Recent trends in molecular testing and maintenance targeted therapies in ovarian cancer

Abstract

Key content Surgical cytoreduction and platinum‐based chemotherapy are the mainstays of ovarian cancer treatment, but 70% of patients with advanced‐stage disease will relapse after responding to first‐line chemotherapy. Recent randomised controlled trials have shown significant improvement in progression‐free survival by adding maintenance therapy including either PARP inhibitors (PARPi), bevacizumab (VEGF‐A inhibitor), or both. Homologous recombination repair is a pathway to repair DNA breaks; homologous recombination deficiency (HRD) is encountered in approximately 50% of ovarian high‐grade serous cancers (HGSC). Patients with HRD tumours demonstrate better progression‐free survival outcomes with PARPi. HRD testing is now approved for patients with high‐grade ovarian cancers including HGSC. Learning objectives To understand available molecular testing in ovarian cancer in England and its implications for maintenance treatment strategies. Ethical issues Patient consent is required if testing involves germline BRCA1/2 mutation (gBRCA1/2mut) assessment. A positive BRCA1/2mut result might have implications for the patient and their family.