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Levine MD, Wang H, Sriram B, Khan A, Senter L, McLaughlin EM, Bixel KL, Chambers LM, Cohn DE, Copeland LJ, Cosgrove CM, Nagel CI, O'Malley DM, Backes FJ. Does the choice of platinum doublet matter? A study to evaluate the impact of platinum doublet choice for treatment of platinum-sensitive ovarian cancer recurrence on the development of future PARP inhibitor and platinum resistance. Gynecol Oncol 2024; 182:51-56. [PMID: 38262238 DOI: 10.1016/j.ygyno.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVES The use of a platinum doublet for the treatment of platinum-sensitive epithelial ovarian cancer (EOC) recurrence is well established. The impact of the non‑platinum chemotherapy used as part of a platinum doublet on PARP inhibitor (PARPi) and platinum sensitivity it not known. We aimed to describe oncologic outcomes in cases of recurrent EOC receiving PARPi as maintenance therapy based on preceding platinum doublet. METHODS Retrospective study of patients with platinum-sensitive recurrent ovarian, fallopian tube or primary peritoneal cancer treated with platinum doublet followed by maintenance PARPi from 1/1/2015 and 1/1/2022. Comparisons were made between patients receiving carboplatin + pegylated liposomal doxorubicin (CD) versus other platinum doublets (OPDs). Descriptive statistics, Kaplan-Meier and univariate survival analyses were performed. RESULTS 100 patients received PARPi maintenance following a platinum doublet chemotherapy regimen for platinum-sensitive recurrence. 25/100 (25%) received CD and 75/100 (75%) received OPDs. Comparing CD and OPDs, median progression-free survival was 8 versus 7 months (p = 0.26), median time to platinum resistance was 15 versus 13 months (p = 0.54), median OS was 64 versus 90 months (p = 0.28), and median OS from starting PARPi was 25 versus 26 months (p = 0.90), respectively. CONCLUSIONS Using pegylated liposomal doxorubicin as part of a platinum doublet preceding maintenance PARPi for platinum-sensitive recurrence does not seem to hasten PARPi resistance or platinum resistance compared to OPDs. Although there was a non-significant trend towards increased OS among patients who received a platinum doublet other than CD prior to PARPi, the OS from PARPi start was similar between groups. Given the retrospective nature of this study and small study population, further research is needed to evaluate if the choice of platinum doublet preceding PARPi maintenance impacts PARPi resistance, platinum resistance and survival.
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Affiliation(s)
- Monica D Levine
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, United States of America.
| | - Heather Wang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Bhargavi Sriram
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Ambar Khan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Leigha Senter
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Eric M McLaughlin
- Center for Biostatistics, The Ohio State University, Columbus, OH, United States of America
| | - Kristin L Bixel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Laura M Chambers
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Larry J Copeland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Casey M Cosgrove
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Christa I Nagel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - David M O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Floor J Backes
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, United States of America
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Liu J, Liu Y, Yang C, Liu J, Hao J. Comprehensive analysis for the immune related biomarkers of platinum-based chemotherapy in ovarian cancer. Transl Oncol 2023; 37:101762. [PMID: 37619523 PMCID: PMC10458992 DOI: 10.1016/j.tranon.2023.101762] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/26/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Ovarian cancer (OC) is one of the most lethal gynecological malignancies. This study aimed to identify biomarkers that were sensitive to platinum-based chemotherapeutic agents and can be used in immunotherapy and explore the importance of their mechanisms of action. METHODS RNA-seq profiles and clinicopathological data for OC samples were obtained from The Cancer Genome Atlas (TCGA) and cBioPortal platform, respectively. Platinum-sensitive and platinum-resistant OC samples in the TCGA cohort were selected based on the clinical information. RNA-seq data for 70 OC samples withSingle-sample gene set enrichment analysis (ssGSEA) and unsupervised clustering were used to classify OC patients from the TCGA cohort into clusters