Measuring Utilization of Maintenance Therapy in Platinum-Sensitive Recurrent Ovarian Cancer

Maintenance therapy can extend progression-free survival (PFS) in patients with platinum-sensitive recurrent ovarian cancer, but approximately half of patients eligible for maintenance therapy do not receive it. Variations in prescribed therapy (bevacizumab vs poly [ADP-ribose] polymerase [PARP] inhibitors) compounds this problem. However, data from a retrospective cohort study found that maintenance therapy indeed prolonged PFS in patients with platinum-sensitive recurrent ovarian cancer. This research was presented in a poster by Jaclyn Wall, MD, from the University of Alabama at Birmingham, at the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer.

In this study, Dr Wall and colleagues analyzed the institutional utilization of maintenance therapy in patients with platinum-sensitive recurrent ovarian cancer from September 2018 to July 2019. All patients had completed second-line or greater platinum-based chemotherapy for 3 to 8 cycles after March 27, 2017 (the date the US Food and Drug Administration granted approval for PARP inhibitor maintenance in this patient population). The researchers evaluated the percentage of patients who received maintenance (and the type of maintenance received) after platinum-based therapy, excluding those who discontinued maintenance therapy because of adverse reactions.

In total, 81 patients with platinum-sensitive recurrent ovarian cancer seen during the study interval were eligible for maintenance, and 68 of those patients were eligible for analysis. PFS in patients recurring on maintenance was defined as the date of initiation of platinum-based chemotherapy until disease progression or death.

Of those 68 individuals, 52 (76.4%) received maintenance—43 (63.2%) received a PARP inhibitor and 9 (13.2%) received bevacizumab. The additional 16 (23.5%) patients did not receive maintenance.

Average follow-up was 14.7 months. Out of the entire population eligible for analysis, 45 have recurred, and 23 remain progression-free at the time of reporting.

Seventeen patients receiving PARP inhibitors remained progression-free compared with 3 receiving bevacizumab and 3 who did not receive maintenance therapy. Overall, the risk of recurrence was reduced by 69% for patients receiving PARP inhibitors and 53% for those administered bevacizumab.

Compared with patients with wild-type mutations, patients with somatic or germline BRCA mutations have greater clinical benefit with maintenance PARP inhibitor therapy. BRCA status was known in 53 patients; 14 of 18 (77.8%) BRCA-positive patients received PARP maintenance, while 3 received no maintenance.

“Consistent with randomized controlled trials, maintenance therapy prolonged PFS in platinum-sensitive recurrent ovarian cancer patients,” the investigators reported. “At our institution, over 75% of patients eligible for maintenance therapy received it. While 23% of patients did not receive maintenance, this could have been based on a multitude of factors, including physician/patient combined decision-making.”

  • SGO 2020 Annual Meeting on Women’s Cancer. Abstract 240.

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