[ { "name": "Testing", "subsection": [ { "name": "Molecular Biomarker Testing", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q3_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 100, "consensus_disagreement": 0, "value": "Testing for BRCA mutation \/ HR status should be performed as soon as a tissue sample is available", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q3_2", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 94, "consensus_disagreement": 6, "value": "Additional core biopsies should be collected for patients receiving neo-adjuvant treatment to enable immediate biomarker testing", "isOption": 0 }, { "disagreement": 50, "optionName": "", "questionNumber": "3_3", "isNoConsensus": 1, "agreement": 50, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "When possible, methylation status should be performed", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q3_5", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 94, "consensus_disagreement": 6, "value": "Biopsy samples for molecular testing could be taken from adnexal OR peritoneal\/omental foci provided there is appropriate tumor sample", "isOption": 0 }, { "disagreement": 31, "optionName": "", "questionNumber": "3_6", "isNoConsensus": 1, "agreement": 69, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Pleural or peritoneal fluid could be used for molecular testing in the absence or unavailability of a core biopsy, provided they are adequately processed and contain a sufficient number of cells ", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q3_7", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 94, "consensus_disagreement": 6, "value": "It is acceptable to start 1st line systemic therapy before ordering tests for BRCA \/ HRD", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q4_2", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 87, "consensus_disagreement": 13, "value": "Both tests (BRCA mutation AND HRD) should be ordered at the same time upfront", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q4_3", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 87.5, "consensus_disagreement": 12.5, "value": "A separate test for somatic BRCA is not required as this can be collected in the HR test", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q4_4", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 81, "consensus_disagreement": 19, "value": "A histological diagnosis of high-grade ovarian cancer is needed before tumor testing for HRd", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q4_5", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 100, "consensus_disagreement": 0, "value": "Patients with Clear Cell, Endometrioid or Mucinous should be offered somatic tumor testing for mismatch repair ", "isOption": 0 }, { "disagreement": 25, "optionName": "", "questionNumber": "Q4_6", "isNoConsensus": 1, "agreement": 75, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Patients with all histological subtypes of Ovarian Cancer except Mucinous should be offered somatic tumor testing for HRD", "isOption": 0 }, { "disagreement": 75, "optionName": "", "questionNumber": "Q4_7", "isNoConsensus": 1, "agreement": 26, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Patients with all histological subtypes of Ovarian Cancer, including Mucinous ovarian cancer that shows a good response to platinum-based chemotherapy, should be offered somatic tumor testing for HRD", "isOption": 0 }, { "disagreement": 63, "optionName": "", "questionNumber": "Q4_8", "isNoConsensus": 1, "agreement": 37, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "HRD should only be offered in high grade serous or endometrioid ovarian cancer subtypes", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q5_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 87, "consensus_disagreement": 13, "value": "HRD tests used in guiding treatment decision should have been validated in prospective randomized clinical trials", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q5_2", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 100, "consensus_disagreement": 0, "value": "It is also acceptable the use of other academic HRD tests provided a previous validation at least in a randomized clinical trial cohort.", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q5_3", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 13, "consensus_disagreement": 87, "value": "Any commercially available tests regardless as to whether they have been validated in clinical trials can be used for guiding treatment decisions", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q5_4", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 94, "consensus_disagreement": 6, "value": "HRD testing should not be replaced by HRR mutation panel testing", "isOption": 0 } ] } ] }, { "name": "Choice of 1st line treatment", "subsection": [ { "name": "Definition of high-risk patient", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q6_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 87.5, "consensus_disagreement": 12.5, "value": "High-risk AOC is defined as FIGO III with residual disease (> 1cm) after initial\/ interval cytoreduction OR FIGO IV", "isOption": 0 }, { "disagreement": 31.25, "optionName": "", "questionNumber": "Q6_3", "isNoConsensus": 1, "agreement": 68.75, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "The use of NACT classifies high-risk AOC, independently of residual disease", "isOption": 0 }, { "disagreement": 