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Many women with ovarian cancer need retreatment, regardless of initial response
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Women who responded well to initial treatment for ovarian cancer required additional treatment for disease recurrence as often as patients with less favorable initial treatment response, according to the results of a retrospective study.
Platinum-based chemotherapy regimens appeared to remain the most effective retreatment option, even among patients thought to be platinum-resistant, researchers also found.
Maximal debulking plus platinum/taxane adjuvant chemotherapy serves as the standard of care for high-grade serous ovarian cancer. However, little uniformity exists in the relapsed setting beyond retreatment with platinum therapies, according to study background.
Thus, Kevin H. Eng, PhD, assistant professor of oncology at Roswell Parker Cancer Institute, and colleagues conducted a retrospective survival analysis using data from treatment centers participating in The Cancer Genome Atlas study to evaluate retreatment strategies for women with ovarian cancer. Researchers identified 461 patients (mean age, 58.7 years) with high-grade serous ovarian cancer who received 1,119 lines of therapy.
The median time to death after progression was 27.9 months (95% CI, 25.9-30.9). The researchers observed that a complete response to primary treatment led to a significant increase in median time until death after relapse (30 months vs. 22.4 months; P < .0001).
Longer initial PFS appeared strongly associated with longer time to death in a continuous manner (HR per month of PFS = 0.96; 95% CI, 0.95-0.98). Women with an initial PFS of more than 18 months had a higher length of survival after progression (36.5 months vs. 24.8 months; P = .00044).
However, a complete response to adjuvant therapy did not appear to affect treatment-free intervals (TFI) after relapse. Patients with initial complete responses had a comparable average number of treatments as patients who did not initially respond to treatment (1.61 vs. 1.45).
The increased time to death after relapse or progression appeared associated with longer average total time on treatment (11.2 months vs. 7.6 months; P = .0339), as well as longer total time off of treatment (20.7 months vs. 12.9 months; P = .005).
According to the researchers, the retreatment of platinum-sensitive patients with platinum/taxane regimens demonstrated superiority to other treatment choices. Among patients whose most recent TFI was less than 18 months (n = 11), platinum-based treatments more than doubled the next TFI compared with nonplatinum regimens (7 months vs. 3.2 months). Platinum regimens improved outcomes regardless of previous response to platinum.
Researchers then evaluated prognostic factors that affect TFI. Overall, the duration of last TFI reduced the HR for retreatment (P = .0445). Further, longer time from surgery (P = .0003), later recurrences (P = .007) and the increased use of platinum therapies (P = .0002) all increased the HR associated with transitioning to new treatment options.
Study limitations included the observational design and the lack of complete drug information from all participating treatment centers.
“The course of ovarian cancer has a common trajectory,” Eng said in a press release. “This study offers a greater understanding of the factors that influence that trajectory and can help inform clinicians on the next best therapy to administer at the time of relapse.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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