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Swisher EM, Aghajanian C, O'Malley DM, Fleming GF, Kaufmann SH, Levine DA, Birrer MJ, Moore KN, Spirtos NM, Shahin MS, Reid TJ, Friedlander M, Steffensen KD, Okamoto A, Sehgal V, Ansell PJ, Dinh MH, Bookman MA, Coleman RL. Impact of homologous recombination status and responses with veliparib combined with first-line chemotherapy in ovarian cancer in the Phase 3 VELIA/GOG-3005 study. Gynecol Oncol 2021; 164:245-253. [PMID: 34906376 DOI: 10.1016/j.ygyno.2021.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 08/11/2021] [Revised: 11/16/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In the Phase 3 VELIA trial (NCT02470585), PARP inhibitor (PARPi) veliparib was combined with first-line chemotherapy and continued as maintenance for patients with ovarian carcinoma enrolled regardless of chemotherapy response or biomarker status. Here, we report exploratory analyses of the impact of homologous recombination deficient (HRD) or proficient (HRP) status on progression-free survival (PFS) and objective response rates during chemotherapy. METHODS Women with Stage III-IV ovarian carcinoma were randomized to veliparib-throughout, veliparib-combination-only, or placebo. Stratification factors included timing of surgery and germline BRCA mutation status. HRD status was dichotomized at genomic instability score 33. During combination therapy, CA-125 levels were measured at baseline and each cycle; radiographic responses were assessed every 9 weeks. RESULTS Of 1140 patients randomized, 742 had BRCA wild type (BRCAwt) tumors (HRP, n = 373; HRD/BRCAwt, n = 329). PFS hazard ratios between veliparib-throughout versus control were similar in both BRCAwt populations (HRD/BRCAwt: 22.9 vs 19.8 months; hazard ratio 0.76; 95% confidence interval [CI] 0.53-1.09; HRP: 15.0 vs 11.5 months; hazard ratio 0.765; 95% CI 0.56-1.04). By Cycle 3, the proportion with ≥90% CA-125 reduction from baseline was higher in those receiving veliparib (pooled arms) versus control (34% vs 23%; P = 0.0004); particularly in BRCAwt and HRP subgroups. Complete response rates among patients with measurable disease after surgery were 24% with veliparib (pooled arms) and 18% with control. CONCLUSIONS These results potentially broaden opportunities for PARPi utilization among patients who would not qualify for frontline PARPi maintenance based on other trials.
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Affiliation(s)
- Elizabeth M Swisher
- Department of Obstetrics and Gynecology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-6460, USA.
| | - Carol Aghajanian
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - David M O'Malley
- The Ohio State University and James CCC, 460 W. 10th Avenue, Columbus, OH 43210, USA
| | - Gini F Fleming
- The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, USA
| | - Scott H Kaufmann
- Division of Oncology Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Michael J Birrer
- Winthrop P Rockefeller Cancer Institute, 4301 W. Markham Street, Little Rock, AR 72205-7199, USA
| | - Kathleen N Moore
- Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, 800 N.E. 10th Street, Oklahoma City, OK 73104, USA
| | - Nick M Spirtos
- Women's Cancer Center of Nevada, 2460 Augusta, Las Vegas NV89109, USA
| | - Mark S Shahin
- Abington Jefferson Hospital, Asplundh Cancer Center of Sidney Kimmel Cancer Center, 3941 Commerce Ave, Willow Grove, PA 19090, USA
| | - Thomas J Reid
- University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Michael Friedlander
- Prince of Wales Clinical School UNSW and Prince of Wales Hospital and ANZGOG, Corner High Street and Avoca Street, Randwick, NSW 2031, Australia
| | - Karina Dahl Steffensen
- Lillebaelt University Hospital of Southern Denmark, Winsløwparken 19, 3, DK-5000 Odense C, Vejle, Denmark
| | - Aikou Okamoto
- The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Vasudha Sehgal
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL 60064-6124, USA
| | - Peter J Ansell
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL 60064-6124, USA
| | - Minh H Dinh
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL 60064-6124, USA
| | - Michael A Bookman
- Kaiser Permanente Northern California, 2238 Geary Blvd, San Francisco, CA 94115, USA
| | - Robert L Coleman
- US Oncology Research, 9180 Pinecroft, The Woodlands, TX 77380, USA
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Fakkert IE, van der Veer E, Abma EM, Lefrandt JD, Wolffenbuttel BHR, Oosterwijk JC, Slart RHJA, Westrik IG, de Bock GH, Mourits MJE. Elevated Bone Turnover Markers after Risk-Reducing Salpingo-Oophorectomy in Women at Increased Risk for Breast and Ovarian Cancer. PLoS One 2017; 12:e0169673. [PMID: 28060958 PMCID: PMC5218401 DOI: 10.1371/journal.pone.0169673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 12/20/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Risk-reducing salpingo-oophorectomy (RRSO) reduces ovarian cancer risk in BRCA1/2 mutation carriers. Premenopausal RRSO is hypothesized to increase fracture risk more than natural menopause. Elevated bone turnover markers (BTMs) might predict fracture risk. We investigated BTM levels after RRSO and aimed to identify clinical characteristics associated with elevated BTMs. METHODS Osteocalcin (OC), procollagen type I N-terminal peptide (PINP) and serum C-telopeptide of type I collagen (sCTx) were measured in 210 women ≥ 2 years after RRSO before age 53. BTM Z-scores were calculated using an existing reference cohort of age-matched women. Clinical characteristics were assessed by questionnaire. RESULTS BTMs after RRSO were higher than age-matched reference values: median Z-scores OC 0.11, p = 0.003; PINP 0.84, p < 0.001; sCTx 0.53, p < 0.001 (compared to Z = 0). After excluding women with recent fractures or BTM interfering medication, Z-scores increased to 0.34, 1.14 and 0.88, respectively. Z-scores for OC and PINP were inversely correlated to age at RRSO. No correlation was found with fracture incidence or history of breast cancer. CONCLUSIONS Five years after RRSO, BTMs were higher than age-matched reference values. Since elevated BTMs might predict higher fracture risk, prospective studies are required to evaluate the clinical implications of this finding.
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Affiliation(s)
- Ingrid E. Fakkert
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Eveline van der Veer
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elske Marije Abma
- Division of Geriatric Medicine, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joop D. Lefrandt
- Division of Vascular Medicine, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruce H. R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan C. Oosterwijk
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Riemer H. J. A. Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Iris G. Westrik
- Division of Vascular Medicine, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marian J. E. Mourits
- Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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