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Zhao M, Qiu S, Wu X, Miao P, Jiang Z, Zhu T, Xu X, Zhu Y, Zhang B, Yuan D, Zhang Y, Sun W, He A, Zhao M, Hou W, Zhang Y, Shao Z, Jia M, Li M, Chen J, Xu J, Chen B, Zhou Y, Shen Y. Efficacy and Safety of Niraparib as First-Line Maintenance Treatment for Patients with Advanced Ovarian Cancer: Real-World Data from a Multicenter Study in China. Target Oncol 2023; 18:869-883. [PMID: 37847485 PMCID: PMC10663182 DOI: 10.1007/s11523-023-00999-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Poly (ADP-ribose) polymerase (PARP) inhibitors are a new maintenance therapy option for patients with ovarian cancer (OC). OBJECTIVE To evaluate the efficacy and influencing factors of the novel PARP inhibitor niraparib for maintenance treatment of Chinese patients with advanced OC. PATIENTS AND METHODS In this retrospective multicenter real-world study patients with advanced OC from 15 hospitals throughout China were enrolled. The primary endpoint was progression-free survival (PFS) and the secondary endpoints included the time to treatment discontinuation and safety. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to identify possible risk factors for PFS, after which a prediction model was established to evaluate the likelihood of achieving an 18-month PFS. The relationship between the dose of niraparib and PFS was also evaluated. RESULTS The PFS rates of 199 patients at 6, 12, 18, 24, and 30 months were 87.4%, 75.9%, 63.6%, 56.1%, and 51.8%, respectively. LASSO regression model revealed that only age < 65 years (P = 0.011), BRCA mutations (P < 0.001), and R0 status after cytoreductive surgery (P = 0.01) were significant factors associated with prolonged PFS times. Based on the LASSO logistic regression analysis, a clinical prediction formula was developed: - 2.412 + 1.396Age≥65yr + 2.374BRCAwt + 1.387R1 + 0.793Interval≥12w + 0.178BMI>24kg/m2 which yielded a cut-off value of 0.091, an area under the curve (AUC) of 0.839 (0.763-0.916), a sensitivity of 94.3%, and an accuracy of 78.5%. A nomogram was then built to visualize the results. The major treatment-emergent adverse events of ≥ grade 3 included a platelet count decrease (19.1%), white blood cell count decrease (15.1%), neutrophil count decrease (13.1%), and anemia (18.6%). The 18-month PFS rates in patients treated with 200 mg niraparib were somewhat higher than in patients treated with 100 mg after 3-months of therapy. CONCLUSIONS For Chinese OC patients, niraparib, particularly at a 200 mg individual starting dose, was an effective therapy with easily manageable safety.
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Affiliation(s)
- Minmin Zhao
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, China
| | - Shanhu Qiu
- Department of General Practice, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Xin Wu
- Department of Gynecological Oncology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200090, China
| | - Pengcheng Miao
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, China
| | - Zhi Jiang
- Department of Gynecologic Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Tao Zhu
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310005, China
| | - Xizhong Xu
- Department of Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, 214122, China
| | - Yanling Zhu
- Department of Gynecology Oncology, Xuzhou Cancer Hospital, Xuzhou, 221005, China
| | - Bei Zhang
- Department of Obstetrics and Gynecology, Xuzhou Central Hospital, Xuzhou, 221009, China
| | - Donglan Yuan
- Department of Gynecological Oncology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, 225317, China
| | - Yang Zhang
- Department of Gynecology, Lianyungang First People's Hospital, Lianyungang, 222002, China
| | - Wei Sun
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Aiqin He
- Department of Gynecology Oncology, Nantong Tumor Hospital, Nantong, 226361, China
| | - Min Zhao
- Department of Gynecological Oncology, Wuxi Maternal and Child Health Hospital, Wuxi School of Medicine, Jiangnan University, Wuxi, 214002, China
| | - Wenjie Hou
- Department of Obstetrics and Gynecology, Dushu Lake Hospital Affiliated to Soochow University (Soochow University Medical Center), Suzhou, 215125, China
| | - Yingli Zhang
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310005, China
| | - Zhuyan Shao
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310005, China
| | - Meiqun Jia
- Department of Gynecology Oncology, Nantong Tumor Hospital, Nantong, 226361, China
| | - Mei Li
- Department of Oncology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, 226001, China
| | - Jun Chen
- Medical Affair Department, Zai Lab (Shanghai) Co., Ltd, Shanghai, 201210, China
| | - Jingcheng Xu
- Medical Affair Department, Zai Lab (Shanghai) Co., Ltd, Shanghai, 201210, China
| | - Bingwei Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, China.
