Brouillard-Saby Flora, Saint-Martin Caroline, Ray-Coquard Isabelle, Gladieff Laurence, Pomel Christophe, Colombo Pierre-Emmanuel, Classe Jean-Marc, Chevrier Marion, Joly Florence, De la Motte Rouge Thibault, Floquet Anne, Sabatier Renaud, Barranger Emmanuel, Costaz Hélène, Leblanc Eric, Marchal Frédéric, Pautier Patricia, Bosquet Lise, Rodrigues Manuel
Medical Oncology, Institut Curie, Paris, France.
Biostatistics, Institut Curie, Paris, France.
Int J Gynecol Cancer. 2023 Apr 3;33(4):577-584. doi: 10.1136/ijgc-2022-003993.
Chemotherapy for high-grade serous ovarian cancers in platinum-sensitive relapse includes carboplatin/paclitaxel, carboplatin/gemcitabine, and carboplatin/pegylated liposomal doxorubicin. According to data, mutated patients are sensitive to replicative stress agents but status is not yet used for the choice of chemotherapy at relapse. Our aim was to assess these doublets according to status in first platinum-sensitive relapse.
The ESME ovarian cancer database comprises a multicenter retrospective cohort of patients with ovarian cancer treated in French cancer centers between January 2011 and December 2017. Patients with high-grade serous ovarian cancers at first platinum-sensitive relapse who received one of these doublets were included. The objective was to compare progression-free survival of each chemotherapy doublet according to status.
Among the 10 263 patients in the database, 1539 patients had a first platinum-sensitive relapse: 825 wild type patients (53.6%) and 304 mutated patients (19.8%) (7 patients had a homologous recombination mutation and status was unkown for 403 patients). Median progression-free survival was longer in mutated patients than in wild type patients when receiving carboplatin/pegylated liposomal doxorubicin without maintenance treatment (15.8 vs 11.8 months; p<0.001). In contrast, we observed no difference in patients treated with carboplatin/paclitaxel (14.6 vs 14.3 months, respectively; p=0.70) or in those treated with carboplatin/gemcitabine (12.0 vs 9.8 months, respectively; p=0.18). In wild type patients without maintenance, better progression-free survival occurred with carboplatin/paclitaxel (median progression-free survival 14.3 months) than with carboplatin/gemcitabine and carboplatin/pegylated liposomal doxorubicin (9.8 and 11.8 months, respectively; p=0.017). In mutated patients without maintenance, there was no difference between the three doublets (median progression-free survival of 14.6, 12.0, and 15.8 months with carboplatin/paclitaxel, carboplatin/gemcitabine, and carboplatin/pegylated liposomal doxorubicin, respectively; p=0.40).
While treatment with carboplatin/paclitaxel, carboplatin/gemcitabine, and carboplatin/pegylated liposomal doxorubicin shows comparable efficacy in mutated patients, treatment with carboplatin/paclitaxel appears to be more effective than carboplatin/gemcitabine and carboplatin/pegylated liposomal doxorubicin in wild type patients with high-grade serous ovarian cancers at first platinum-sensitive relapse.
铂敏感复发的高级别浆液性卵巢癌的化疗方案包括卡铂/紫杉醇、卡铂/吉西他滨和卡铂/聚乙二醇脂质体阿霉素。根据数据，发生基因突变的患者对复制应激剂敏感，但该状态尚未用于复发时化疗方案的选择。我们的目的是根据首次铂敏感复发时的状态评估这些双联化疗方案。
ESME卵巢癌数据库包含一个多中心回顾性队列，该队列研究了2011年1月至2017年12月期间在法国癌症中心接受治疗的卵巢癌患者。纳入首次铂敏感复发且接受上述双联化疗方案之一的高级别浆液性卵巢癌患者。目的是根据状态比较每种化疗双联方案的无进展生存期。
数据库中的10263例患者中,1539例患者出现首次铂敏感复发：825例野生型患者（53.6%）和304例发生基因突变的患者（19.8%）（7例患者发生同源重组突变，403例患者的状态未知）。在未接受维持治疗的情况下，接受卡铂/聚乙二醇脂质体阿霉素治疗的发生基因突变的患者的中位无进展生存期长于野生型患者（15.8个月对11.8个月；p<0.001）。相比之下，我们观察到接受卡铂/紫杉醇治疗的患者（分别为14.6个月和14.3个月；p=0.70）或接受卡铂/吉西他滨治疗的患者（分别为12.0个月和9.8个月；p=0.18）之间无差异。在未接受维持治疗的野生型患者中，卡铂/紫杉醇的无进展生存期（中位无进展生存期14.3个月）优于卡铂/吉西他滨和卡铂/聚乙二醇脂质体阿霉素（分别为9.8个月和11.8个月；p=0.017）。在未接受维持治疗的发生基因突变的患者中，三种双联方案之间无差异（卡铂/紫杉醇、卡铂/吉西他滨和卡铂/聚乙二醇脂质体阿霉素的中位无进展生存期分别为14.6个月、12.0个月和15.8个月；p=0.40）。
虽然卡铂/紫杉醇、卡铂/吉西他滨和卡铂/聚乙二醇脂质体阿霉素在发生基因突变的患者中显示出相当的疗效，但在首次铂敏感复发的野生型高级别浆液性卵巢癌患者中，卡铂/紫杉醇治疗似乎比卡铂/吉西他滨和卡铂/聚乙二醇脂质体阿霉素更有效。
