Real-world outcomes of PARP inhibitor maintenance in advanced ovarian cancer: a focus on disease patterns and treatment modalities at recurrence.

IF 7.1 2区医学 Q1 ONCOLOGY ESMO Open Pub Date : 2025-01-17 DOI:10.1016/j.esmoop.2024.104119

M Loverro, C Marchetti, V Salutari, D Giannarelli, L Vertechy, F M Capomacchia, C Caricato, M Campitelli, C Panico, G Avesani, F Cocciolillo, A Rosati, G Scambia, A Fagotti

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Abstract

Background: The utilization of poly-ADP-ribose polymerase (PARP) inhibitors (PARPi) as a first-line maintenance therapy for advanced ovarian cancer has increased significantly, with ∼80% of patients potentially eligible. This expansion has led to a rise in the population experiencing platinum-sensitive recurrence, yet data on first recurrence during PARPi are limited. This real-world study from a high-volume referral center aims to elucidate recurrence rates, disease distribution, and treatment modalities at the time of progression in PARPi-treated patients.

Materials and methods: We analyzed our prospectively maintained database to identify patients receiving first-line PARPi maintenance from January 2019 to December 2022 at our institution.

Results: A total of 373 cases were identified, 51.5% of which had a BRCA mutation. With a median follow-up of 38 months, 44.8% of patients experienced recurrence, with 90.3% having a platinum-free interval exceeding 6 months. Recurrences were oligometastatic in 44.9% of cases, with BRCA mutations strongly predicting this pattern (hazard ratio 3.014, confidence interval 1.486-6.113, P = 0.002). The median progression-free survival was 39 months, significantly longer for BRCA-mutated and homologous recombination deficiency-positive patients. Over one-third of platinum-sensitive recurrent patients were candidates for local treatments, and PARPi administration was prolonged in 53.7%.

Conclusions: Despite the notable survival improvement, a significant proportion of the population will experience a platinum-sensitive recurrence on PARPi, for which local treatments are often a viable option. Our study highlights the need for further research to determine whether the ablation of oligometastatic sites has a significant impact on post-recurrence survival and to identify if there are patient categories that would benefit from personalized follow-up due to their susceptibility to oligometastatic recurrences and local treatments.

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PARP抑制剂维持在晚期卵巢癌中的实际结果：疾病模式和复发治疗方式的重点

背景：利用聚adp核糖聚合酶（PARP）抑制剂（PARPi）作为晚期卵巢癌的一线维持治疗已显著增加，约80%的患者可能符合条件。这种扩大导致铂敏感复发的人口增加，但PARPi期间首次复发的数据有限。这项来自大容量转诊中心的真实世界研究旨在阐明parpi治疗患者进展时的复发率、疾病分布和治疗方式。材料和方法：我们分析了我们前瞻性维护的数据库，以确定2019年1月至2022年12月在我们机构接受一线PARPi维持的患者。结果：共检出373例，其中51.5%的患者存在BRCA突变。中位随访38个月，44.8%的患者出现复发，90.3%的患者无铂间期超过6个月。44.9%的病例为低转移性复发，BRCA突变强烈预测了这种模式（风险比3.014，置信区间1.486-6.113,P = 0.002）。中位无进展生存期为39个月，brca突变和同源重组缺陷阳性患者的生存期明显更长。超过三分之一的铂敏感复发患者适合局部治疗，53.7%的患者延长PARPi给药时间。结论：尽管生存期显著改善，但很大比例的PARPi患者会出现铂敏感性复发，局部治疗通常是一种可行的选择。我们的研究强调需要进一步的研究来确定少转移部位的消融是否对复发后的生存有显著的影响，并确定是否有患者类别由于对少转移复发和局部治疗的易感性而受益于个性化随访。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ESMO Open Medicine-Oncology

CiteScore

11.70

自引率

2.70%

发文量

255

审稿时长

10 weeks

期刊介绍： ESMO Open is the online-only, open access journal of the European Society for Medical Oncology (ESMO). It is a peer-reviewed publication dedicated to sharing high-quality medical research and educational materials from various fields of oncology. The journal specifically focuses on showcasing innovative clinical and translational cancer research. ESMO Open aims to publish a wide range of research articles covering all aspects of oncology, including experimental studies, translational research, diagnostic advancements, and therapeutic approaches. The content of the journal includes original research articles, insightful reviews, thought-provoking editorials, and correspondence. Moreover, the journal warmly welcomes the submission of phase I trials and meta-analyses. It also showcases reviews from significant ESMO conferences and meetings, as well as publishes important position statements on behalf of ESMO. Overall, ESMO Open offers a platform for scientists, clinicians, and researchers in the field of oncology to share their valuable insights and contribute to advancing the understanding and treatment of cancer. The journal serves as a source of up-to-date information and fosters collaboration within the oncology community.