ROCSAN trial (GINECO-EN203b/ENGOT-EN8): A multicentric randomized phase II/III evaluating dostarlimab in combination with niraparib versus niraparib alone compared to chemotherapy in the treatment of endometrial/ovarian carcinosarcoma after at least one line of platinum based chemotherapy

TPS5604

Background: Gynecological carcinosarcomas (CS) are rare and highly aggressive tumors with a 5-year overall survival (OS) < 10%. After initial treatment majority of patients (pts) relapse and receive diverse chemotherapies (CT) producing modest benefits. The median PFS in relapse after platinum based CT is less than 4 months and median OS less than 1 year. New innovative strategies are urgently needed. Since CS showed high DNA damage response activity and potentially a high tumor mutation load resulting in neo-antigens, a synergy between PARPi and anti-PD1 is expected. Methods: ROCSAN is a multicentric, randomized, open-label, integrated Phase II/III study. In the Phase II, 63 pts with recurrent or progressing endometrial or ovarian CS after at least a first line of platinum-based CT will be randomized (2:2:1) to receive either niraparib in monotherapy, niraparib in combination with dostarlimab or standard CT (paclitaxel, doxorubicine, gemcitabine, topotecan). Stratification factors include the number of previous CT lines (1 vs 2-3), FIGO stage at diagnosis (I-II vs III-IV), CS localisation (ovarian vs endometrial), and performance status (0-1 vs 2). The primary objective of the Phase II is to select the best experimental strategy between niraparib and dostarlimab/niraparib combination based on Response Rate at 4 months (RR-4M by RECIST1.1). A single stage design with a 10% unacceptable RR-4M and a 30% targeted RR-4M was used to determine Phase II sample size, assuming a 10% one sided alpha for each comparison and more than 90% power. A pick-the-winner selection design could be used in case of promising efficacy in each experimental arm. At the interim analysis, an Independent Data Monitoring Committee will make recommendation for the selection of the optimal experimental arm. The Steering committee could then support to continue enrolment for the international Phase III which is calibrated to detect an improvement in median OS from 7 months (Standard CT) to 11.7 months (best experimental arm). Assuming a 5% alpha level and 80% power, 133 additional pts could be randomized (2:1). Secondary endpoints include safety, PFS, PFS2, TTST, ORR, duration of response, patient report outcomes (assessed via EORTC QLQ-C30 OV28, HADS, PRO-CTCAE). A translational program supported by European Community is associated to the clinical study to identify predictive biomarkers of response/resistance to study treatments, to correlate with immune environment, a special focus on genetic instability and the EMT process will be included. Trial is currently recruiting only in France for the phase II part, the first pt was randomized in July 2020. Clinical trial information: NCT 03651206.

[Management of pregnant women with advanced cervical cancer: About five cases observed in Lille from 2002 till 2009. Evaluation of practices referring to the new French recommendations of 2008]

PURPOSE

An update on the management of invasive cervical cancer (from stage IB) diagnosed during pregnancy with reference to the recent French guidelines.

PATIENTS AND METHODS

We retrospectively analyzed patients for whom invasive cervical cancer was diagnosed during pregnancy and managed jointly by Jeanne-de-Flandres and Roubaix maternity and by Oscar-Lambret cancer center between 2002 and 2009.

RESULTS

Five patients were included: four stage IB1, and one stage IB2. Five pregnancies resulted in the birth of six alive children. Three patients received neoadjuvant chemotherapy during pregnancy. One patient had a laparoscopic pelvic lymphadenectomy in first trimester. Two laparoscopic extraperitoneal paraortic lymphadenectomy have been made. The mean time of survey is 47.5 months (12-94 months). One patient died of her cancer.

CONCLUSION

The diagnosis of cervical cancer during pregnancy involves the same therapeutic guidelines in the absence of pregnancy. The laparoscopic pelvic lymphadenectomy (up to 20 to 24 weeks of gestation) is crucial in the therapeutic treatment for tumors less than 4cm. Neoadjuvant chemotherapy is used during pregnancy for patients refusing medical termination of pregnancy.

[Pelvic and abdominal actinomycosis presenting as a parietal mass]

INTRODUCTION

Actinomycosis is a rare disease. It has a highly varied clinical picture and may simulate genital or gastrointestinal neoplasms.

CASE

This 45-year-old woman was referred for suspected ovarian cancer, with secondary lesions of the liver and pelvic wall. Pelvic actinomycosis was first suggested by the presence of an intrauterine device (IUD), which had been in place for several years without any follow-up. The final diagnosis was based upon histological examination of a biopsy sample of the parietal mass.

COMMENTS

The association of apparent pelvic tumors with infection and inflammation together with the presence of an IUD must suggest genital actinomycosis and lead to the rejection of any immediate surgical resection. The diagnosis is usually histological, with samples obtained either surgically or by percutaneous stereotactic biopsy. The treatment is essentially medical and consists of long-term antibiotics (penicillin). The prognosis is usually good.

Loss of efficacy of ondansetron-dexamethasone during successive courses in female patients receiving high-dose cisplatin

This study was designed to evaluate the efficiency of the association ondansetron-dexamethasone during successive courses in 22 chemotherapy-naive female patients receiving a chemotherapy regimen including cisplatin at a dose of 100 mg/m2. The antiemetic treatment consisted of dexamethasone 20 mg i.v. and ondansetron 24 mg i.v. the day of chemotherapy, then ondansetron 8 mg per os every 8 hours for 5 days. A complete control of emesis with no or mild nausea was observed in 41% of cases on the first day of the first course, in 9.5% after the 3rd course. No patient experienced a complete response after the sixth. Similar results were obtained when nausea and vomiting were assessed on the worst day of D2 or D3. Our study shows that, as with other antiemetics, ondansetron-dexamethasone efficiency decreases with the number of courses.