25, "optionName": "", "questionNumber": "Q6_4", "isNoConsensus": 1, "agreement": 75, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Symptomatic ascites that requires paracentesis at presentation is considered High-Risk factor for prognosis even if that patient underwent subsequent cytoreduction to <1cm residual disease ", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q6_5", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 81.25, "consensus_disagreement": 18.75, "value": "Worse chemotherapy response after NACT may be considered a high-risk characteristic", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q6_6", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 81.25, "consensus_disagreement": 18.75, "value": "Tumor primary chemosensitivity measured by worse KELIM scores may indicate a high-risk characteristic", "isOption": 0 } ] }, { "name": "Frontline Bevacizumab in patients with NO previous bowel obstruction\/subocclusion or extensive bowel resection", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q7_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 87.5, "consensus_disagreement": 12.5, "value": "Every effort should be made to gain HRD and\/or BRCA status before starting bevacizumab", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q7_2", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 82, "consensus_disagreement": 18, "value": "Patients with HRD tumors do not need to automatically receive Bevacizumab 1st line ", "isOption": 0 }, { "disagreement": 38, "optionName": "", "questionNumber": "Q7_3", "isNoConsensus": 1, "agreement": 63, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Patients with BRCA mutation and\/or HRD tumors AND high-risk disease should receive Bevacizumab 1st line", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q7_4", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 12, "consensus_disagreement": 88, "value": "Patients with BRCA mutation and\/or HRD tumors should receive Bevacizumab 1st line regardless of being “high-risk”", "isOption": 0 }, { "disagreement": 75, "optionName": "", "questionNumber": "Q7_5", "isNoConsensus": 1, "agreement": 25, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Patients with BRCA mutation and\/or HRD tumors who are stage III and in complete (R0) resection after primary debulking surgery should receive bevacizumab 1st line with the intent to add PARPi", "isOption": 0 }, { "disagreement": 75, "optionName": "", "questionNumber": "Q7_6", "isNoConsensus": 1, "agreement": 25, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Patients with high-risk disease should receive Bevacizumab upfront regardless of BRCA\/HR status", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q7_7", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 81, "consensus_disagreement": 19, "value": "Patients with BRCA wild type\/unknown and\/or HRP\/HR unknown tumors AND high-risk disease should receive Bevacizumab upfront", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q7_8", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 18.75, "consensus_disagreement": 81.25, "value": "Patients with BRCA wild type\/unknown and\/or HRP\/HR unknown tumors should receive Bevacizumab upfront regardless of being “high-risk”", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q7_9", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 18.699996948242188, "consensus_disagreement": 81.300003051757812, "value": "Upfront Platinum-based chemotherapy with the intention for Interval Debulking Surgery downgrades the intention to use Bevacizumab", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q7_10", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 81.300003051757812, "consensus_disagreement": 18.699996948242188, "value": "Poor chemosensitivity after1-3 cycles of initial chemotherapy (e.g.: determined by RECIST or KELIM score) should be an indication for adding Bevacizumab", "isOption": 0 }, { "disagreement": 38, "optionName": "", "questionNumber": "Q7_11", "isNoConsensus": 1, "agreement": 63, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Bevacizumab should be added to chemotherapy as soon as possible to deepen the response \/ tumour shrinkage possible with platinum-based chemotherapy", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q7_13", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 18.75, "consensus_disagreement": 81.25, "value": "If an early good response (cycle 1-3) is achieved in platinum-based chemotherapy with bevacizumab, it is accepted that bevacizumab can be discontinued after terminating the chemotherapy, so that PARPi could be used as monotherapy maintenance treatment", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q7_15", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 18.75, "consensus_disagreement": 81.25, "value": "Performance status ECOG 2 (versus 0\/1) downgrades the intention to use Bevacizumab", "isOption": 0 } ] }, { "name": "Frontline Bevacizumab in patients WITH previous bowel obstruction\/subocclusion or extensive bowel resection", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q8_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 81, "consensus_disagreement": 19, "value": "Every effort should be made to gain HRD and\/or BRCA status before starting bevacizumab", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q8.1_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 87.5, "consensus_disagreement": 12.5, "value": "Do you consider that the outcomes of ICON-7 and