In a recent study, nearly half of the patients with advanced ovarian cancer who received first-line PARP inhibitor maintenance treatment faced a relapse. This highlights the urgent need for better postrecurrence treatment strategies.
The research published in ESMO Open showed that while recent trials have demonstrated significant improvements in progression-free survival (PFS) for PARP inhibitors, relapse remains a serious challenge. In these trials, PFS after three years varies significantly, from 12% to 60%.
Even with these setbacks, PARP inhibitors are commonly used in clinical settings. A large study indicated that up to 79% of patients with advanced ovarian cancer might qualify for PARP maintenance treatment under European reimbursement policies, which has resulted in a larger patient population and new challenges for oncologists. They must now understand how PARP inhibitors affect recurrence and subsequent survival, which can influence treatment decisions.
Most available research on PARP inhibitors focuses on clinical trials, leaving a gap in real-world data. This study aimed to fill that gap by examining disease characteristics, recurrence rates, and treatments given after progression among patients treated with first-line PARP inhibitors at a tertiary cancer center in Rome, Italy.
The researchers looked at data from patients treated between January 2019 and December 2022, all of whom had a complete or partial response to six cycles of platinum-based chemotherapy. They collected clinical information, tissue samples, and data regarding the patients’ BRCA genetic status and homologous recombination deficiency.
During the treatment, patients received regular check-ups, including CT scans, physical exams, and blood tests to monitor cancer markers. Platinum sensitivity was defined as recurrence occurring more than six months after finishing primary chemotherapy. Recurrences were classified based on the number and location of lesions.
The study included 373 patients, with 51.5% having a somatic or germline BRCA mutation. Neoadjuvant chemotherapy was performed in 46.9% of cases, and 89.5% had complete cytoreduction. By April 2024, 167 patients, or 44.8%, had had a recurrence, with a median follow-up of 38 months. Among these, 69 patients died from their disease.
Most recurrences happened during the maintenance phase, with 92.8% occurring then. The PFS was less than six months for 9.7% of patients, between six and twelve months for 14.2%, and over twelve months for 20.9%.
Of the patients whose cancer returned, 44.9% had fewer than five lesions. Interestingly, those with BRCA mutations were more likely to have oligometastatic disease, indicating fewer lesions at recurrence.
For those whose cancer recurred and were platinum-sensitive, most underwent further treatment. About 56.6% received second-line chemotherapy, while 41.2% received local treatments like secondary surgery or stereotactic radiotherapy. Among those receiving local treatment, about half continued with PARP inhibitors.
After local treatment, 61.3% of patients who had secondary surgery opted for further chemotherapy, while 38.7% continued with PARP inhibitors for an average of seven months. Those treated with stereotactic radiotherapy continued for about eight months.
The overall median PFS for all patients was 39 months. Notably, those with oligometastatic recurrence patterns had notably longer PFS compared to those with diffuse recurrences.
The authors acknowledged several limitations in their study, including its retrospective design and modest size, which might affect the conclusions. However, they stressed that their findings mirror those from randomized trials, underscoring the relevance of PARP inhibitors in real-world settings.
In summary, this study provides valuable insights into the outcomes of first-line PARP inhibitor treatments and emphasizes the need for enhanced strategies to manage recurrence in advanced ovarian cancer.
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ovarian cancer,PARP inhibitor,recurrence,treatment
