![hrd-positive hrd-positive](https://www.mdpi.com/cancers/cancers-12-01206/article_deploy/html/images/cancers-12-01206-g001-550.jpg)
We have those trials-bevacizumab, atezolizumab. Monk, MD, FACS, FACOG: I think we have those trials.
#HRD POSITIVE TRIAL#
Kathleen Moore, MD: I know, but we’re going to have to figure out the next trial for these people, and we’ll put them in it because we want them to do better.īradley J. Monk, MD, FACS, FACOG: Which is half the patients. We’re going to have to guess for a while to do what’s best for our patients.īradley J. Kathleen Moore, MD: I think there’s still a lot of clinical equipoise in HRD negative, and I think everybody is going to understand that. Monk, MD, FACS, FACOG: It’s not going to happen. I’m going to go ahead and add olaparib just for the heck of it.” The HRD comes back negative, and you’re not going to go, “Oh, maybe PAOLA was wrong. Monk, MD, FACS, FACOG: You’re not going to be giving BEV. Why don’t we do a PARP inhibitor trial in the biomarker negative, however we pick a biomarker? I think it’s a great idea.īradley J. That’s really the key, and you called for it. We have no way to control for the confounders that you just brought up, which could have explained these data. Coleman, MD, FACOG, FACS: This is the reason why, when we do randomized controlled trials, we are able to control for confounders. Kathleen Moore, MD: Fifty percent of these patients may never have qualified, and they’re a totally different population from the HRD-negative who are still platinum sensitive. Coleman, MD, FACOG, FACS: That’s exactly right. And they may, but these people may not have ever made it to AVANOVA.īradley J. At least you’ve excluded the patients who have progressed.…However, you don’t know who is going to make it to 6 or 12 months.
![hrd-positive hrd-positive](https://positivebioscience.com/wp-content/uploads/2020/03/BRCA-HRD-826x470.jpg)
Kathleen Moore, MD: You can predict that in PAOLA-1 and PRIMA a little because they’ve responded. Kathleen Moore, MD: The other thing is that-and we brought this up earlier-in the platinum-sensitive space, the best predictor of a PARP inhibitor is being platinum sensitive, right? Birrer, MD, PhD: That’s exactly what I think is going to be said, and I don’t believe that, sorry. Monk, MD, FACS, FACOG: Maybe niraparib is a better PARP inhibitor. I’d never buy that, but at least that effect of “Well, niraparib has 3 months up front in PRIMA.” Why don’t we see that when we add olaparib to BEV ?īradley J. Birrer, MD, PhD: I wouldn’t necessarily expect synergism. Monk, MD, FACS, FACOG: I would have, but I wasn’t right. Birrer, MD, PhD: You would expect at least an additive effect, and you don’t see it.īradley J. It’s consistent with other people smarter than me and with what they thought. Birrer, MD, PhD: But it’s fair to say it’s an odd result.īradley J. Monk, MD, FACS, FACOG: Bevacizumab isn’t dead. Kathleen Moore, MD: There’s no additive effect.īradley J. I think the other studies support the use. Kathleen Moore, MD: If this is a truly representative HRD negative, you could choose either. Kathleen Moore, MD: You’re comparing with an active comparator, and in the HRD-if it’s truly HRD negative-I don’t think we have the right assay just yet. Kathleen Moore, MD: There’s no difference.īradley J. I was so excited to see the HRD-negative benefit of adding olaparib to bevacizumab. Monk, MD, FACS, FACOG: Or in Joyce Liu’s. Coleman, MD, FACOG, FACS: Or in Joyce Liu’s study.īradley J. Monk, MD, FACS, FACOG: For example, in AVANOVA, there’s no bevacizumab arm. Coleman, MD, FACOG, FACS: The results had no direct independency, we didn’t pull out the…īradley J. There was no independent radiology review. Monk, MD, FACS, FACOG: It didn’t pass the sniff test, because those end points were not placebo controlled. Coleman, MD, FACOG, FACS: It didn’t rattle you.īradley J. We had a trial conducted by Joyce Liu of Dana-Farber Cancer Institute with olaparib-cediranib, and then we had this AVANOVA trial with niraparib-bevacizumab. The real opportunity is in the non- BRCA patients. I was taught that if you have BRCA, then the PARP inhibitor works. I’m really excited about adding anti-VEGF and PARP inhibition in all comers. Monk, MD, FACS, FACOG: One of the most surprising discoveries with this PAOLA-1 trial is the activity, or the lack thereof, in the non-HRD patients.