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Management of oligometastatic ovarian cancer recurrence during PARP inhibitor maintenance
  1. Eleonora Palluzzi1,
  2. Claudia Marchetti1,2,
  3. Serena Cappuccio1,2,
  4. Giacomo Avesani3,
  5. Gabriella Macchia4,
  6. Maria Antonietta Gambacorta2,3,
  7. Fabrizio Cocciolillo5,
  8. Giovanni Scambia1,2 and
  9. Anna Fagotti1,2
  1. 1Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
  2. 2Università Cattolica del Sacro Cuore, Rome, Italy
  3. 3Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
  4. 4Dipartimento Servizi e Laboratori, Direzione Scientifica, Gemelli Molise Hospital, Radiotherapy Unit, Università Cattolica del Sacro Cuore, Campobasso, Italy
  5. 5Nuclear Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
  1. Correspondence to Dr Anna Fagotti, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; anna.fagotti{at}policlinicogemelli.it

Abstract

Objective The benefit of surgery and maintenance treatment with PARP inhibitors (PARPi) has been clearly demonstrated in ovarian cancer. Also, the efficacy and safety of stereotactic body radiotherapy has been shown in patients with metastatic, persistent, and recurrent disease. The aim of this study is to evaluate the management of oligometastatic progression during PARPi maintenance treatment.

Methods This is an observational, retrospective, single-arm study conducted from June 2017 to December 2020 in patients with recurrent ovarian cancer with oligometastatic progression under PARPi maintenance treatment and receiving surgery or stereotactic body radiotherapy for such recurrence. PARPi treatment was continued until further progression of the disease. The primary objective of the study was the median prolongation of the treatment-free interval-p (without platinum) after local treatment.

Results A total of 186 patients with ovarian cancer were treated with PARPi at recurrence. Of these, 30 (16%) developed oligometastatic progression. The median age was 49.5 years (range 35–73). Olaparib, niraparib and rucaparib were administered to 33%, 60%, and 7% of patients, respectively. The median prolongation of the treatment-free interval-p of patients treated with surgery or stereotactic body radiotherapy was 6 and 10 months, respectively (p=0.53). The median treatment-free interval-p of patients treated with surgery or stereotactic body radiotherapy at the time of oligometastatic progression was 32 and 29 months, respectively (p=0.44). At the time of this publication, 50% of patients are still on treatment with PARPi following progression.

Conclusions Patients with recurrent ovarian cancer who have oligometastic progression during PARPi maintenance may continue to benefit from PARPi if combined with local treatment.

  • ovarian neoplasms
  • cytoreduction surgical procedures
  • radiotherapy
  • BRCA1 protein

Data availability statement

We will provide our data for the reproducibility of this study in other centers if such is requested. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Data availability statement

We will provide our data for the reproducibility of this study in other centers if such is requested. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Footnotes

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  • Contributors All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by EP, SC and CM. The first draft of the manuscript was written by EP. The section on Radiotherapy was written by GM. Statistical analysis was performed by CM. Revision and validation of the manuscript was performed by AF, CM and GS. AF is the guarantor for the study. All authors read and approved the final manuscript.

  • 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 CM reports fees for advisory work from GSK, AstraZeneca, Pharmamar, and Clovis outside the submitted work. GS reports consulting fees or speaker fees from TESARO Bio Italy Srl, Clovis Oncology Italy Srl, Johnson & Johnson, AstraZeneca/MSD, Covidien AG, a Medtronic company, and from Baxter Healthcare SA outside the submitted work. AF reports consulting fees or speaker fees from Pharmamar, Johnson & Johnson, AstraZeneca/MSD and MSD Italia Srl outside the submitted work.

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