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open access
The Future
Clearly, future optimal therapy for high-grade serous
ovarian cancer will depend on optimal molecular stratification and this
is just as true for bevacizumab and olaparib as it will be for future
agents. While this will help rise to the challenge of optimizing therapy
for inter-patient molecular heterogeneity, monotherapy may never
overcome intra-patient heterogeneity. If we want to improve the
durability of responses, that pool of resistant clones may need to be
narrowed by using combination therapies. Indeed, recent clinical data
for the addition of the VEGFR inhibitor, cedirinib, to olaparib have
shown a significant increase in response rate and a near-doubling of
progression free survival (47).
The majority of this benefit was in the BRCA1/BRCA2 wild-type (or
unknown) group, perhaps demonstrating that combinations can overcome
monotherapy dependencies but also highlighting that there is still a lot
to learn about biomarkers for anti-angiogenic and PARP inhibitor agents
in ovarian cancer.
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