with different proportions of infiltrating immune cells. ESTIMATE analysis was used to assess the immune landscape among clusters. Differential expression, univariate Cox regression, and LASSO regression analyses were performed to construct prognostic model. Spearman correlation analysis was conducted to investigate the correlations among immune checkpoint inhibitors (ICIs) and risk score, half-maximal drug inhibitory concentration (IC50) and risk score. RESULTS Using ssGSEA and unsupervised clustering, OC samples were divided into two clusters with different immune cell infiltration. Then, 1715 differentially expressed immune-related genes (DEIRGs) were identified between two clusters, 984 differentially expressed platinum-sensitive related genes (DEPSRGs) between 149 platinum-sensitive and 63 platinum-resistant OC samples were identified, and 5384 differentially expressed genes (DEGs) between 380 OC and 194 normal samples were detected from the TCGA cohort. Six biomarkers (GMPPB, SRPK1, STC1, PRSS16, HPDL, and SPTSSB) were detected to establish a prognostic model. The OC patients in the TCGA cohort were classified into high- and low-risk groups. The receive operating characteristic (ROC) curve was plotted and demonstrated that the prognostic model performed well with the area under ROC curve (AUC) greater than 0.6. The expressions of 5 ICIs, including CD200, TNFRSF18, CD160, CD200R1, and CD274 (PD-L1), were significantly different between two risk groups, and the risk score was significant negative associated with CTLA4, TNFRSF4, TNFRSF18, and CD274. Moreover, there were significant differences in IC50 of 10 chemo drugs between two risk groups, patients in the high-risk group could be more resistant to po0tinib, dasatinib, and neratinib. CONCLUSION In summary, this study constructed a novel prognostic model based on six prognostic biomarkers, including GMPPB, SRPK1, STC1, PRSS16, HPDL, and SPTSSB, which can be utilized for predicting the prognosis of OC patients. These biomarkers were the potential therapeutic targets.
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Affiliation(s)
- Jiao Liu
- Department of Gynecology, Benxi Central Hospital, Benxi 117000, Liaoning Province, China
| | - Yaoyao Liu
- Department of Gynecology, Benxi Central Hospital, Benxi 117000, Liaoning Province, China
| | - Chunjiao Yang
- Department of Radiotheropy, Benxi Central Hospital, Benxi 117000, Liaoning Province, China
| | - Jingjing Liu
- Department of Gynecology, Benxi Central Hospital, Benxi 117000, Liaoning Province, China
| | - Jiaxin Hao
- Department of Orthopedics, Benxi Central Hospital, Benxi 117000, Liaoning Province, China.
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Petrelli F, Rea CG, Solinas C, Ghidini A, Borgonovo K, Celotti A, Villa A, Luciani A, Lorusso D. Treatments for relapsed, BRCA-wild type, platinum-sensitive ovarian cancer: A systematic review and network meta-analysis. Cancer Treat Rev 2023; 118:102571. [PMID: 37201444 DOI: 10.1016/j.ctrv.2023.102571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/06/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Although platinum-based chemotherapy (CT) is considered the standard treatment for relapsed platinum-sensitive ovarian cancer, there is currently no standard treatment for these patients. We compared the effectiveness of modern and older therapies in relapsed platinum-sensitive, BRCA-wild type, and ovarian cancers using a network meta-analysis (NMA). METHODS A systematic search of PubMed, EMBASE, and Cochrane Library was performed up to October 31, 2022. Randomized controlled trials (RCT) that compared different second-line approaches were included. The primary endpoint was overall survival (OS) and the secondary endpoint was progression-free survival (PFS). RESULTS In total, 17 RCTs (n = 9405) comparing various strategies were included. The risk of death was significantly decreased with carboplatin + pegylated liposomal doxorubicin + bevacizumab compared to platinum-based doublet CT (hazard ratio [HR] = 0.59, 95%CI 0.35, 1). Various strategies, including secondary cytoreduction followed by platinum-based CT, carboplatin + pegylated liposomal doxorubicin + bevacizumab, and platinum-based CT with bevacizumab or cediranib, were better than platinum-based doublets alone for PFS. CONCLUSIONS This NMA showed that carboplatin + pegylated liposomal doxorubicin + bevacizumab seems to increase the efficacy of standard second-line CT. These strategies can be considered when treating patients with relapsed platinum-sensitive ovarian cancer without BRCA mutations. This study provides systematic comparative evidence for the efficacy of different second-line therapies for relapsed ovarian cancer.