GOG-0218 assessed after primary debulking surgery are transposable to patients treated with neo-adjuvant chemo and interval debulking surgery (e.g higher benefit in high-risk disease patients)?", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q8_2", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 100, "consensus_disagreement": 0, "value": "Patients with HRD tumors do not need to automatically receive Bevacizumab 1st line ", "isOption": 0 }, { "disagreement": 69, "optionName": "", "questionNumber": "Q8_3", "isNoConsensus": 1, "agreement": 32, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Patients with BRCA mutation and\/or HRD tumors AND high-risk disease should receive Bevacizumab 1st line", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q8_4", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 12, "consensus_disagreement": 88, "value": "Patients with BRCA mutation and\/or HRD tumors should receive Bevacizumab 1st line regardless of being “high-risk”", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q8_5", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 18.699996948242188, "consensus_disagreement": 81.300003051757812, "value": "Patients with BRCA mutation and\/or HRD tumors who are stage III and in complete (R0) resection after primary debulking surgery should receive bevacizumab 1st line with the intent to add PARPi", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q8_6", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 12.5, "consensus_disagreement": 87.5, "value": "Patients with high-risk disease should receive Bevacizumab upfront regardless of BRCA\/HR status", "isOption": 0 }, { "disagreement": 63, "optionName": "", "questionNumber": "Q8_7", "isNoConsensus": 1, "agreement": 38, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Patients with BRCA wild type\/unknown and\/or HRP\/HR unknown tumors AND high-risk disease should receive Bevacizumab upfront", "isOption": 0 }, { "disagreement": 75, "optionName": "", "questionNumber": "Q8_8", "isNoConsensus": 1, "agreement": 26, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Patients with BRCA wild type\/unknown and\/or HRP\/HR unknown tumors should receive Bevacizumab upfront regardless of being “high-risk”", "isOption": 0 }, { "disagreement": 69, "optionName": "", "questionNumber": "Q8_9", "isNoConsensus": 1, "agreement": 32, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Upfront Platinum-based chemotherapy with intention for Interval Debulking Surgery downgrades the intention to use Bevacizumab", "isOption": 0 }, { "disagreement": 25, "optionName": "", "questionNumber": "Q8_10", "isNoConsensus": 1, "agreement": 75, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Poor chemosensitivity after1-3 cycles of initial chemotherapy (e.g.: determined by RECIST or KELIM score) should be an indication for adding Bevacizumab", "isOption": 0 }, { "disagreement": 63, "optionName": "", "questionNumber": "Q8_11", "isNoConsensus": 1, "agreement": 38, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Bevacizumab should be added to chemotherapy as soon as possible to deepen the response \/ tumour shrinkage possible with platinum-based chemotherapy", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q8_12", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 87.5, "consensus_disagreement": 12.5, "value": "If an early good response (cycle 1-3) is achieved in platinum-based chemotherapy (i.e RECIST or KELIM score), it is accepted that bevacizumab is not added to chemotherapy, so that PARPi could be", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q8_14", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 87.5, "consensus_disagreement": 12.5, "value": "High chemosensitivity after 1-3 cycles of initial chemotherapy (e.g.: determined by RECIST or KELIM score) should be an indication for prescribing a PARP inihibitor", "isOption": 0 }, { "disagreement": 44, "optionName": "", "questionNumber": "Q8_15", "isNoConsensus": 1, "agreement": 56, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Patients with high volume disease and in need of a rapid response should be offered bevacizumab", "isOption": 0 }, { "disagreement": 63, "optionName": "", "questionNumber": "Q8_16", "isNoConsensus": 1, "agreement": 38, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Performance status ECOG 2 (versus 0\/1) downgrades the intention to use Bevacizumab", "isOption": 0 } ] }, { "name": "Frontline Bevacizumab in patients with LOW grade carcinomas", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q9_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 88, "consensus_disagreement": 12, "value": "Patients with high-risk disease should receive Bevacizumab upfront", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q9_2", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 18.75, "consensus_disagreement": 81.25, "value": "Patients should receive Bevacizumab upfront regardless of being “high-risk”", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q9_5", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 100, "consensus_disagreement": 0, "value": "Patients with low-grade carcinomas should be preferably referred to clinical trials", "isOption": 0 } ] }, { "name": "Frontline Bevacizumab in mucinous \/ clear cell carcinomas", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q10_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 88, "consensus_disagreement": 12, "value": "Patients with high-risk disease should