Christina Fotopoulou, MD, PhD

Christina Fotopoulou, MD, PhD, of Imperial College London, called DUO-O “a big, celebrated study” that breaks new ground, at least for a subset of patients. “We are beginning to see some encouraging data for immunotherapy in ovarian cancer,” she said as the invited discussant of the study.

A chief concern is the lack of a control regimen that contained olaparib for maintenance, “because we know that bevacizumab plus olaparib is better than bevacizumab alone,” she said, referencing the PAOLA-1 study (see reference 3 in the main article). Although DUO-O is the first positive immunotherapy trial in ovarian cancer, this factor makes it challenging to isolate the individual contribution from durvalumab, she said.

She also discussed the value of triple maintenance therapy outside of the homologous recombination deficiency (HRD)-negative subset, where already other well established regimens are approved and efficacious, based for example on the results of the PAOLA-1 study (reference 3). The question is whether we really need triple therapy in this subset,” Dr. Fotopoulou said.

However, in PAOLA-1, maintenance with olaparib and bevacizumab had no effect in HRD-negative patients, unlike DUO-O, where the hazard ratio was 0.68. “DUO-O has brought light onto this ‘dark side of the moon.’ In that less favorable patient population, we have an effect with the triple therapy…. It is the first immuno-oncology study to show a benefit in patients with advanced ovarian cancer,” she said.

“Questions remain—how to define selection algorithms for optimal treatment stratification strategies, how to avoid unnecessary repetition and overlap but not miss opportunities for treatment, and how to choose and filter what really works in which patient subset with the least toxicity,” she noted. 

DISCLOSURE: Dr. Fotopoulou reported financial relationships with Aptitude Health, AstraZeneca, Clovis Oncology, Eisai, Ethicon/Johnson & Johnson, GlaxoSmithKline, Global Oncology One, and Roche/Genentech.