Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Kaiser Permanente Northern California, San Francisco, CA, USA.
Gynecol Oncol. 2021 Aug;162(2):375-381. doi: 10.1016/j.ygyno.2021.05.031. Epub 2021 Jun 8.
In the phase 3 VELIA/GOG-3005 trial, veliparib added to carboplatin-paclitaxel and continued as maintenance improved progression-free survival (PFS) compared to carboplatin-paclitaxel alone in patients with newly diagnosed ovarian carcinoma. Primary analysis of PFS was by investigator (INV) assessment, with a supplemental analysis of PFS by blinded independent central review (BICR).
Patients received veliparib or placebo with carboplatin-paclitaxel (6 cycles) and as maintenance (30 additional cycles). The primary analysis compared PFS in the veliparib-throughout arm to the carboplatin-paclitaxel only arm in the BRCA mutation (BRCAm), homologous recombination deficiency (HRD), and intention-to-treat (ITT) populations. Exploratory analyses of PFS in BRCA wildtype (BRCAwt), homologous recombination proficient (HRP), and HRD + BRCAwt populations were also performed. PFS per BICR and overall concordance rates between INV and BICR assessments were analyzed.
Hazard ratios for PFS by INV and BICR were consistent in each of the primary analysis and exploratory populations. In the ITT population, median PFS per INV was 23.5 months in the veliparib-throughout arm versus 17.3 months in the control arm (hazard ratio [HR] 0.683, 95% confidence interval [CI] 0.562-0.831; P < 0.001). Median PFS by BICR was 29.3 months versus 19.2 months (HR 0.687, 95% CI 0.504-0.806). In the ITT population, the overall concordance rates between INV and BICR were 78% and 75% for the veliparib-throughout and control arms, respectively.
Hazard ratios for PFS per BICR and per INV were consistent, with no suggestion of investigator bias. These findings support the reliability of PFS by INV in ovarian cancer trials.
在 3 期 VELIA/GOG-3005 试验中,与单独使用卡铂紫杉醇相比,在新诊断的卵巢癌患者中,维利帕里布联合卡铂紫杉醇并持续作为维持治疗可改善无进展生存期(PFS)。PFS 的主要分析由研究者评估(INV)进行,并用盲法独立中心审查(BICR)对 PFS 进行补充分析。
患者接受维利帕里布或安慰剂联合卡铂紫杉醇(6 个周期)以及维持治疗(30 个周期)。主要分析比较了维利帕里布全程治疗组与仅接受卡铂紫杉醇治疗组在 BRCA 突变(BRCAm)、同源重组缺陷(HRD)和意向治疗(ITT)人群中的 PFS。还对 BRCA 野生型(BRCAwt)、同源重组功能正常(HRP)和 HRD+BRCAwt 人群中的 PFS 进行了探索性分析。分析了 BICR 评估的 PFS 以及 INV 和 BICR 评估之间的总体一致性率。
在主要分析和探索性人群中,INV 和 BICR 评估的 PFS 风险比一致。在 ITT 人群中,维利帕里布全程治疗组的 INV 评估中位 PFS 为 23.5 个月,而对照组为 17.3 个月(风险比[HR]0.683,95%置信区间[CI]0.562-0.831;P<0.001)。BICR 评估的中位 PFS 为 29.3 个月与 19.2 个月(HR 0.687,95%CI0.504-0.806)。在 ITT 人群中,INV 和 BICR 之间的总体一致性率分别为 78%和 75%,用于维利帕里布全程治疗组和对照组。
BICR 和 INV 评估的 PFS 风险比一致,没有提示研究者的偏见。这些发现支持 INV 在卵巢癌试验中评估 PFS 的可靠性。