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Original research
Procedural interventions for oligoprogression during treatment with immune checkpoint blockade in gynecologic malignancies: a case series
  1. Tiffany Y Sia1,
  2. Vivian Wan2,
  3. Michael Finlan1,
  4. Qin C Zhou3,
  5. Alexia Iasonos3,
  6. Oliver Zivanovic1,4,
  7. Yukio Sonoda1,4,
  8. Dennis S Chi1,4,
  9. Kara Long Roche1,4,
  10. Elizabeth Jewell1,4,
  11. William P Tew5,6,
  12. Roisin E O'Cearbhaill5,6,
  13. Seth Cohen5,6,
  14. Vicky Makker5,6,
  15. Ying L Liu5,6,
  16. Claire F Friedman5,6,
  17. Chrisann Kyi5,6,
  18. Dmitriy Zamarin5,6 and
  19. Ginger Gardner1,4
  1. 1Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  2. 2Obstetrics & Gynecology, Brooklyn Hospital Center, Brooklyn, New York, USA
  3. 3Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  4. 4Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
  5. 5Medicine, Weill Cornell Medical College, New York, New York, USA
  6. 6Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  1. Correspondence to Dr Ginger Gardner, Gynecologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; gardnerg{at}mskcc.org

Abstract

Objective To evaluate the feasibility and outcomes of performing procedural interventions, defined as surgical resection, tumor ablation, or targeted radiation therapy, for oligoprogressive disease among patients with gynecologic malignancies who are treated with immune checkpoint blockade.

Methods Patients with gynecologic cancers treated with immune checkpoint blockade between January 2013 and October 2021 who underwent procedural interventions including surgical resection, interventional radiology ablation, or radiation therapy for oligoprogressive disease were identified. Procedures performed before immune checkpoint therapy initiation or ≥6 months after therapy completion were excluded. Long immunotherapy duration prior to intervention was defined as ≥6 months. Progression-free survival and overall survival were calculated from procedure date until disease progression or death, respectively.

Results During the study period, 886 patients met inclusion criteria and received immune checkpoint blockade therapy. Of these, 34 patients underwent procedural interventions for oligoprogressive disease; 7 underwent surgical resection, 3 underwent interventional radiology ablation, and 24 underwent radiation therapy interventions. Primary disease sites included uterus (71%), ovary (24%), and cervix (6%). Sites of oligoprogression included abdomen/pelvis (26%), bone (21%), lung (18%), distant lymph node (18%), brain (9%), liver (6%), and vagina (3%). Most tumors (76%) did not exhibit microsatellite instability or mismatch repair deficiency. Approximately half (53%) of the patients had long immune checkpoint therapy duration prior to intervention. Median progression-free survival following the procedure was 5.3 months (95% CI, 3.1–9.9), and median overall survival was 21.7 months (95% CI, 14.9–not estimable). Long versus short immune checkpoint therapy duration prior to procedure and length of immune checkpoint therapy had no effect on progression-free or overall survival.

Conclusions Procedural interventions for patients with oligoprogression on immune checkpoint blockade therapy are feasible and demonstrate favorable outcomes. With expanding use of immune checkpoint therapy, it is important to investigate combined modalities to maximize therapeutic benefit for patients with gynecologic cancers.

  • Gynecologic Surgical Procedures
  • Radiotherapy

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available upon reasonable request from the corresponding author (Ginger Gardner).

https://doi.org/10.1136/ijgc-2023-004842

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    Data availability statement

    Data are available upon reasonable request. The data that support the findings of this study are available upon reasonable request from the corresponding author (Ginger Gardner).

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    Footnotes

    • Presented at This work was presented as a Featured Poster at the 2022 International Gynecologic Cancer Symposium in New York, NY, USA.

    • Contributors Conceptualization: TYS, DZ, GG. Data curation: TYS, VW, OZ, YS, DSC, KL, EJ, WT, RO, SC, VM, YLL, CFF, CK, DZ, GG. Formal analysis: TYS, QCZ, AI. Methodology: TYS, DZ, GG. Supervision: DZ, GG. Writing – original draft: TYS, VW, MF. Writing – reviewing and editing: TYS, MF, QCZ, YS, DSC, EJ, RO, DZ, GG. GG is responsible for the overall content as guarantor.

    • Competing interests Outside the submitted work, AI reports consulting fees from Mylan. CFF reports institutional research support from Seagen, Merck, BMS, AstraZeneca, Mersana, and Hotspot Therapeutics; consulting fees from BMS, Seagen, and Aadi Biosciences; honoraria for lectures from Onclive; meeting/travel support by Puma; and participation on Data Safety Monitoring or Advisory Board of Merck, Genentech, and Marengo (all uncompensated). DZ reports institutional research support from AstraZeneca, Merck, Plexxikon Synthekine, and Genentech; consulting fees from AstraZeneca, Synthekine, Astellas, Tessa Therapeutics, Memgen, Celldex, Crown Biosciences, Hookipa Biotech, Kalivir, Xencor, and GSK; royalties from Merck; and stock options from Accurius Therapeutics, ImmunOS Therapeutics, and Calidi Biotherapeutics. VM reports meeting/travel support by Eisai and Merck; participation on Data Safety Monitoring or Advisory Board of Duality, Merck, Karyopharm, Exelexis, Eisai, Karyopharm, BMS, Clovis, Faeth Immunocore, Morphosys, AstraZeneca, Novartis, GSK, and Bayer (all unpaid); and study support to the institution by Merck, Eisai, AztraZeneca, Faeth, Karyopharm, Zymeworks, Duality, Clovis, Bayer, and Takeda. YLL reports institutional research funding from Repare Therapeutics, AstraZeneca, and GSK; honoraria from Total Health and Sarah Lawrence College; and travel/meeting support by AstraZeneca. DSC reports personal fees from Apyx Medical, Verthermia Inc., Biom ‘Up, and AstraZeneca, as well as recent or current stock/options ownership of Apyx Medical, Verthemia, Intuitive Surgical, Inc., TransEnterix, Inc., Doximity, Moderna, and BioNTech SE. EJ reports personal fees from Covidien/Medtronic. RO reports personal fees from Tesaro/GSK, Regeneron, R-PHARM, Seattle Genetics, Fresenius Kabi, Gynecologic Oncology Foundation, Bayer, Curio, Miltenyi, 2seventybio, and Immunogen; and other from Hitech Health, all outside the submitted work; non-compensated steering committee membership for the PRIMA, Moonstone (Tesaro/GSK), and DUO-O (AstraZeneca) studies; a non-compensated advisor role for Carina Biotech; and funding for clinical research from Bayer/Celgene/Juno, Tesaro/GSK, Merck, Ludwig Cancer Institute, Abbvie/StemCentrx, Regeneron, TCR2 Therapeutics, Atara Biotherapeutics, MarkerTherapeutics, Syndax Pharmaceuticals, Genmab/Seagen Therapeutics, Sellas Therapeutics, Genentech, Kite Pharma, Acrivon, Lyell Immunopharma, and Gynecologic Oncology Foundation. CK reports grant funding from Conquer Cancer Foundation; grant funding paid to the institution from Merus, Gritstone, and BMS; and consulting fees from Scenic Immunology B.V. and OncLive. All other authors have no potential conflicts of interest to disclose.

    • 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.