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Affiliation(s)
| | | | - Cinzia Solinas
- Medical Oncology, AOU Cagliari, P.O. Duilio Casula, Monserrato (CA), Italy
| | | | | | | | | | - Andrea Luciani
- Oncology Unit, ASST Bergamo ovest, Treviglio (BG), Italy
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
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Cueva JF, Palacio I, Churruca C, Herrero A, Pardo B, Constenla M, Santaballa A, Manso L, Estévez P, Maximiano C, Legerén M, Marquina G, de Juan A, Quindós M, Sánchez L, Barquin A, Fernández I, Martín C, Juárez A, Martín T, García Y, Yubero A, Gallego A, Martínez Bueno A, Guerra E, González-Martín A. Real-world safety and effectiveness of maintenance niraparib for platinum-sensitive recurrent ovarian cancer: A GEICO retrospective observational study within the Spanish expanded-access programme. Eur J Cancer 2023; 182:3-14. [PMID: 36706655 DOI: 10.1016/j.ejca.2022.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
AIM To describe patient characteristics, effectiveness and safety in a real-world population treated with niraparib in the Spanish expanded-access programme. PATIENTS AND METHODS This retrospective observational study included women with platinum-sensitive recurrent high-grade serous ovarian cancer who received maintenance niraparib within the Spanish niraparib expanded-access programme. Eligible patients had received ≥2 previous lines of platinum-containing therapy, remained platinum-sensitive after the penultimate line of platinum and had responded to the most recent platinum-containing therapy. Niraparib dosing was at the treating physician's discretion (300 mg/day fixed starting dose or individualised starting dose [ISD] according to baseline body weight and platelet count). Safety, impact of dose adjustments, patient characteristics and effectiveness were analysed using data extracted from medical records. RESULTS Among 316 eligible patients, 80% had BRCA wild-type tumours and 66% received an ISD. Median niraparib duration was 7.8 months. The most common adverse events typically occurred within 3 months of starting niraparib. Median progression-free survival was 8.6 (95% confidence interval [CI] 7.6-10.0) months. One- and 2-year overall survival rates were 86% (95% CI 81-89%) and 65% (95% CI 59-70%), respectively. Dose interruptions, dose reductions, haematological toxicities and asthenia/fatigue were less common with ISD than fixed starting dose niraparib, but progression-free survival was similar irrespective of dosing strategy. Subsequent therapy included platinum in 71% of patients who received further treatment. CONCLUSION Outcomes in this large real-world dataset of niraparib-treated patients are consistent with phase III trials, providing reassuring evidence of the tolerability and activity of niraparib maintenance therapy for platinum-sensitive recurrent ovarian cancer. CLINICALTRIALS GOV REGISTRATION NCT04546373.
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Affiliation(s)
- Juan F Cueva
- Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
| | - Isabel Palacio
- Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | - Ana Herrero
- Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Beatriz Pardo
- Institut Català d'Oncologia (ICO) Duran i Reynals, Barcelona, Spain.
| | - Manuel Constenla
- Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain.
| | - Ana Santaballa
- Hospital Universitario i Politècnic la Fe, Valencia, Spain.
| | - Luis Manso
- Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Purificación Estévez
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain.
| | | | - Marta Legerén
- Hospital Universitario Clínico San Cecilio, Granada, Spain.
| | - Gloria Marquina
- Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Complutense University (UCM), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Ana de Juan
- Hospital Universitario Marqués de Valdecilla, Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
| | - María Quindós
- Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | | | | | | | | | | | - Teresa Martín
- Hospital Universitario de Salamanca, Salamanca, Spain.
| | - Yolanda García
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - Alfonso Yubero
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | | | | | - Eva Guerra
- Hospital Universitario Ramón y Cajal, Madrid, Spain.
