Evaluating Bevacizumab and PARP Inhibitors as Important Treatment Options

The following is a transcript by Dr. Michael Birrer, taken from Survivornet.com. Dr. Birrer, formerly medical director of gyn/onc and the gyn/onc research program at MGH, is now at the University of Alabama.

How do you decide what patients should get bevacizumab versus PARP? And that's really the million dollar question, and it's a very unique question. 

For those of us treating ovarian cancer patients, for almost 20 years, all we had was Carboplatin and Taxol. 

And we would argue about what taxane to use, or we might argue about IP versus IV. 

But there weren't really earth-shattering questions. 

Now we have choices, so it's terrific for the patients. 

But nevertheless, one needs to make that choice. 

And I think that the field is migrating that if patients have either germline or somatic BRCA1 gene mutations, that when possible, they should get a PARP inhibitor. 

However, you need to recognize you're looking at about 20% of the patient population. 

The other 80%, you need options. 

And there is where one might consider bevacizumab. 

Now does everybody get bev? Probably not, if you have certainly tumor infiltrating the bowel or other contraindications that might be risky. 

But again, that's a small patient population. 

So that's the way most of us are dividing this down. 

Genetic abnormalities giving rise to ovarian cancer-- BRCA1, BRCA2-- will get PARP inhibitor maintenance. 

And if they don't, they should be offered bevacizumab. 

What's the next step? And would there be an option to give both? The answer is, absolutely. 

So there are several ongoing trials looking at the combination of olaparib with bevacizumab, so we'll know the answer to that. 

If I were to give an educated guess, I would say we'll be treating with both agents in the near future.