For patients with relapsed high-grade serous ovarian cancer, maintenance treatment with poly (ADP-ribose) polymerase (PARP) inhibitors following platinum-based chemotherapy improves progression-free survival. Progression-free survival is also improved with PARP inhibitor treatment following subsequent chemotherapy in relapsed high-grade serous ovarian cancer. As data regarding subsequent chemotherapy are scarce and PARP inhibitor and platinum-based chemotherapy mechanisms may impact outcomes, researchers aimed to examine real-world data of patients treated with subsequent chemotherapy.
Patients with high-grade serous ovarian cancer treated until July 15, 2020, in 3 hospitals were included. Patients had been treated with subsequent chemotherapy after progression to maintenance PARP inhibitor treatment. End points included objective response rate, median progression-free survival, and overall survival.
A total of 56 patients were identified. Of these, 31 patients had BRCA mutation and 1 patient had BRIP1 mutation. Four (7.1%) patients received PARP inhibitor treatment after first-line chemotherapy, 26 (46.4%) patients after 2 lines, and 26 (46.4%) after ≥3 lines. Of the patients studied, 34 (60.7%) received olaparib and 22 (39.3%) received niraparib. The median progression-free survival for patients with recurrent disease was 7.5 months. This was longer in patients with BRCA mutation, who had a median progression-free survival of 10.1 months compared with 5.5 months for patients without BRCA mutation. The median progression-free survival after subsequent chemotherapy in patients with relapsed high-grade serous ovarian cancer was 15.8 months, which was also longer in patients with BRCA mutation, compared with those without (20.9 vs 15.4 months).
The overall response rate to subsequent platinum-based chemotherapy was 33.3%. Disease progression without any response to treatment was observed in 28.6% of patients. The overall response rate was 22.7% for patients who received subsequent platinum-based treatment with a platinum-free interval of 6 to 12 months and 42.8% for patients who received subsequent platinum treatment with platinum-free interval for ≥12 months. Five complete responses were observed among patients with BRCA mutation who had received treatment with PARP inhibitors in the recurrent setting.
Median overall survival and progression-free survival were significantly longer in patients with a platinum-free interval of >12 months compared with other subgroups. The median overall survival in patients who received subsequent platinum-based chemotherapy following a platinum-free interval of 6 to 12 months was 14.2 months compared with 28.2 months for patients with an interval of >12 months. Median progression-free survival was 5.5 months for patients with a platinum-free interval of 6 to 12 months and 9.6 months for those with an interval of >12 months.
Data suggested a greater benefit from subsequent platinum-based chemotherapy after PARP inhibition for the subgroup of patients with a platinum-free interval of ≥12 months. Patients with a platinum-free interval of 6 to 12 months experienced a benefit from subsequent platinum-based chemotherapy after PARP inhibition that was similar to that found in the nonplatinum group. Researchers conclude that the role of subsequent platinum-based chemotherapy after PARP inhibition in patients with a platinum-free interval of 6 to 12 months warrants further research.
Abstract 281. ESGO 2020.
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