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Evaluation of patterns of progression on poly (ADP-ribose) polymerase inhibitor (PARPi) maintenance in ovarian cancer: a cross-sectional study
  1. Victoria R Cerda1,
  2. Diana Lu2,
  3. Marla Scott1,
  4. Kenneth H Kim1,
  5. Bobbie Jo Rimel1 and
  6. Mitchell Kamrava2
  1. 1 Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
  2. 2 Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
  1. Correspondence to Dr Mitchell Kamrava, Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA; mitchell.kamrava{at}cshs.org

Abstract

Introduction Despite improvement in progression-free survival with poly (ADP-ribose) polymerase inhibitors (PARPi) as maintenance therapy for ovarian cancer, many patients will eventually progress on therapy. Oligoprogression is uniquely suited to considerations of local consolidation therapy in this setting, but not commonly used in ovarian cancer. In this study we evaluated the proportion of patients on PARPi maintenance who developed limited sites of disease, the location of progression, and their natural history.

Methods From January 2006 to December 2020, natural language processing software (DEEP6AI) was used to identify 58 patients with ovarian cancer treated with PARPi maintenance after complete or partial response after surgery and platinum-based chemotherapy at our institution. Patients were assessed for presence and location of recurrence based on radiologic findings.

Results The median patient age was 65 (IQR 57–71) years. Patients had a median of two lines of chemotherapy prior to starting PARPi. With a median follow-up of 48 (range 12–149) months, 32 (55%) patients had a recurrence on maintenance olaparib and 11 (34%) patients developed oligoprogression (≤3 sites). For the 11 patients with oligoprogression, three patients developed recurrence in one site, five in two sites, and three in three sites. The sites of oligoprogression were pelvic/periaortic nodal (27%), peritoneal (27%), liver (27%), lung/mediastinal (14%), and brain (5%). The median progression-free survival for the entire cohort was 6.0 months (95% CI 4.2 to 7.8); median overall survival was not met. There were no significant differences in overall survival (p=0.81) or progression-free survival (p=0.95) between patients with and without oligoprogression.

Conclusions One-third of patients on PARPi maintenance experienced oligoprogression defined as limited to ≤3 sites. These patients may benefit from local consolidation therapy. A larger dataset is needed to validate these findings to assess if trials investigating local therapy for these patients is of value.

  • ovarian cancer
  • radiation oncology
  • ovarian neoplasms
  • gynecology
  • neoplasm metastasis

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article.

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Footnotes

  • VRC and DL are joint first authors.

  • Contributors VRC: primary author, design of work, analysis, interpretation of data, revision, manuscript editing DL: primary author, analysis, interpretation of data, revision, manuscript editing. MS: analysis, drafting and revising manuscript. KHK: data analysis, drafting and revising manuscript. BJR: concept of work, data analysis, drafting and revising manuscript. MK: senior author, design of work, data analysis, interpretation of data, manuscript editing, guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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