Introduction/Background Bevacizumab and PARP-inhibitors (PARPi) showed a survival benefit in first-line settings. Nevertheless, there is still poor knowledge about the consequences of these medications on disease presentation at recurrence and, consequently, on secondary cytoreductive surgery (SCS). This study aims to assess the feasibility of SCS in patients receiving different first-line maintenance regimens.
Methodology We retrospectively identified all platinum-sensitive recurrent epithelial ovarian cancer patients who underwent SCS, at our institution, after maintenance therapy either with bevacizumab (B-SCS) or PARPi (P-SCS), from January 2015 to January 2023. All patients underwent pre-operative PET-CT scan and diagnostic laparoscopy before SCS. Disease distribution were classified according to pre-operative radiological data.
Results Overall, 114 cases were identified (84 B-SCS and 30 P-SCS), and complete gross resection (CGR) was achieved in 106 (93%) patients.
P-SCS patients presented more frequently with a BRCA mutation (p=0.04) and received more neoadjuvant chemotherapy in the first-line setting (p=0.02). At disease recurrence, patients treated with PARPi were more likely to have a single-site or oligometastatic disease compared to the B-SCS group (p=0,012).
At the time of SCS, both groups had similar proportions of CGR (p=0.08); due to extent of disease, P-SCS were more keen to undergo minimally-invasive approach (MIS), compared with B-SCS (33.3% versus 19.0%, p=0.11) with lower surgical complexity (60.7% versus 70%, p=0.365), albeit not statistically relevant. There was no difference in post-operative complications (p=0.511).
At logistic regression, the MIS approach (p=0.022) and the single-site recurrence (p=0.04) were the only factors independently related to a lower risk of post-operative complications, while having received either bevacizumab or PARPi did not have any impact on that (p=0.512).
Conclusion First-line PARPi administration appears to affect patterns of recurrence, with a higher chance of observing a single or oligometastatic recurrence. SCS in PARPi previously treated populations is feasible and safe, with similar peri-operative outcomes, compared to the Bevacizumab group.
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