Management of advanced ovarian cancer in Spain: an expert Delphi consensus

Abstract

Background To determine the state of current practice and to reach a consensus on recommendations for the management of advanced ovarian cancer using a Delphi survey with a group of Spanish gynecologists and medical oncologists specially dedicated to gynecological tumors. Methods The questionnaire was developed by the byline authors. All questions but one were answered using a 9-item Likert-like scale with three types of answers: frequency, relevance and agreement. We performed two rounds between December 2018 and July 2019. A consensus was considered reached when at least 75% of the answers were located within three consecutive points of the Likert scale. Results In the first round, 32 oncologists and gynecologists were invited to participate, and 31 (96.9%) completed the online questionnaire. In the second round, 27 (87.1%) completed the online questionnaire. The results for the questions on first-line management of advanced disease, treatment of patients with recurrent disease for whom platinum might be the best option, and treatment of patients with recurrent disease for whom platinum might not be the best option are presented. Conclusions This survey shows a snapshot of current recommendations by this selected group of physicians. Although the majority of the agreements and recommendations are aligned with the recently published ESMO-ESGO consensus, there are some discrepancies that can be explained by differences in the interpretation of certain clinical trials, reimbursement or accessibility issues.

Controversies in the treatment of advanced ovarian cancer in the PARP inhibitors era: a Delphi consensus

“…Regarding the use of desensitization protocols in patients that present hypersensitivity reaction to carboplatin there was a wide consensus to perform it in patients who might receive PARPi maintenance therapy, but not in those who had received it previously. Platinum has always been the cornerstone in ovarian cancer, but it has become even more important since the benefit exhibited by PARPi maintenance in patients responding to platinum [ 33 ]. However, it seems that in patients with previous PARPi the efficacy of a platinum-based subsequent regimen is diminished [ 34 ], so an alternative to platinum could be considered instead a desensitization protocol.…”

The efficacy of TP chemotherapy combined with karelizumab on the postoperative clinical status of patients with advanced ovarian cancer

“…Therefore, in this study, the levels of VEGF and MMP-9 in the observation group were lower than those in the control group, thus showing that karelizumab can effectively reduce the levels of these two factors. These effects exert impact on a patient's immunity system and can reduce angiogenesis by significantly controlling the growth of tumor cells and avoiding large-scale invasion and other conditions [16][17][18]. The levels of tumor markers mainly reflect the development of tumor cells.…”