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Original research
Treatment of ovarian clear cell carcinoma with immune checkpoint blockade: a case series
  1. Tiffany Y Sia1,
  2. Beryl Manning-Geist1,
  3. Sushmita Gordhandas1,
  4. Rajmohan Murali2,
  5. Antonio Marra2,
  6. Ying L Liu3,
  7. Claire F Friedman3,4,
  8. Travis J Hollmann2,5,
  9. Oliver Zivanovic1,
  10. Dennis S Chi1,
  11. Britta Weigelt2,
  12. Jason A Konner3 and
  13. Dmitriy Zamarin3,4
  1. 1Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  2. 2Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  3. 3Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  4. 4Department of Medicine, Weill Cornell Medical College, New York, New York, USA
  5. 5Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  1. Correspondence to Dr Dmitriy Zamarin, Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA; zamarind{at}mskcc.org

Abstract

Background Although immune checkpoint blockade has demonstrated limited effectiveness against ovarian cancer, subset analyses from completed trials suggest possible superior efficacy in the clear cell carcinoma subtype.

Objective To describe the outcomes of patients with ovarian clear cell carcinoma treated with immune checkpoint blockade.

Methods This was a single-institution, retrospective case series of patients with ovarian clear cell carcinoma treated with a programmed cell death protein 1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor with or without concomitant cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibition between January 2016 and June 2021. Demographic variables, tumor microenvironment, molecular data, and clinical outcomes were examined. Time to treatment failure was defined as the number of days between start of treatment and next line of treatment or death.

Results A total of 16 eligible patients were analyzed. The median treatment duration was 56 days (range 14–574); median time to treatment failure was 99 days (range 27–1568). The reason for discontinuation was disease progression in 88% of cases. Four patients (25%) experienced durable clinical benefit (time to treatment failure ≥180 days). One patient was treated twice with combined immune checkpoint blockade and experienced a complete response each time. All 12 patients who underwent clinical tumor-normal molecular profiling had microsatellite-stable disease, and all but one had low tumor mutation burden. Multiplex immunofluorescence analysis available from pre-treatment biopsies of two patients with clinical benefit demonstrated abundant tumor-infiltrating lymphocytes expressing PD-1.

Conclusion Our study suggests a potential role for immune checkpoint blockade in patients with clear cell carcinoma of the ovary. Identification of genetic and microenvironmental biomarkers predictive of response will be key to guide therapy.

  • Ovarian Cancer
  • Ovarian Neoplasms

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/ijgc-2022-003430

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • JAK and DZ contributed equally.

    • Contributors Conceptualization: TYS, JAK, DZ, YLL. Data curation: TYS, BM-G, SG, RM, TH, BW. Formal analysis: TYS, RM, AM, YLL, BW, JAK, DZ. Methodology: all authors. Supervision: JAK, DZ. Roles/Writing - original draft: TYS, JAK, DZ. Writing - review and editing: all authors. Guarantors: JAK, DZ.

    • Funding This study was supported in part by the by the National Cancer Institute Cancer Center core grant P30 CA008748. DZ is supported by the Ovarian Cancer Research Foundation Liz Tilberis Award and the Department of Defense Ovarian Cancer Research Academy (OC150111). BW is supported in part by the Breast Cancer Research Foundation and Cycle for Survival grants. CFF is supported by SU2C Convergence 2.0.

    • Competing interests DZ reports institutional grants from Genentech, AstraZeneca, and Plexxikon, as well as personal fees from Genentech, AstraZeneca, Xencor, Memgen, Takeda, Synthekine, Immunos, and Calidi Biotherapeutics, outside of the submitted work. DZ is also an inventor on a patent related to the use of oncolytic Newcastle Disease Virus for cancer therapy. He is also a member of the Parker Institute for Cancer Immunotherapy at MSK. BW reports ad hoc membership of the Scientific Advisory Board of Repare Therapeutics. YLL reports research funding from AstraZeneca, GlaxoSmithKline, and REPARE therapeutics, outside of the submitted work. CFF reports institutional funding from Merck, Daiichi, Genentech/Roche, AstraZeneca, and Bristol-Myers Squibb; personal consulting fees from Seagen and Bristol-Myers Squibb; and Scientific Advisory Board participation for Merck and Genentech (compensation waived), outside of the submitted work. The remaining authors have no disclosures.

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