| | - Ying Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, China.
| | - Yang Shen
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, China.
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Sabatier R, Rousseau F, Joly F, Cropet C, Montégut C, Frindte J, Cinieri S, Guerra Alía EM, Polterauer S, Yoshida H, Vergote I, Colombo N, Hietanen S, Largillier R, Canzler U, Gratet A, Marmé F, Favier L, Pujade-Lauraine E, Ray-Coquard I. Efficacy and safety of maintenance olaparib and bevacizumab in ovarian cancer patients aged ≥65 years from the PAOLA-1/ENGOT-ov25 trial. Eur J Cancer 2023; 181:42-52. [PMID: 36634389 DOI: 10.1016/j.ejca.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The phase III PAOLA-1/ENGOT-ov25 study (NCT02477644) showed that addition of olaparib to bevacizumab maintenance improved progression-free survival (PFS) in patients with newly diagnosed advanced ovarian cancer. We evaluated maintenance olaparib plus bevacizumab in older patients in PAOLA-1. METHODS Baseline clinical and molecular data, and PFS, were compared between older (aged ≥65 years) and younger patients (<65 years). Factors associated with olaparib efficacy, and safety in age subgroups, were also assessed. RESULTS Of 806 randomised patients, 292 (36.2%) were ≥65 years. A lower proportion of older versus younger patients had an Eastern Cooperative Oncology Group performance status of 0 (61.0% versus 76.2%) and upfront surgery (42.0% versus 55.7%). Older patients were less likely to have a BRCA1/2 mutation (17.1% versus 36.7%) or homologous recombination deficiency-positive status (34.1% versus 55.7%). After median follow-up of 22.1 months, median PFS was 21.6 months with olaparib versus 16.6 months with placebo in the older population (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.41-0.75), comparable with the younger population (median 22.9 versus 16.9 months; HR 0.61, 95% CI 0.49-0.77). PFS benefits were observed in patients with a BRCA mutation or homologous recombination deficiency-positive tumours. Incidence of olaparib-related grade ≥3 adverse events in older patients was comparable with that of younger patients (36.8% versus 31.7%) although hypertension and anaemia were more common in older patients. No treatment-related deaths occurred in older patients receiving olaparib. CONCLUSION Older patients enrolled in PAOLA-1 achieved similar PFS benefits compared with younger patients, with a similar safety profile.
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Affiliation(s)
- Renaud Sabatier
- Department of Medical Oncology, Institut Paoli-Calmettes, CRCM, Aix-Marseille Univ, Inserm, CNRS, Marseille, and GINECO, France.
