Introduction The role of cytoreductive surgery in the poly-ADP ribose polymerase inhibitors era is not fully investigated. We evaluated the impact of surgery performed prior to platinum-based chemotherapy followed by olaparib maintenance in platinum-sensitive BRCA-mutated recurrent ovarian cancer.
Methods This retrospective study included platinum-sensitive recurrent ovarian cancer BRCA-mutated patients from 13 Multicenter Italian Trials in Ovarian cancer and gynecological malignancies centers treated between September 2015 and May 2019. The primary outcomes were progression-free survival and overall survival. Data on post-progression treatment was also assessed.
Results Among 209 patients, 72 patients (34.5%) underwent cytoreductive surgery followed by platinum-based chemotherapy and olaparib maintenance, while 137 patients (65.5%) underwent chemotherapy treatment alone. After a median follow-up of 37.3 months (95% CI: 33.4 to 40.8), median progression-free survival in the surgery group was not reached, compared with 11 months in patients receiving chemotherapy alone (P<0.001). Median overall survival was nearly double in patients undergoing surgery before chemotherapy (55 vs 28 months, P<0.001). Post-progression therapy was assessed in 127 patients: response rate to chemotherapy was 29.2%, 8.8%, and 9.0% in patients with platinum-free interval >12 months, between 6 and 12 months, and <6 months, respectively.
Conclusion Cytoreductive surgery performed before platinum therapy and olaparib maintenance was associated with longer progression-free survival and overall survival in BRCA-mutated platinum-sensitive relapsed ovarian cancer patients. In accordance with our preliminary results, the response rate to chemotherapy given after progression during olaparib was associated with platinum-free interval.
- ovarian cancer
- cytoreduction surgical procedures
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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SCC and LM are joint first authors.
Twitter @lucia_musacchio, @Barto_Med, @DrFMartinelli, @PignataSandro
SCC and LM contributed equally.
Contributors Conceptualization SP, SCC; data curation LM, SCC, MB; formal analysis LA, LM; investigation SCC, LM, SP; methodology SCC, LM, SP; project administration SP; supervision SP; writing original draft SCC, LM, SP. All authors acquired data, and revised and approved the final version of the manuscript.
Funding SP is recipient of grants from Associazione Italiana per la Ricerca sul Cancro (AIRC). Grants numbers IG-5776, IG-13114, IG-18921.
Competing interests VS has been part of advisory boards of GSK, PharmaMar, Roche, MSD, EISAI, Clovis, AstraZeneca. DL reports personal financial interests (advisory roles) with AstraZeneca, Biocad, Clovis Oncology, Genmab, Merck, MSD, Roche, Tesaro-GSK, Amgen, Immunogen, Pharmamar, and institutional financial interests (Study Grants) with AstraZeneca, Clovis Oncology, MSD, Tesaro-GSK, Pharmamar, Roche. Others Global Clinical Lead ENGOT-CX11 Pembrolizumab; Board of Directors, GCIG (Gynecologic Cancer Inter Group). CM reports an advisory role for GSK, Arquer Diagnostic, Pharmamar, Clovis Oncology, and travel grant from Roche. FR reports honoraria from GSK, Pharmamar, Clovis, MSD as sponsors for meetings. GV is an advisor for AstraZeneca, GSK, Amgen, and received speaking honoraria from AstraZeneca, GSK, Roche, Pharmamar. GS reports honoraria from AstraZeneca, MSD, Roche, Clovis, GSK, Pharmamar, Roche (advisory role), and received institutional financial interest (study grants) from AstraZeneca, MSD, GSK, Pharmamar, and he is a member of the board of the National Health Institute. SP reports honoraria from AstraZeneca, MSD, Roche Clovis, GSK Pfizer Pharmamar.
Provenance and peer review Not commissioned; externally peer reviewed.
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