receive Bevacizumab upfront", "isOption": 0 }, { "disagreement": 25, "optionName": "", "questionNumber": "Q10_2", "isNoConsensus": 1, "agreement": 75, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Patients should receive Bevacizumab upfront regardless of being “high-risk”", "isOption": 0 }, { "disagreement": 0, "optionName": "", "optionName": "", "questionNumber": "Q10_3", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 81, "consensus_disagreement": 19, "value": "Patients with high volume symptomatic ascites that require a paracentesis (even in the absence of other high-risk features) should be offered bevacizumab, independently of tumor histology", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q10_4", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 18.75, "consensus_disagreement": 81.25, "value": "Patients with mucinous \/ clear cell carcinomas should not receive Bevacizumab treatment", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q10_5", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 100, "consensus_disagreement": 0, "value": "Patients with mucinous \/ clear cell carcinomas should be preferably referred to clinical trials", "isOption": 0 } ] }, { "name": "Frontline Bevacizumab schedule", "isOption": 0, "statements": [ { "disagreement": 38, "optionName": "", "questionNumber": "Q11_1", "isNoConsensus": 1, "agreement": 62, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Bevacizumab should be used as in GOG-218 trial (15mg\/kg\/3wk) irrespective of BRCA\/HR status", "isOption": 0 }, { "disagreement": 63, "optionName": "", "questionNumber": "Q11_2", "isNoConsensus": 1, "agreement": 37, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Bevacizumab should be used as in ICON7 trial (7,5mg\/kg\/3wk) irrespective of BRCA\/HR status", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q11_3", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 82, "consensus_disagreement": 18, "value": "Bevacizumab should be used as in GOG-218 trial (15mg\/kg\/3wk) if the intent is to combine with a PARPi", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q11_4", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 12.5, "consensus_disagreement": 87.5, "value": "Bevacizumab can be used beyond 15 months if I feel my patient is continuing to benefit", "isOption": 0 } ] } ] }, { "name": "Maintenance therapy: Specific situations", "subsection": [ { "name": "FIGO II patients options", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q12_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 18.75, "consensus_disagreement": 81.25, "value": "I treat FIGO II as an advanced disease", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q12_2", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 18.75, "consensus_disagreement": 81.25, "value": "I treat FIGO IIB as an advanced disease", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q12_3", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 81, "consensus_disagreement": 19, "value": "FIGO II patients should be followed only with active surveillance", "isOption": 0 }, { "disagreement": 75, "optionName": "", "questionNumber": "Q12_4", "isNoConsensus": 1, "agreement": 25, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Maintenance therapy could be considered for FIGO II patients", "isOption": 0 }, { "disagreement": 67, "optionName": "", "questionNumber": "Q12x_4.1", "isNoConsensus": 1, "agreement": 33, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Would you reconsider your response to question 4 if it was specifically targeted at FIGO IIB patients with BRCA mutation? How well do you agree or disagree with it in this scenario?", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q12_5", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 94, "consensus_disagreement": 6, "value": "FIGO II patients should be preferably referred to participate in clinical trials addressing maintenance therapy", "isOption": 0 } ] }, { "name": "Stable disease patients options", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q13_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 100, "consensus_disagreement": 0, "value": "For patients already on Bevacizumab, they should continue the maintenance with Bevacizumab", "isOption": 0 }, { "disagreement": 63, "optionName": "", "questionNumber": "Q13_2", "isNoConsensus": 1, "agreement": 37, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "For patients not treated previously with Bevacizumab, they should add bevacizumab as maintenance treatment", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q13_3", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 6, "consensus_disagreement": 94, "value": "Regardless of previous Bevacizumab utilization, patients should receive early second line regimen (before progression) as in patients with progressive disease", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q13_4", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 94, "consensus_disagreement": 6, "value": "Regardless of previous Bevacizumab utilization, patients should be preferably referred to clinical trials addressing maintenance therapy", "isOption": 0 }, { "disagreement": 25, "optionName": "", "questionNumber": "Q13_5", "isNoConsensus": 1, "agreement": 76, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "For patients with only stable disease post 1st line therapy PARPi should not be initiated", "isOption": 0 } ] } ] }, { "name": "Choice of Maintenance therapy after 1st Line