Creating Communities of Excellence: How Does Your Ovarian Cancer Front-Line Maintenance Strategy Compare with Experts?
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Jill, a 58-year-old woman with stage IIIc advanced ovarian cancer has achieved a complete response after initial debuling surgery followed by NCCN guideline recommended regimen of paclitaxel/carboplatin chemotherapy. Molecular diagnostic testing shows that she has a BRCA1 mutataion. Which of the following choices would be the optimal maintenance treatment strategy for Jill?

Bevacizumab monotherapy

Olaparib monotherapy

Bevacizumab plus olaparib combination therapy

Rucaparib monotherapy

Wendy, a 50-year-old woman with stage III BRCA1/2 wildtype advanced ovarian cancer is on 300mg once daily niraparib maintenance therapy. She presents with moderate thrombocytopenia (platelet count 50,000/μL). What would be the guideline-based management strategy?

Administer platelet transfusions with no dose interruption

Discontinue niraparib and switch to another PARP inhibitor

Dose interruption until resolution of platelet counts (>100,000/μL), resume niraparib at the same dose of 300mg

Dose interruption until resolution of platelet counts (>100,000/μL), resume niraparib at a reduced dose of 200mg

Holly, a 42-year-old non-Hispanic Black woman has been diagnosed with advanced ovarian cancer. She is eager to get guideline concordant care but she lives in a small town, far from an academic teaching hospital. All the following contribute to the challenges she faces, EXCEPT:

She is 4-5 times less likely than White patients to get DNA diagnostic testing

She is >20% less likely to get either PARP inhibitors or bevacizumab compared with non-Hispanic White patients

Black patients are less likely to receive guideline concordant (or recommended) care

Physicians are less likely to recommend BRCA1/2 testing to Black women than to White women, even after adjusting for predicted risk of mutation

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