| | - Frédérique Rousseau
- Department of Medical Oncology, Institut Paoli-Calmettes, CRCM, Aix-Marseille Univ, Inserm, CNRS, Marseille, and GINECO, France
| | | | | | - Coline Montégut
- Department of Medical Oncology, Institut Paoli-Calmettes, CRCM, Aix-Marseille Univ, Inserm, CNRS, Marseille, and GINECO, France
| | - Johanna Frindte
- Department of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen, and AGO, Germany
| | - Saverio Cinieri
- UOC Oncologia Medica - Ospedale Senatore Antonio Perrino, Brindisi, and MITO, Italy
| | | | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, and AGO-Austria, Austria
| | | | - Ignace Vergote
- University Hospital Leuven, Leuven Cancer Institute, Leuven, and BGOG, European Union, Belgium
| | - Nicoletta Colombo
- University of Milan-Bicocca and Istituto Europeo di Oncologia, Milan, and MANGO, Italy
| | | | | | - Ulrich Canzler
- Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, and National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, and AGO, Germany
| | | | - Frederik Marmé
- Medical Faculty Mannheim, Heidelberg University, Mannheim, and AGO, Germany
| | - Laure Favier
- Centre Georges François Leclerc, Dijon, and GINECO, France
| | | | - Isabelle Ray-Coquard
- Centre Léon Bérard and University Claude Bernard Lyon 1, Lyon and GINECO, France
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Velev M, Puszkiel A, Blanchet B, de Percin S, Delanoy N, Medioni J, Gervais C, Balakirouchenane D, Khoudour N, Pautier P, Leary A, Ajgal Z, Hirsch L, Goldwasser F, Alexandre J, Beinse G. Association between Olaparib Exposure and Early Toxicity in BRCA-Mutated Ovarian Cancer Patients: Results from a Retrospective Multicenter Study. Pharmaceuticals (Basel) 2021; 14:ph14080804. [PMID: 34451901 PMCID: PMC8399031 DOI: 10.3390/ph14080804] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 12/27/2022] Open
Abstract
Factors associated with olaparib toxicity remain unknown in ovarian cancer patients. The large inter-individual variability in olaparib pharmacokinetics could contribute to the onset of early significant adverse events (SAE). We aimed to retrospectively analyze the pharmacokinetic/pharmacodynamic relationship for toxicity in ovarian cancer patients from “real life” data. The clinical endpoint was the onset of SAE (grade III/IV toxicity or dose reduction/discontinuation). Plasma olaparib concentration was assayed using liquid chromatography at any time over the dosing interval. Trough concentrations (CminPred) were estimated using a population pharmacokinetic model. The association between toxicity and clinical characteristics or CminPred was assessed by logistic regression and non-parametric statistical tests. Twenty-seven patients were included, among whom 13 (48%) experienced SAE during the first six months of treatment. Olaparib CminPred was the only covariate significantly associated with increased risk of SAE onset (odds ratio = 1.31, 95% CI = [1.10; 1.57], for each additional 1000 ng/mL). The ROC curve identified a threshold of CminPred = 2500 ng/mL for prediction of SAE onset (sensitivity/specificity 0.62 and 1.00, respectively). This study highlights a significant association between olaparib plasma exposure and SAE onset and identified the threshold of 2500 ng/mL trough concentration as potentially useful to guide dose adjustment in ovarian cancer patients.
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Affiliation(s)
- Maud Velev
- Department of Medical Oncology, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (M.V.); (S.d.P.); (Z.A.); (L.H.); (F.G.); (G.B.)
| | - Alicja Puszkiel
- Department of Pharmacokinetics and Pharmacochemistry, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (A.P.); (B.B.); (D.B.); (N.K.)
- INSERM UMR-S1144, Faculté de Pharmacie, Université de Paris, 75006 Paris, France
| | - Benoit Blanchet
- Department of Pharmacokinetics and Pharmacochemistry, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (A.P.); (B.B.); (D.B.); (N.K.)
- UMR8038 CNRS, U1268 INSERM, Faculté de Pharmacie, Université de Paris, PRES Sorbonne Paris Cité, CARPEM, 75006 Paris, France
| | - Sixtine de Percin
- Department of Medical Oncology, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (M.V.); (S.d.P.); (Z.A.); (L.H.); (F.G.); (G.B.)
| | - Nicolas Delanoy
- Department of Medical Oncology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France; (N.D.); (J.M.); (C.G.)
| | - Jacques Medioni
- Department of Medical Oncology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France; (N.D.); (J.M.); (C.G.)
| | - Claire Gervais
- Department of Medical Oncology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France; (N.D.); (J.M.); (C.G.)
