maintenance PARP inhibitor or bevacizumab (or both) should be made at the same time shortly after starting platinum-based chemotherapy | The decision to include bevacizumab and/or PARP inhibitor in the patient’s first-line treatment should be made at the same time during receipt of platinum-based chemotherapy | 19.0 | 81.0 |
| Homologous recombination deficiency/BRCA results are needed before a final decision on the use of maintenance treatment can be made | 88.0 | 12.0 | |
| For BRCA mutation patients, who are already receiving bevacizumab (as part of the first-line regimen), you would recommend: | Keep bevacizumab and add PARP inhibitor as maintenance regimen | 88.0 | 12.0 |
| For homologous recombination deficiency (with BRCA wild-type/unknown) patients, who are already receiving bevacizumab (as part of the first-line regimen), you would recommend: | Keep bevacizumab and add PARP inhibitor as maintenance regimen | 94.0 | 6.0 |
| For BRCA mutation patients, not receiving bevacizumab (as part of the first-line regimen), you would recommend: | Add PARP inhibitor as maintenance regimen | 88.0 | 12.0 |
| The decision to use maintenance PARP inhibitor or bevacizumab (or both) should be made at the same time shortly after starting platinum-based chemotherapy | Response according to RECIST should be considered in addition to homologous recombination deficiency/BRCA when making a final decision on maintenance treatment with no need to add other biomarkers | 93.8 | 6.2 |
| For homologous recombination deficiency (with BRCA wild type/unknown) patients, not receiving bevacizumab (as part of first line), you would recommend: | Add PARP inhibitor as a maintenance regimen | 81.3 | 18.7 |
| Statements that did not achieve consensus | |||
| The decision to use maintenance PARP inhibitor or bevacizumab (or both) should be made at the same time shortly after starting platinum-based chemotherapy | The decision to add bevacizumab has to be made earlier than PARP inhibitor in the treatment pathway | 50.0 | 50.0 |
| Additional clinical biomarkers, such as KELIM, should be considered in addition to homologous recombination deficiency/BRCA when making a final decision on maintenance treatment | 69.0 | 31.0 | |
| For homologous recombination unknown (with BRCA wild-type/unknown) patients, who are already receiving bevacizumab (as part of the first-line regimen), you would recommend: | Keep bevacizumab alone as maintenance therapy | 56.0 | 44.0 |
Bold values indicate the achieved (≥80% agreement or disagreement) or nearest-to-consensus across each statement.
KELIM, CA-125 elimination rate constant K; PARP, poly(ADP-ribose) polymerase.