根据HRD/BRCA野生型基因组特征,热灌注化疗(HIPEC)在III期卵巢癌中的疗效:III期OVHIPEC试验结果

Effect of HIPEC according to HRD/BRCAwt genomic profile in stage III ovarian cancer: Results from the phase III OVHIPEC trial.

作者信息

Koole Simone N, Schouten Philip C, Hauke Jan, Kluin Roel J C, Nederlof Petra, Richters Lisa K, Krebsbach Gabriele, Sikorska Karolina, Alkemade Maartje, Opdam Mark, Schagen van Leeuwen Jules H, Schreuder Henk W R, Hermans Ralph H M, de Hingh Ignace H J T, Mom Constantijne H, Arts Henriette J G, van Ham Maaike, van Dam Peter, Vuylsteke Peter, Sanders Joyce, Horlings Hugo M, van de Vijver Koen K, Hahnen Eric, van Driel Willemien J, Schmutzler Rita, Sonke Gabe S, Linn Sabine C

机构信息

Department of Gynecology, The Netherlands Cancer Institute, Center of Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands.

Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.

出版信息

Int J Cancer. 2022 Oct 15;151(8):1394-1404. doi: 10.1002/ijc.34124. Epub 2022 Jun 4.

Abstract

The addition of hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin to interval cytoreductive surgery improves recurrence-free (RFS) and overall survival (OS) in patients with stage III ovarian cancer. Homologous recombination deficient (HRD) ovarian tumors are usually more platinum sensitive. Since hyperthermia impairs BRCA1/2 protein function, we hypothesized that HRD tumors respond best to treatment with HIPEC. We analyzed the effect of HIPEC in patients in the OVHIPEC trial, stratified by HRD status and BRCAm status. Clinical data and tissue samples were collected from patients included in the randomized, phase III OVHIPEC-1 trial. DNA copy number variation (CNV) profiles, HRD-related pathogenic mutations and BRCA1 promotor hypermethylation were determined. CNV-profiles were categorized as HRD or non-HRD, based on a previously validated algorithm-based BRCA1-like classifier. Hazard ratios (HR) and corresponding 99% confidence intervals (CI) for the effect of RFS and OS of HIPEC in the BRCAm, the HRD/BRCAwt and the non-HRD group were estimated using Cox proportional hazard models. Tumor DNA was available from 200/245 (82%) patients. Seventeen (9%) tumors carried a pathogenic mutation in BRCA1 and 14 (7%) in BRCA2. Ninety-one (46%) tumors classified as BRCA1-like. The effect of HIPEC on RFS and OS was absent in BRCAm tumors (HR 1.25; 99%CI 0.48-3.29), and most present in HRD/BRCAwt (HR 0.44; 99%CI 0.21-0.91), and non-HRD/BRCAwt tumors (HR 0.82; 99%CI 0.48-1.42), interaction P value: 0.024. Patients with HRD tumors without pathogenic BRCA1/2 mutation appear to benefit most from treatment with HIPEC, while benefit in patients with BRCA1/2 pathogenic mutations and patients without HRD seems less evident.

摘要

在间歇性肿瘤细胞减灭术中添加顺铂腹腔热灌注化疗(HIPEC)可改善Ⅲ期卵巢癌患者的无复发生存期(RFS)和总生存期(OS)。同源重组缺陷(HRD)的卵巢肿瘤通常对铂类更敏感。由于热疗会损害BRCA1/2蛋白功能,我们推测HRD肿瘤对HIPEC治疗反应最佳。我们分析了OVHIPEC试验中患者接受HIPEC治疗的效果,并根据HRD状态和BRCAm状态进行分层。从随机Ⅲ期OVHIPEC-1试验纳入的患者中收集临床数据和组织样本。确定DNA拷贝数变异(CNV)图谱、HRD相关致病突变和BRCA1启动子高甲基化情况。基于先前验证的基于算法的BRCA1样分类器,将CNV图谱分类为HRD或非HRD。使用Cox比例风险模型估计HIPEC对BRCAm组、HRD/BRCAwt组和非HRD组的RFS和OS影响的风险比(HR)及相应的99%置信区间(CI)。245例患者中有200例(82%)可获得肿瘤DNA。17例(9%)肿瘤携带BRCA1致病突变,14例(7%)携带BRCA2致病突变。91例(46%)肿瘤分类为BRCA1样。HIPEC对BRCAm肿瘤的RFS和OS无影响(HR 1.25;99%CI 0.48-3.29),在HRD/BRCAwt组(HR 0.44;99%CI 0.21-0.91)和非HRD/BRCAwt肿瘤组中影响最为明显(HR 0.82;99%CI 0.48-1.42),交互P值为0.024。无BRCA1/2致病突变的HRD肿瘤患者似乎从HIPEC治疗中获益最大,而BRCA1/2致病突变患者和非HRD患者的获益似乎不太明显。

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