Extending the platinum-free interval: The impact of omitting 2nd line platinum chemotherapy in intermediate platinum-sensitive ovarian cancer.

Author(s) Dockery, L.E.; Rubenstein, A.R.; Ding, K.; Mashburn, S.G.; Burkett, W.C.; Davis, A.M.; Doo, D.W.; Arend, R.C.; Moore, K.N.; Gunderson, C.C.
Journal Gynecol Oncol
Date Published 2019 11

OBJECTIVES: Patients with epithelial ovarian cancer (EOC) recurring between 6 and 12 months after primary platinum chemotherapy have worse prognosis than those recurring in >12 months. Artificially prolonging the platinum-free interval (PFI) with cytotoxic chemotherapy was tested in MITO-8 with poor outcomes. This study aimed to determine the impact of using non-platinum or targeted therapy in 2nd line treatment of EOC patients recurring 6-12 months after completion of primary platinum-based chemotherapy.

METHODS: A multi-institutional retrospective review of 177 patients with recurrent EOC and PFI of 6-12 months following primary chemotherapy was performed comparing platinum versus non-platinum chemotherapy or targeted therapy for 2nd line treatment. PFI1 was defined as the date of last chemotherapy to date of recurrence. PFS2/3 were defined as start of 2nd or 3rd line chemotherapy to start of subsequent line.

RESULTS: Of 177 patients, the majority of patients were Caucasian, had serous histology, and underwent primary cytoreductive surgery. Median PFI1 was 8.2 months (95% CI 8-9 months). Second line platinum was omitted in 28% of patients. Bevacizumab was used in 2nd line in 16% of patients; 19% received other targeted therapies. Median PFS2 for platinum chemotherapy was longer than non-platinum (7.1 vs 3 months, p = 0.0114). Median PFS2 was significantly longer for platinum vs. targeted therapy (7.1 vs. 3 months p = 0.0431). Median OS for platinum in 2nd line vs. no platinum was 43.6 vs. 37.6 months (p = 0.0174).

CONCLUSIONS: Use of non-platinum chemotherapy and even targeted therapy to prolong PFI in patients with EOC recurring between 6 and 12 months leads to worse survival.

DOI 10.1016/j.ygyno.2019.07.008
Keywords Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Bevacizumab; Disease Progression; Disease-Free Survival; Female; Humans; Middle Aged; Molecular Targeted Therapy; Neoplasm Recurrence, Local; Ovarian Neoplasms; Platinum Compounds; Retrospective Studies; Treatment Outcome
ISSN 1095-6859
Citation Gynecol Oncol. 2019;155(2):201206.