| | - David Balakirouchenane
- Department of Pharmacokinetics and Pharmacochemistry, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (A.P.); (B.B.); (D.B.); (N.K.)
| | - Nihel Khoudour
- Department of Pharmacokinetics and Pharmacochemistry, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (A.P.); (B.B.); (D.B.); (N.K.)
| | - Patricia Pautier
- Gustave Roussy Cancer Center, Department of Medical Oncology, Université Paris-Saclay, 94805 Villejuif, France; (P.P.); (A.L.)
| | - Alexandra Leary
- Gustave Roussy Cancer Center, Department of Medical Oncology, Université Paris-Saclay, 94805 Villejuif, France; (P.P.); (A.L.)
| | - Zahra Ajgal
- Department of Medical Oncology, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (M.V.); (S.d.P.); (Z.A.); (L.H.); (F.G.); (G.B.)
| | - Laure Hirsch
- Department of Medical Oncology, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (M.V.); (S.d.P.); (Z.A.); (L.H.); (F.G.); (G.B.)
| | - François Goldwasser
- Department of Medical Oncology, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (M.V.); (S.d.P.); (Z.A.); (L.H.); (F.G.); (G.B.)
| | - Jerome Alexandre
- Department of Medical Oncology, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (M.V.); (S.d.P.); (Z.A.); (L.H.); (F.G.); (G.B.)
- Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université, Inserm, Team Personalized Medicine, Pharmacogenomics and Therapeutic Optimization (MEPPOT), 75006 Paris, France
- Correspondence: ; Tel.: +33-01-(58)-414141
| | - Guillaume Beinse
- Department of Medical Oncology, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (M.V.); (S.d.P.); (Z.A.); (L.H.); (F.G.); (G.B.)
- Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université, Inserm, Team Personalized Medicine, Pharmacogenomics and Therapeutic Optimization (MEPPOT), 75006 Paris, France
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Battisti NML, Decoster L, Williams GR, Kanesvaran R, Wildiers H, Ring A. Targeted Therapies in Older Adults With Solid Tumors. J Clin Oncol 2021; 39:2128-2137. [PMID: 34043448 PMCID: PMC8260907 DOI: 10.1200/jco.21.00132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/07/2021] [Accepted: 02/23/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Nicolò Matteo Luca Battisti
- Department of Medicine—Breast Unit, The Royal Marsden NHS Foundation Trust, Breast Cancer Research Division, The Institute of Cancer Research, Surrey, United Kingdom
| | - Lore Decoster
- Department of Medical Oncology, Universitair Ziekenhuis (UZ) Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Grant R. Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | | | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven Cancer Institute, Laboratory of Experimental Oncology, Leuven, Belgium
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - Alistair Ring
- Department of Medicine—Breast Unit, The Royal Marsden NHS Foundation Trust, Breast Cancer Research Division, The Institute of Cancer Research, Surrey, United Kingdom
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Liposits G, Lichtman S. Taking the next step in PARP-inhibitor clinical trials in older women with ovarian cancer - Staging the aging. Gynecol Oncol Rep 2021; 35:100710. [PMID: 33553556 PMCID: PMC7846923 DOI: 10.1016/j.gore.2021.100710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/21/2020] [Accepted: 01/12/2021] [Indexed: 11/25/2022] Open
Abstract
•Older patients are still underrepresented in randomized controlled clinical trials.•Older patients receiving PARP-inhibitors tend to achieve shorter PFS, even those considered fit.•Older patients experience more side effects, than their younger counterparts.•Prospective "real-world" data is needed in unselected older women with ovarian cancer receiving PARP-inhibitors.
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Affiliation(s)
- G. Liposits
- Department of Oncology, Odense University Hospital, J.B. Winsløws Vej 4., 5000 Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, J.B. Winsløws Vej 19.3, 5000 Odense C, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense, Denmark
| | - S.M. Lichtman
- Memorial Sloan Kettering Cancer Center, Commack, USA
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