Three main considerations:
1. Surgery upfront or NACT followed by interval surgery
2. Choice of front-line chemo
3. Molecularly targeted therapy: HRD, BRCA
Primary surgery depends on patient's clinical condition and the possibility of complete cytoreduction.
If NACT 3 cycles chemo--> surgery--> 3 cycles chemo
Choice of chemo
Standard: carbo taxol 3 week. Total 6 cycles
Molecular therapy:
Bevacizumab: improves PFS
The biggest change has been in BRCA improves OS as maintenance.
In the maintenance setting:
BRCA mutated: niraparib ( PRIMA), Olaparib with or without avastin
BRCA WT but HRD: Niraparib, olaparib
BRCA WT, HRD p: niraparib, avastin
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