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Yoshihama T, Kuroda Y, Chiyoda T, Takahashi M, Yoshimura T, Saotome K, Nanki Y, Sakai K, Kobayashi Y, Yamagami W, Aoki D. Efficacy and safety of olaparib maintenance monotherapy for Japanese patients with platinum-sensitive relapsed ovarian, fallopian tube, and primary peritoneal cancer. Int J Clin Oncol 2022. [PMID: 35835930 DOI: 10.1007/s10147-022-02212-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Olaparib maintenance therapy for platinum-sensitive relapsed ovarian cancer has been approved in Japan since April 2018. Here, we report the experience administering this therapy in our hospital, with the aim of evaluating efficacy and safety in the Japanese population. METHODS The study included 52 patients with platinum-sensitive relapsed ovarian, fallopian tube, and primary peritoneal cancer. All patients started olaparib at a dose of 300 mg twice daily. Information about treatment efficacy and adverse effects was collected retrospectively from medical records. RESULTS Median age was 58 years old (range: 33-80), and 82.7% of the patients were diagnosed with high-grade serous carcinoma. Sixteen patients (30.8%) possessed the BRCA1/2 pathogenic variant (15 germline and 1 tissue), 3 (5.8%) possessed variants of unknown significance (2 germline and 1 tissue), 16 (30.8%) possessed wild type, and 17 (32.7%) were not analyzed. Median progression-free survival was 15.3 months (95% CI 9.0-21.6). Patients with BRCA1/2 pathogenic variants showed significantly longer PFS than patients with wild-type BRCA1/2 (p = 0.007). Disease progression caused 34 cases to discontinue olaparib. Eighteen (34.6%) individuals exhibited ≥ grade 3 anemia, although they recovered in response to appropriate management. One patient discontinued olaparib because of prolonged renal dysfunction. Another patient presented with grade 3 fatigue, but recovered after 2 weeks of interruption and continued olaparib treatment. CONCLUSION Olaparib maintenance therapy for platinum-sensitive recurrent ovarian cancer in the Japanese population is sufficiently safe and no less effective than reports from previous studies.
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Caeiro C, Leão I, Oliveira I, Sousa I, André T. Recurrent Ovarian Cancer with BRCAness Phenotype: A Treatment Challenge. Adv Ther 2022; 39:5289-5299. [PMID: 36063278 PMCID: PMC9442551 DOI: 10.1007/s12325-022-02259-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/04/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Ovarian cancer is a leading cause of death among women with gynecologic malignancies. The relapse rate is high after platinum-based therapy, with the effectiveness of subsequent treatment lines decreasing over time. Recent data suggest the benefit of maintenance therapy with niraparib in platinum-sensitive recurrent disease. CASE PRESENTATIONS We report a case series of five women with advanced ovarian cancer and BRCAness phenotype who responded favorably, and in some cases with long-term response, to maintenance therapy with niraparib. Toxicities were as expected and generally manageable. Two patients developed grade 2/3 hematological toxicity, which resolved with treatment suspension and subsequent dose reductions, and one patient reported a rare skin toxicity while responding to full-dose niraparib treatment, which was controlled with photoprotection and sunscreen. DISCUSSION AND CONCLUSIONS This case series highlights the role of PARP1/2 inhibitors as a new standard of care as maintenance therapy for recurrent platinum-sensitive high-grade ovarian cancer, irrespective of BRCA status.
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Affiliation(s)
- Cláudia Caeiro
- Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Inês Leão
- Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Inês Oliveira
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisbon, Portugal
| | - Isabel Sousa
- Centro Hospitalar Universitário de São João, Porto, Portugal
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Pautier P, Motte-Rouge TDL, Lécuru F, Classe JM, Ferron G, Floquet A, Kurtz JE, Freyer G, Hardy-Bessard AC. Prise en charge médicale de la récidive du cancer épithélial de l'ovaire: Medical management of recurrent epithelial ovarian cancer. Bull Cancer 2021; 108:S22-S32. [PMID: 34955159 DOI: 10.1016/s0007-4551(21)00584-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The panel of therapeutic options available for medical treatment of relapsed ovarian cancer increased over the last years. In late, platinum-sensitive relapse, standard treatment remains platinum-based polychemotherapy. The choice between bevacizumab added to chemotherapy followed by maintenance and inhibitors of poly-(ADP-riboses) polymerases (PARPi) after response to platinum-based therapy should be discussed, taking into account prior treatment, contraindications, and disease characteristics (biology, symptoms…). The addition of bevacizumab at first platinum-sensitive relapse can be considered if it has not been administered in first line, and it is optional (rechallenge) if previously administered (but without Marketing Authorization in this setting). PARPi are indicated for maintenance therapy after response to platinum-based chemotherapy (whatever the treatment line), regardless of BRCA mutational status, in case of no prior administration. Early relapses are associated with poor prognosis and therapeutic options are more limited. They are treated by monochemotherapy without platinum agents, associated with bevacizumab if not administered previously. Beyond first early relapse, there is no standard and inclusion in a clinical trial should be proposed if possible. Several clinical studies assessing associations of immunotherapy and chemotherapy and/or antiangiogenic drugs and/or targeted therapies (such as PARPi) are ongoing in early or late relapse.
