DR HERZOG: The other study that was, I thought, very interesting at ASCO looked at this whole concept of giving IP therapy once again. And so there’s a group that is now looking at that. In fact, there were 2 studies that came out at ASCO looking at that, 1 from the Japanese group and then 1 — that was the PETROC trial — which was a randomized GCIG trial, which was Phase II, looking at the benefits of using intraperitoneal chemotherapy. Interestingly, they found that those that were at 9 months had a better progression-free survival if they had received intraperitoneal chemotherapy.

Now, what’s interesting is I’m not aware of very many analyses that use 9 months as their landmark. And so it was very interesting. The data is not mature yet, completely. And so we’ll have to wait for the final analysis to see if, really, medians are different and to see whether more accepted landmarks, such as a year or 2 years or 3 years are actually different with the intraperitoneal.

This certainly contradicts the results of what we saw from GOG-0252, which came out this year, which basically some people will say was not done to adequately evaluate intraperitoneal chemotherapy. Others will tell you that it’s the nail in the coffin of intraperitoneal chemotherapy because we finally use similar doses and we only change out the route of therapy. The problem is that we had bevacizumab in all of the arms. And the question then becomes, is bev able to overcome that advantage that you get with IP when you add it to intravenous therapy?

The other question is, of course, we used a lower dose of drug in terms of duration of exposure, and everything that you would think about in terms of the pharmacokinetics, than what we saw in GOG-0172. And so that was what many people wanted, to have an apples-to-apples comparison. Now that it’s been compared, those that were not supporters of IP say, “See? It doesn’t work.” Those that are say, “Well, maybe you need to do a higher dose. Maybe, you don’t need — if you don’t have bev in the control arm, you would have seen the difference.” There’s a lot of hand-waving going on right now. So it was interesting that this ASCO study came in, at least with preliminary data, showing some advantage.

There was also a second paper that came out from the Japanese that looked at intraperitoneal chemotherapy with dose-dense docetaxel. And they seemed to have fairly favorable data supporting IP, but it’s a single-arm Phase II and, therefore, how do you put it into context, again, because you’re already dealing with patients that are likely to have a long PFS and OS.

Treatment strategies in the management of ovarian cancer (OC)

Mechanism of action of PARP inhibitors and importance of BRCA testing

PARP inhibitors as primary treatment after multiple lines of therapy

PARP inhibitors as maintenance therapy

Tolerability of olaparib

Treatment options after olaparib failure

Differences among PARP inhibitors

Future directions in OC research