Angeles Alvarez Secord, MD, talks with her patient, Michelle Berke, about the difference between treatment and maintenance.
PUBLISHED December 27, 2017
Angeles Alvarez Secord, MD: Now we’re in a situation where we are doing maintenance treatment in the second-line setting. I want to back up and talk about how you made that decision to continue with maintenance bevacizumab versus changing to another drug if you have just a partial response. As a physician, when I’m considering maintenance treatment in that situation, if somebody has a complete response or a partial response, I think it’s very reasonable. If somebody has progressive disease, then you might make a switch to the right chemotherapy option. But now we have another option, PARP inhibitors. If somebody has a BRCA1 or BRCA2 mutation, that’s an option. It could be an option that opens up another situation. So, this gets into the whole situation of, what’s maintenance and what’s treatment? As a patient, do you feel like that’s difficult to understand? Or, how do you keep those 2 apart?
Michelle Berke: No. They kind of overlap, a little bit. Like you said, I’m on a PARP inhibitor now. This is treatment, but it’s also maintenance for me, right?
Angeles Alvarez Secord, MD: Well, you’re on it for treatment, but you have definitely responded.
Michelle Berke: It’s kind of like treatment, now, because I am doing so well on it. So, it overlaps a little bit.
Angeles Alvarez Secord, MD: I agree with you 100%. I think it’s hard for some people to tease that out. If somebody has a complete response in that situation, and even a partial response, some people lump this together under the maintenance. Other people will say, “Hey, wait! You have a partial response, you’re treating cancer, and that’s treatment.” Or, they look at it as, even if you have a complete response, you still have cancer there. We know it’s going to come back, quickly. That’s still treatment. So, the lines are blurred.
Michelle Berke: It’s very blurred.
Angeles Alvarez Secord, MD: But they’re important distinctions because some of the FDA approvals for PARP inhibitors are treatment approvals, and others are maintenance approvals. I like the way you think about it though. I think that’s good. So, you had a partial response to chemotherapy. We kept you on the bevacizumab for quite some time. You were tolerating that well. You had some issues with your blood pressure?
Michelle Berke: For about 6 or 7 months, my blood pressure was a little high on that. I think that’s why we stopped it.
Angeles Alvarez Secord, MD: Actually, you progressed. We actually had to work, a little bit, to get your blood pressure under control. But we were at a point where it was stable. So, we were OK with that.
Michelle Berke: And now, it’s under control. I’m not on blood pressure medication or anything right now.
Angeles Alvarez Secord, MD: Which is probably awesome.