Cancer Res Treat.  2022 Oct;54(4):1219-1229. 10.4143/crt.2021.1010.

Identification of Patients with Recurrent Epithelial Ovarian Cancer Who Will Benefit from More Than Three Lines of Chemotherapy

• Seol A
• Yim GW
• Chung JY
• Kim SI
• Lee M
• Kim HS
• Chung HH
• Kim JW
• Park NH
• Song YS

• KMID: 2534201
• DOI: http://doi.org/10.4143/crt.2021.1010

Abstract

Purpose
This study aimed to identify patients who would benefit from third and subsequent lines of chemotherapy in recurrent epithelial ovarian cancer (EOC).
Materials and Methods
Recurrent EOC patients who received third, fourth, or fifth-line palliative chemotherapy were retrospectively analyzed. Patients’ survival outcomes were assessed according to chemotherapy lines. Based on the best objective response, patients were divided into good-response (stable disease or better) and poor response (progressive disease or those who died before response assessment) groups. Survival outcomes were compared between the two groups, and factors associated with chemotherapy responses were investigated.
Results
A total of 189 patients were evaluated. Ninety-four and 95 patients were identified as good and poor response group respectively, during the study period of 2008 to 2021. The poor response group showed significantly worse progression-free survival (median, 2.1 months vs. 9.7 months; p < 0.001) and overall survival (median, 5.0 months vs. 22.9 months; p < 0.001) compared with the good response group. In multivariate analysis adjusting for clinicopathologic factors, short treatment-free interval (TFI) (hazard ratio [HR], 5.557; 95% confidence interval [CI], 2.403 to 12.850), platinum-resistant EOC (HR, 2.367; 95% CI, 1.017 to 5.510), and non-serous/endometrioid histologic type (HR, 5.045; 95% CI, 1.152 to 22.088) were identified as independent risk factors for poor response. There was no difference in serious adverse events between good and poor response groups (p=0.167).
Conclusion
Third and subsequent lines of chemotherapy could be carefully considered for palliative purposes in recurrent EOC patients with serous or endometrioid histology, initial platinum sensitivity, and long TFIs from the previous chemotherapy regimen.

Keyword

Epithelial ovarian carcinoma; Drug therapy; Recurrence; Survival; Treatment response; Prognosis

Figure

• 

  Fig. 1 Comparisons of survival outcomes in the 3rd line, 4th line, and 5th line chemotherapy groups. (A) Kaplan-Meier curves for progression-free survival in the 3rd line, 4th line, and 5th line chemotherapy groups; p-values of comparisons between two groups: (1) vs. (2), p=0.916; (1) vs. (3), p=0.040; (2) vs. (3), p=0.034; Number at risk is the number of patients who are at risk of recurrence after 3rd, 4th, or 5th line chemotherapy. (B) Kaplan-Meier curves for overall survival in the 3rd line, 4th line, and 5th line chemotherapy groups; p-values of comparisons between two groups: (1) vs. (2), p=0.483; (1) vs. (3), p=0.078; (2) vs. (3), p=0.282. Number at risk is the number of patients who are at risk of death after 3rd, 4th, or 5th line chemotherapy. CI, confidence interval.

• 

  Fig. 2 Comparisons of survival outcomes in the good response group and poor response group. (A) Kaplan-Meier curves for progression-free survival in the good response group and poor response group. Number at risk is the number of patients in good and poor response group who are at risk of recurrence after 3rd, 4th, or 5th line chemotherapy. (B) Kaplan-Meier curves for overall survival in the good response group and poor response group. Number at risk is the number of patients in good and poor response group who are at risk of death after 3rd, 4th, or 5th line chemotherapy. CI, confidence interval.

• 

  Fig. 3 Comparisons of survival outcomes in the BRCA wild-type group and BRCA mutation group. (A) Kaplan-Meier curves for progression-free survival in the BRCA wild group and BRCA mutation group. Number at risk is the number of patients in BRCA wild-type group and BRCA mutation group who are at risk of recurrence after 3rd, 4th, or 5th line chemotherapy. (B) Kaplan-Meier curves for overall survival BRCA wild group and BRCA mutation group. Number at risk is the number of patients in the BRCA wild-type group and BRCA mutation group who are at risk of death after 3rd, 4th, or 5th line chemotherapy. CI, confidence interval.

Reference

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