Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK; Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
Gynecol Oncol. 2019 Feb;152(2):278-285. doi: 10.1016/j.ygyno.2018.11.030. Epub 2018 Nov 28.
The role of endocrine therapy (ET) in high grade serous ovarian carcinoma (HGSOC) is poorly defined due to the lack of phase III data and significant heterogeneity of clinical trials performed. In this study, we sought to identify predictive factors of endocrine sensitivity in HGSOC.
HGSOC patients who received at least four weeks of ET for relapsed disease following one line of chemotherapy at the Edinburgh Cancer Centre were identified. Exclusion criteria were use of endocrine therapy as maintenance therapy or of unknown duration. Duration of therapy and best CA125 response as per modified GCIG criteria were recorded. Oestrogen receptor (ER) histoscore, treatment free interval, prior lines of chemotherapy, and type of ET were evaluated as predictive factors.
Of 431 patients identified, 269 were eligible (77.0% letrozole, 18.6% tamoxifen, 2.2% megesterol acetate, 2.2% other). The median duration of therapy was 126 days (range 28-1427 days). 32.7% remained on ET for ≥180 days and 14.1% for ≥365 days. The CA125 response and clinical benefit rates (response or stable disease) were 8.1% and 40.1% respectively. ER histoscore >200 (P = 0.0016) and a treatment free interval of ≥180 days (P < 0.0001) were independent predictive factors upon multivariable analysis.
ET should be considered as a viable strategy to defer subsequent chemotherapy for relapsed HGSOC. Patients with an ER histoscore >200 and a treatment free interval of ≥180 days are most likely to derive benefit.
由于缺乏 III 期数据和临床试验的显著异质性，内分泌治疗 (ET) 在高级别浆液性卵巢癌 (HGSOC) 中的作用仍未明确。本研究旨在确定 HGSOC 中内分泌敏感性的预测因素。
在爱丁堡癌症中心，我们鉴定了在一线化疗后复发疾病中接受至少四周 ET 治疗的 HGSOC 患者。排除标准为将内分泌治疗作为维持治疗或治疗时间未知。记录治疗持续时间和根据改良 GCIG 标准的最佳 CA125 反应。评估雌激素受体 (ER) 组织评分、无治疗间隔、先前化疗线和 ET 类型作为预测因素。
在鉴定的 431 名患者中，269 名符合条件（77.0%来曲唑、18.6%他莫昔芬、2.2%甲孕酮、2.2%其他）。治疗持续时间的中位数为 126 天（范围 28-1427 天）。32.7%的患者 ET 持续时间≥180 天，14.1%的患者 ET 持续时间≥365 天。CA125 反应和临床获益率（反应或疾病稳定）分别为 8.1%和 40.1%。多变量分析显示，ER 组织评分>200（P=0.0016）和无治疗间隔时间≥180 天（P<0.0001）是独立的预测因素。
对于复发的 HGSOC，ET 应被视为一种可行的推迟后续化疗的策略。ER 组织评分>200 和无治疗间隔时间≥180 天的患者最有可能受益。
