Subsequent chemotherapy less effective in recurrent ovarian cancer, maintenance olaparib
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Subsequent chemotherapy showed less efficacy in BRCA 1 and 2-mutated, platinum-sensitive, recurrent epithelial ovarian cancer treated with maintenance olaparib compared with placebo, according to a presentation at ESMO Virtual Congress 2020.
“The SOLO2 trial has shown that maintenance therapy with olaparib has an important effect on the PFS1, the PFS2 and overall survival with benefit around certain amounts; however, the optimal management of patients after progression is still to be determined,” Jean-Sebastein Frenel, MD, PhD, of the GINECO & Institut de Cancerologie de l'Ouest, Saint-Herblain, France, said during his presentation.
Researchers examined the efficacy of subsequent chemotherapy at the time of disease progression in patients with platinum-sensitive relapsed epithelial ovarian cancer and a BRCA1/2 mutation in this post-hoc analysis of the SOLO2 trial. They evaluated first subsequent treatment in patients who had RECIST progression in the olaparib and placebo arms and examined time to second progression calculated from the date of RECIST progression after olaparib maintenance to next progression or death.
Overall, 106 of 195 (54%) patients in the olaparib arm and 80 of 99 (81%) patients in the placebo arm had a RECIST progression, and 161 of 186 (87%) patients received a first subsequent therapy, including chemotherapy (93%) and a PARP inhibitor (18%, all in the placebo arm). According to the abstract, 44% and 56% of patients in the placebo arm received a non-platinum and a platinum-based chemotherapy, respectively, compared with 37% and 63% of patients in the olaparib arm.
Frenel and colleagues found that in patients who received subsequent treatment, time to second progression was longer in the placebo arm compared with the olaparib arm (11.1 vs. 7 months; HR = 1.93; 95% CI, 1.35-2.76). Further, in the placebo, compared with the olaparib arm, time to second progression was 14.3 vs. 7 months with platinum-based chemotherapy and 8.3 vs. 5.5 months with non-platinum chemotherapy.
“Efficacy of subsequent chemotherapy (particularly platinum-based chemotherapy) assessed by time to second progression, appears to be less in patients having received maintenance olaparib compared to placebo,” Frenel said. “The exact reason remains to be explored in detail; induction of chemoresistance, selection of poorly chemosensitive relapsing patients by olaparib, or both? The best management of patients relapsing after olaparib maintenance should be studied in a prospective manner.”
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Frenel J-S, et al. Abstract 813MO. Presented at: European Society for Medical Oncology Virtual Congress 2020; Sept. 19-21, 2020.
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