Multicenter real-world data of subsequent chemotherapy after progression to PARP inhibitors in a maintenance relapse setting

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• dc.contributor.author Romeo, Margarita
• dc.contributor.author Taus García, Álvaro
• dc.contributor.author Barretina-Ginesta, Maria Pilar
• dc.date.accessioned 2023-01-25T07:30:32Z
• dc.date.available 2023-01-25T07:30:32Z
• dc.date.issued 2022
• dc.description.abstract Despite impressive progression-free survival (PFS) results from PARP inhibitors (PARPi) in ovarian cancer, concerns about their effect on post-progression treatment outcomes have recently arisen, particularly when administered in the relapsed setting. Overlapping mechanisms of resistance between PARPi and platinum have been described, and optimal therapies upon progression to PARPi are unknown. We communicate real-world data (RWD) on outcomes of subsequent chemotherapy upon progression to PARPi used as maintenance in ovarian cancer relapses, particularly focusing on platinum rechallenge, according to BRCA status. Methods: Data from high-grade serous or endometrioid ovarian cancer patients who received subsequent chemotherapy after progression to maintenance PARPi in the relapsed setting, in 16 Catalan hospitals between August 2016 and April 2021, and who were followed-up until July 2021, were included. Endpoints were overall response rate (ORR), and PFS and overall survival (OS) measured from the subsequent chemotherapy starting date. Results: 111 patients were included [46 (41.4%) presented pathological BRCA1/2 mutations, 8 (7.5%) in other homologous recombination-related genes]. Sixty-four patients (57.7%) had received two prior chemotherapy lines, including the one immediately prior to PARPi. PARPi were niraparib (n = 60, 54.1%), olaparib (n = 49, 44.1%), and rucaparib (n = 2, 1.8%). A total of 81 patients remained platinum-sensitive (PS population) after progression to PARPi (when progressionfree interval [PFI] was >6 months after the last cycle of prior platinum) [median PFI 12.0 months (interquartile range, IQR, 8.8–17.1)]. Of those, 74 were treated with subsequent platinum regimens, with the following results: ORR of 41.9%, median PFS (mPFS) of 6.6 months (95% CI 6–9.2), and median OS (mOS) of 20.6 months (95% CI 13.6–28.9). Analysis of these 74 patients according to BRCA status showed that PFIs for BRCA mutant and non BRCA-mutant patients were 13.6 [IQR11.2–22.2] and 10.3 [IQR 7.4–14.9] months, respectively (p = 0.010); ORR were 40.0% versus 43.6%, respectively; Rates of progression (as best response) to subsequent platinum were 45.7% versus 17.9%, respectively (p = 0.004); mPFS and mOS were 3.5 (95% CI 2.5–8.6) versus 7.5 months (95% CI 6.5–10.1, p = 0.03), and 16.4 (95% CI 9.3–27.5) versus 24.2 months (95% CI 17.2–NR, p = 0.036), respectively. Conclusion: this is the largest series of real-world data on ovarian cancer patients retreated with platinum in the post-PARPi scenario, separately analyzing BRCA mutant and non-mutant patients, to our knowledge. In our platinum-sensitive population, rechallenge with platinum after progression upon PARPi in the 3rd or later lines for ovarian cancer relapses shows relevant ORR and similar PFS outcomes to historical series of the prePARPi era. However, BRCA mutant patients presented significantly higher rates of progression under subsequent platinum and worse survival outcomes associated with subsequent platinum than non-BRCA-mutant patients.
• dc.format.mimetype application/pdf
• dc.identifier.citation Romeo M, Gil-Martín M, Gaba L, Teruel I, Taus Á, Fina C, et al. Multicenter real-world data of subsequent chemotherapy after progression to PARP inhibitors in a maintenance relapse setting. Cancers (Basel). 2022 Sep 11; 14(18): 4414. DOI: 10.3390/cancers14184414
• dc.identifier.doi http://dx.doi.org/10.3390/cancers14184414
• dc.identifier.issn 2072-6694
• dc.identifier.uri http://hdl.handle.net/10230/55429
• dc.language.iso eng
• dc.publisher MDPI
• dc.rights Copyright © 2022 by Romeo M, Gil-Martín M, Gaba L, Teruel I, Taus Á, Fina C, et al. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Ovarian cancer
• dc.subject.keyword PARP inhibitors
• dc.subject.keyword Platinum sensitivity
• dc.subject.keyword Platinum rechallenge
• dc.subject.keyword mechanisms of resistance
• dc.title Multicenter real-world data of subsequent chemotherapy after progression to PARP inhibitors in a maintenance relapse setting
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion