Évolution des traitements adjuvants des cancers de l’ovaire

High grade cancer of the ovary is a poor prognosis disease most often diagnosed at an advanced stage. Main prognostic factors include stage of disease, possibility of complete surgery and chemosensitivity. New maintenance targeted therapy deeply changed the prognosis of some ovarian cancers. In early stages, adjuvant treatment after surgery remains based on a platinum-based association for 6 cycles. In initially inoperable advanced stages, neoadjuvant chemotherapy must be discussed on a case-by-case basis during a multidisciplinary meeting. Standard of care remains first-line chemotherapy –with the 3 weekly association carboplatin-paclitaxel–, with or without bevacizumab after surgery. Poly-(ADP-ribose) polymerase inhibitors (PARPi) are indicated as maintenance treatment from the first line of advanced forms (FIGO stages III and IV) with BRCA1 or BRCA2 mutation following partial or complete response to chemotherapy (olaparib ou niraparib), when there is no indication for bevacizumab; they are also indicated as maintenance treatment with olaparib associated to bevacizumab in patients whose HRD test (homologous recombination deficiency: DNA repair defect by homologous recombination) is positive (with or without BRCA mutation) and have an indication for bevacizumab. In case of contraindication or no indication for bevacizumab, niraparib can also be used alone for 3 years after response to chemotherapy, whatever the HR status.