Platinum-based regimen", "subsection": [ { "name": "Decision making time to use maintenance PARPi or bevacizumab (or both)", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q14_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 19, "consensus_disagreement": 81, "value": "The decision to include bevacizumab or\/and PARPi in the patient’s 1st line treatment should be made at the same time during receipt of platinum-based chemotherapy ", "isOption": 0 }, { "disagreement": 50, "optionName": "", "questionNumber": "Q14_2", "isNoConsensus": 1, "agreement": 50, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "The decision to add bevacizumab has to be made earlier than PARPi in the treatment pathway ", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q14_3", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 88, "consensus_disagreement": 12, "value": "HRD\/BRCA results are needed before a final decision on use of maintenance treatment can be made", "isOption": 0 }, { "disagreement": 31, "optionName": "", "questionNumber": "Q14_4", "isNoConsensus": 1, "agreement": 69, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Additional clinical biomarkers such as KELIM should be considered in addition to HRD\/BRCA when making a final decision on maintenance treatment", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q14_5", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 93.75, "consensus_disagreement": 6.25, "value": "Response according to RECIST should be considered in addition to HRD\/BRCA when making a final decision on maintenance treatment with no need to add other biomarkers. ", "isOption": 0 } ] }, { "name": "BRCA mutation patients already receiving Bevacizumab in frontline:", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q15_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 88, "consensus_disagreement": 12, "value": "Keep Bevacizumab AND add PARP inhibitors as maintenance regimen", "isOption": 0 } ] }, { "name": "HRD (with BRCA wild type\/unknown) patients receiving Bevacizumab in frontline: ", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q16_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 94, "consensus_disagreement": 6, "value": "Keep Bevacizumab AND add PARPi as maintenance regimen", "isOption": 0 } ] }, { "name": "HR unknown (with BRCA wild type\/unknown) patients, receiving Bevacizumab in frontline", "isOption": 1, "statements": [ { "disagreement": 0, "optionName": "Option 1", "questionNumber": "Q17_1", "isNoConsensus": 1, "agreement": 56.25, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Option 1: Keep Bevacizumab alone as maintenance therapy", "isOption": 1 }, { "disagreement": 0, "optionName": "Option 2", "questionNumber": "Q17_2", "isNoConsensus": 1, "agreement": 0, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Option 2: Stop Bevacizumab AND add PARPi as a maintenance regimen", "isOption": 1 }, { "disagreement": 0, "optionName": "Option 3", "questionNumber": "Q17_3", "isNoConsensus": 1, "agreement": 44, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Option 3: Assess early response to 1st line chemotherapy to guide decision", "isOption": 1 } ] }, { "name": "BRCA wild patients, receiving Bevacizumab in frontline", "isOption": 1, "statements": [ { "disagreement": 0, "optionName": "Option 1", "questionNumber": "18_1", "isNoConsensus": 1, "agreement": 37.5, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Option 1: Keep Bevacizumab alone as maintenance therapy", "isOption": 1 }, { "disagreement": 0, "optionName": "Option 2", "questionNumber": "18_2", "isNoConsensus": 1, "agreement": 18.75, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Option 2: Keep Bevacizumab AND add PARPi as maintenance regimen", "isOption": 1 }, { "disagreement": 0, "optionName": "Option 3", "questionNumber": "18_4", "isNoConsensus": 1, "agreement": 43.75, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Option 3: Consider clinical biomarkers, such as response to chemotherapy when making decisions", "isOption": 1 } ] }, { "name": "BRCA mutation patients NOT receiving Bevacizumab in frontline:", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q19_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 88, "consensus_disagreement": 12, "value": "Add PARPi as maintenance regimen", "isOption": 0 } ] }, { "name": "HRD (with BRCA wild type\/unknown) patients, not receiving Bevacizumab in frontline", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q20_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 81.25, "consensus_disagreement": 18.75, "value": "Add PARPi as a maintenance regimen", "isOption": 0 } ] }, { "name": "HRP\/unknown (with BRCA wild type\/unknown) patients, not receiving Bevacizumab in frontline", "isOption": 1, "statements": [ { "disagreement": 0, "optionName": "Option 1", "questionNumber": "21_1", "isNoConsensus": 1, "agreement": 12.5, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Option 1: Add PARPi as maintenance regimen", "isOption": 1 }, { "disagreement": 0, "optionName": "Option 2", "questionNumber": "21_2", "isNoConsensus": 1, "agreement": 0, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Option 2: Add bevacizumab as maintenance regimen", "isOption": 1 }, { "disagreement": 0, "optionName": "Option 3", "questionNumber": "21_3", "isNoConsensus": 1, "agreement": 12.5, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Option 3: No maintenance therapy offered", "isOption": 1 }, { "disagreement": 0, "optionName": "Option 