In a recent article published in Gynecologic Oncology, researchers reviewed the current state of ovarian cancer management and proposed shifting treatment paradigms in light of current pressures on the healthcare system.
In a previous study from Wuhan, China, patients with cancer were found to have an elevated risk of COVID-19 infection compared with the general populace. The authors suggested that potential risk factors for infection were hospital admissions and recurrent hospital visits, based on the high level of infection that was approximately twice (0.79%) that of the cumulative incidence (0.37%) reported throughout the city during the same time frame. They proposed that aggressive measures be undertaken to minimize the frequency of cancer patients’ hospital visits during the pandemic, emphasizing that proper isolation protocols must be in place to mitigate the risk of COVID-19 infection in case patients required treatment.1
If oral therapies are viable alternatives to intravenous (IV) therapies and can be used in the desired setting, clinicians can minimize the need for clinical visits. This may have been particularly important in regions where oncology centers were being converted temporarily into COVID-19 units to better manage outbreaks, and where prescribing IV treatments requiring hospital or infusion clinic visits increased pressure on scarce resources. Because oral treatments for cancer can be taken at home, in a safe and sequestered environment, they may minimize undue risks for patients, caregivers, and medical teams.
Clinicians need to weigh the benefits and risks of each therapeutic option, based on administration modality, individual patient goals, comorbidities, required toxicity management services rendered by nurses, laboratory assessment requirements, risk of severe side effects, and economic concerns. Healthcare professionals will need to assess patients’ risk of dying from COVID-19 relative to the cancer treatment by examining the risk–benefit profiles for each therapy and its mode of administration against other factors. Oral agents such as poly (ADP-ribose) polymerase (PARP) inhibitors, targeted agents, and hormonal therapies may be appropriate to consider for ovarian cancer treatment as alternatives to IV therapies, including cytotoxic chemotherapy.
Randomized placebo-controlled trials of PARP inhibitors have shown improved progression-free survival (PFS) when utilized as maintenance therapy in first-line and platinum-sensitive recurrent ovarian cancer settings. Specifically, PARP inhibitors (eg, olaparib, niraparib, and rucaparib) have been approved as maintenance therapies after partial or complete response to platinum-based chemotherapy in recurrent ovarian cancer. Olaparib received US Food and Drug Administration approval for use as maintenance therapy in patients with advanced-stage BRCA-mutated ovarian cancer following initial frontline chemotherapy. Studies further support additional options for frontline maintenance therapy, including olaparib combined with bevacizumab, as well as niraparib, and veliparib.2
Of particular note, for patients with germline BRCA1/2-associated relapsed ovarian cancer, are results from a randomized phase 3 study that suggest oral olaparib therapy demonstrated improved efficacy compared with IV chemotherapy. In patients with germline BRCA-mutated platinum-sensitive relapsed ovarian cancer who had received ≥2 prior lines of platinum-based chemotherapy, there were statistically significant and clinically relevant improvements in objective response rate and PFS when olaparib was compared with nonplatinum chemotherapy (eg, pegylated liposomal doxorubicin, paclitaxel, gemcitabine, or topotecan).3 This suggests that treatment with PARP inhibitor therapy may be a viable alternative to IV chemotherapy.1
In the COVID-19 pandemic setting, clinicians should weigh the benefits of maintenance therapy with an oral PARP inhibitor; simply adopting a watchful waiting approach may lead to cancer recurrence, and this may eventually increase the burden on the healthcare system, especially if IV infusions are required later.
The researchers emphasized that it is time for the global healthcare community to act, using logical approaches and all available therapies to decrease unnecessary risks as well as the number of inpatient and outpatient clinical visits. This will, in turn, preserve healthcare resources and reduce COVID-19 spread.
Monk BJ, Coleman RL, Moore KN, et al. COVID-19 and ovarian cancer: exploring alternatives to intravenous (IV) therapies. Gynecol Oncol. 2020;158:34-36.
- Yu J, Ouyang W, Chua MLK, Xie C. SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China. JAMA Oncol. 2020;6:1108-1110.
- Walsh CS. Latest clinical evidence of maintenance therapy in ovarian cancer. Curr Opin Obstet Gynecol. 2020;32:15-21.
- Penson RT, Valencia RV, Cibula D, et al. Olaparib versus nonplatinum chemotherapy in patients with platinum-sensitive relapsed ovarian cancer and a germline BRCA1/2 mutation (SOLO3): a randomized phase III trial. J Clin Oncol. 2020;38:1164-1174.