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Affiliation(s)
- Patricia Pautier
- Département d'oncologie médicale, institut Gustave-Roussy, Villejuif, France.
| | | | - Fabrice Lécuru
- Service de chirurgie sénologique, gynécologique et reconstructrice, institut Curie, 26 rue d'Ulm, Paris, France ; Faculté de médecine, Université de Paris, Paris, France
| | - Jean-Marc Classe
- Service de chirurgie oncologique, institut de cancérologie de l'Ouest, France ; Faculté de médecine, université de Nantes, Nantes, France
| | - Gwenaël Ferron
- Département de chirurgie oncologique, institut Claudius-Regaud - IUCT Toulouse, France ; INSERM CRCT 19 (Oncogenèse des sarcomes), centre de recherches en cancérologie de Toulouse, 2, avenue Hubert-Curien, Toulouse, France
| | - Anne Floquet
- Département d'oncologie médicale, Institut Bergonié, 229 cours Agonne, Bordeaux, France
| | - J E Kurtz
- Pôle d'oncologie médico-chirurgicale et d'hématologie, ICANS-Europe, Strasbourg, France
| | - Gilles Freyer
- Service d'oncologie médicale, institut de cancérologie des HCL ; Université Lyon 1, Lyon, France
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Lainé A, Sims TT, Le Saux O, Ray-Coquard I, Coleman RL. Treatment Perspectives for Ovarian Cancer in Europe and the United States: Initial Therapy and Platinum-Sensitive Recurrence after PARP Inhibitors or Bevacizumab Therapy. Curr Oncol Rep 2021; 23:148. [PMID: 34751835 DOI: 10.1007/s11912-021-01128-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Although the survival rate of patients with ovarian cancer (OC) has significantly improved, OC is still one of the most common causes of gynecologic cancer death in women worldwide. The current advances in primary treatment are based on recent regulatory approvals and recurrency of such treatments, challenging the development of a unified approach to care. Herein, we examine how integration of these new approaches is applied to patient's treatment. RECENT FINDINGS We and others have recently reported clinical trials using bevacizumab and/or inhibitors of Poly (ADP-ribose) polymerase (PARP), which have greatly affected the change in first-line treatments for OC. As first-line therapy has evolved, therapeutic agents once designated for recurrent disease are increasingly being incorporated, changing our standard of care following previously indexed trials. Here, we provide an overview of the current treatment for OC patients, and we highlight practice patterns in Europe and in the USA with corresponding opinions on current and future treatments for platinum-sensitive recurrent OC.
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Affiliation(s)
- Alexandra Lainé
- Centre Léon Bérard, University Claude Bernard Lyon I, Lyon, France.
| | - Travis T Sims
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Olivia Le Saux
- Centre Léon Bérard, University Claude Bernard Lyon I, Lyon, France
| | | | - Robert L Coleman
- Gynecologic Oncology, US Oncology Research, The Woodlands, TX, USA
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Harrison R, Zighelboim I, Cloven NG, Marcus JZ, Coleman RL, Karam A. Secondary cytoreductive surgery for recurrent ovarian cancer: An SGO clinical practice statement. Gynecol Oncol 2021; 163:448-452. [PMID: 34686355 DOI: 10.1016/j.ygyno.2021.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- R Harrison
- Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - I Zighelboim
- Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - N G Cloven
- Gynecologist Oncologist, Texas Oncology, Fort Worth Cancer Center, Fort Worth, TX, USA
| | - J Z Marcus
- Rutgers, New Jersey Medical School, Department of Obstetrics, Gynecology and Reproductive Health, Newark, NJ, USA
| | - R L Coleman
- Gynecologic Oncology, US Oncology & US Oncology Research, The Woodlands, TX, USA
| | - A Karam
- Stanford School of Medicine, Stanford, CA, USA.