4", "questionNumber": "21_4", "isNoConsensus": 1, "agreement": 75, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Option 4: Assess response to platinum chemotherapy to guide final decision on maintenance treatment", "isOption": 1 } ] }, { "name": "Important factors for consideration on PARPi maintenance therapy", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q22_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 87, "consensus_disagreement": 13, "value": "Previous bone marrow toxicity during chemotherapy", "isOption": 0 }, { "disagreement": 38, "optionName": "", "questionNumber": "22_2", "isNoConsensus": 1, "agreement": 62, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Renal impairment", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q22_3", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 87.5, "consensus_disagreement": 12.5, "value": "Hepatic impairment", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q22_4", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 94, "consensus_disagreement": 6, "value": "Risk of drug-drug interactions", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q22_5", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 86, "consensus_disagreement": 14, "value": "Other comorbidities – please comment", "isOption": 0 }, { "disagreement": 38, "optionName": "", "questionNumber": "22_6", "isNoConsensus": 1, "agreement": 63, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Treatment schedule (shorter duration)", "isOption": 0 }, { "disagreement": 38, "optionName": "", "questionNumber": "22_7", "isNoConsensus": 1, "agreement": 62, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Treatment schedule (once daily versus twice daily pills)", "isOption": 0 }, { "disagreement": 50, "optionName": "", "questionNumber": "22_8", "isNoConsensus": 1, "agreement": 50, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Potential higher risk of secondary malignant hemopathy, especially in patients with BRCA mutation", "isOption": 0 } ] } ] }, { "name": "Duration and monitoring during maintenance therapy", "subsection": [ { "name": "Interruption of maintenance on recurrence", "isOption": 0, "statements": [ { "disagreement": 0, "optionName": "", "questionNumber": "Q23_1", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 93.75, "consensus_disagreement": 6.25, "value": "Isolated recurrent disease can be treated with local therapy before deciding on interrupting maintenance treatment", "isOption": 0 } ] }, { "name": "Definition of Progressive Disease in Clinical Practice", "isOption": 0, "statements": [ { "disagreement": 75, "optionName": "", "questionNumber": "Q23_1", "isNoConsensus": 1, "agreement": 25, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Radiological progression according to RECIST associated with worsening (or appearance) of clinical symptoms.", "isOption": 0 }, { "disagreement": 25, "optionName": "", "questionNumber": "Q23_2", "isNoConsensus": 1, "agreement": 75, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Radiological progression according to RECIST, with or without worsening (or appearance) of clinical symptoms", "isOption": 0 } ] } ] }, { "name": "Supportive care during maintenance therapy", "subsection": [ { "name": "Supportive measures and care for patients in maintenance therapy", "isOption": 0, "statements": [ { "disagreement": 38, "optionName": "", "questionNumber": "Q25_1", "isNoConsensus": 1, "agreement": 63, "consensus_agreement": 0, "consensus_disagreement": 0, "value": "Surgical team should regularly follow the patient even in the earlier stages of their maintenance therapy", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q25_2", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 81.25, "consensus_disagreement": 18.75, "value": "Nutritional team should regularly follow the patient even in the earlier stages of their maintenance therapy", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q25_3", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 94, "consensus_disagreement": 6, "value": "Psychological support by a specialized team should be offered even in the earlier stages of maintenance therapy", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q25_5", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 81, "consensus_disagreement": 19, "value": "Psychological support in individual sessions should be preferred rather than in group sessions", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q25_6", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 87.5, "consensus_disagreement": 12.5, "value": "Psychological support to caregivers, offered by a specialized team, is an essential measure during maintenance therapy", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q25_7", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 100, "consensus_disagreement": 0, "value": "Psychological support by a specialized team should be offered to caregivers individually", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q25_9", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 100, "consensus_disagreement": 0, "value": "Engagement in physical activities should be stimulated to all patients", "isOption": 0 }, { "disagreement": 0, "optionName": "", "questionNumber": "Q25_10", "isNoConsensus": 0, "agreement": 0, "consensus_agreement": 100, "consensus_disagreement": 0, "value": "Concrete measures followed by prescriptions for physical activities should be offered", "isOption": 0 } ] } ] } ]