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Foote JR, Secord AA, Liang MI, Ehrisman JA, Cohn DE, Jewell E, Havrilesky LJ. Targeted composite value-based endpoints in platinum-sensitive recurrent ovarian cancer. Gynecol Oncol 2019; 152:445-451. [PMID: 30876487 PMCID: PMC7522787 DOI: 10.1016/j.ygyno.2018.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES FDA-approved treatments for platinum-sensitive recurrent ovarian cancer (PSROC) include bevacizumab and PARP inhibitors (PARPi); clinical decisions regarding therapy must be made prior to initiating chemotherapy. Using the American Society of Clinical Oncology (ASCO) and European Society of Medical Oncology (ESMO) value frameworks, we assessed relative values of concurrent/maintenance biologic therapies in PSROC. METHODS Value scores were calculated for key maintenance therapies based on randomized controlled trials: bevacizumab (OCEANS, GOG 213); olaparib (Study 19, SOLO2); niraparib (NOVA); rucaparib (ARIEL3). Personalized value scorecards were constructed for patients with germline/somatic-BRCA mutations, homologous recombination deficiency (HRD), and wild-type BRCA (wBRCA). ASCO value scores assess clinical benefit, toxicity, long-term survival, symptom palliation, treatment-free interval, and quality of life (QOL). ESMO value scores assess clinical benefit, toxicity, and QOL. RESULTS ASCO scores were highest for maintenance PARPi in germline/somatic-BRCA mutation cohorts: olaparib (SOLO2) = 47, (Study 19) = 62; niraparib = 50; rucaparib = 54. HRD cohorts had slightly lower scores: niraparib = 46; rucaparib = 37. wBRCA cohorts had the lowest scores: niraparib = 26; rucaparib = 26; and olaparib (Study 19) = 32, as did patients receiving bevacizumab (OCEANS) = 35, (GOG 213) = 26. ESMO scores demonstrated high-value for maintenance PARPi in germline/somatic-BRCA mutation cohorts and low-value for bevacizumab and PARPi in wBRCA cohorts. CONCLUSIONS The value of maintenance PARPi therapy depends heavily on BRCA status, with the highest value scores in germline/somatic-BRCA mutation cohorts. Personalized value scorecards provide a visual aid to assess the harm-benefit balance of maintenance PARPi for PSROC.
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Affiliation(s)
| | | | | | | | - David E Cohn
- The Ohio State University, James Cancer Hospital, Columbus, OH, USA
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11
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Mullen MM, Kuroki LM, Thaker PH. Novel treatment options in platinum-sensitive recurrent ovarian cancer: A review. Gynecol Oncol 2018; 152:416-425. [PMID: 30409489 DOI: 10.1016/j.ygyno.2018.10.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 11/26/2022]
Abstract
Epithelial ovarian cancer (EOC) is the leading cause of death due to gynecologic malignancy. The majority of advanced stage EOC patients, even those who respond well to frontline therapy, will ultimately recur and succumb to their disease. In platinum-sensitive EOC patients, or those who recur ≥6 months from initial diagnosis, treatment of recurrent disease has traditionally consisted of repeat platinum-based chemotherapy. Secondary cytoreduction remains controversial. Due to recent advances in molecularly targeted treatment options, outcomes for advanced stage EOC patients are significantly improving and hold great promise. This review discusses pivotal trials establishing platinum-based combination chemotherapy as the standard of care and addresses the utility of increasing a patient's platinum-free interval. It then discusses the role of anti-angiogenesis therapeutics, specifically bevacizumab, cediranib, and trebananib and their side effects. Lastly, it reviews key trials for the three poly-adenosine diphosphate [ADP]-ribose polymerases (PARP) inhibitors that have been FDA-approved for maintenance therapy in platinum-sensitive recurrent EOC: olaparib, rucaparib, and niraparib. This review concludes with a discussion regarding ongoing and future clinical trials.
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Affiliation(s)
- Mary M Mullen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO, United States of America
| | - Lindsay M Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO, United States of America
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO, United States of America.
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Lorusso D, Fontanella C, Maltese G, Lepori S, Tripodi E, Bogani G, Raspagliesi F. The safety of antiangiogenic agents and PARP inhibitors in platinum-sensitive recurrent ovarian cancer. Expert Opin Drug Saf 2017; 16:687-696. [PMID: 28471247 DOI: 10.1080/14740338.2017.1325871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Recurrence is a common event in endothelial ovarian cancer (EOC) patients, and the choice of the most appropriate treatment is driven by the platinum-free interval, molecular characteristics of the disease such as BRCA mutational status, previous treatments and toxicity. Areas covered: This review focuses on the main hematologic and non-hematologic toxicities correlated with the use of licensed antiangiogenic agents and PARP inhibitors in recurrent platinum-sensitive EOC, providing recommendations for their management. Expert opinion: The clinical research over the next years will be focused on a more precise characterization of molecular pathways underlying tumorigenesis of the five ovarian tumors, to improve the decision-making process in these rare diseases. For this purpose, new study designs and international collaborations will become mandatory. Immunotherapy, antiangiogenic agents and PARP inhibitors will be combined to build a treatment strategy algorithm which will allow patients to receive all the available treatment option, in the more appropriate sequence.
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Affiliation(s)
- Domenica Lorusso
- a Gynecologic Oncology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Caterina Fontanella
- a Gynecologic Oncology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Giuseppa Maltese
- a Gynecologic Oncology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Stefano Lepori
- a Gynecologic Oncology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Elisa Tripodi
- a Gynecologic Oncology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Giorgio Bogani
- a Gynecologic Oncology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Francesco Raspagliesi
- a Gynecologic Oncology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
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13
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Eisenhauer EL, Zanagnolo V, Cohn DE, Salani R, O'Malley DM, Sutton G, Callahan MJ, Cobb B, Fowler JM, Copeland LJ. A phase II study of gemcitabine, carboplatin and bevacizumab for the treatment of platinum-sensitive recurrent ovarian cancer. Gynecol Oncol 2014; 134:262-6. [PMID: 24910452 DOI: 10.1016/j.ygyno.2014.05.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/27/2014] [Accepted: 05/30/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The doublet gemcitabine and carboplatin is effective for the treatment of recurrent ovarian cancer, while multi-agent chemotherapy with bevacizumab may add additional benefit. This phase II study tested the efficacy and safety of a biweekly gemcitabine, carboplatin, and bevacizumab combination in patients with platinum-sensitive recurrent ovarian, peritoneal, or tubal cancer (ROC). PATIENTS AND METHODS Eligible patients received concurrent gemcitabine 1000 mg/m(2), carboplatin area under the curve 3, and bevacizumab 10 mg/kg administered intravenously on days 1 and 15 every 28 days for six cycles or up to 24 cycles if clinical benefit occurred. The primary end points were progression-free survival (PFS) by RECIST, and safety; the secondary end points were objective response rates and overall survival. RESULTS Overall, 45 patients were enrolled. The median PFS was 13.3 months (95% CI, 11.3 to 15.3). The objective response rate was 69%. Grade 4 hematologic toxicities included neutropenia (27%) and thrombocytopenia (2%). Grades 3 and 4 non-hematologic toxicities included fatigue (18%), pain (9%), and nausea/vomiting (4%). There were 2 episodes of cerebrovascular accidents, 2 noted DVTs, and no episodes of bowel perforation. Median OS was 36.1 months (95% CI, 26.7 to 45.5). CONCLUSION Biweekly gemcitabine, carboplatin, and bevacizumab were an effective regimen in recurrent ovarian cancer, with comparable toxicity to recently reported day 1 gemcitabine, carboplatin, bevacizumab, and day 8 gemcitabine. Response rate and PFS are improved from reported outcomes of the gemcitabine carboplatin doublet. The degree to which biweekly dosing may present a more rationale schedule for this triplet should be evaluated further.
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Affiliation(s)
- Eric L Eisenhauer
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Vanna Zanagnolo
- Division of Gynaecology, European Institute of Oncology, Milano, Italy
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ritu Salani
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - David M O'Malley
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Gregory Sutton
- Division of Gynecologic Oncology, St. Vincent Indianapolis Hospital, Indianapolis, IN, USA
| | - Michael J Callahan
- Division of Gynecologic Oncology, St. Vincent Indianapolis Hospital, Indianapolis, IN, USA
| | - Bobbi Cobb
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jeffrey M Fowler
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Larry J Copeland
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
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