Cytoreductive surgery followed by chemotherapy and olaparib maintenance in BRCA 1/2 mutated recurrent ovarian cancer: a retrospective MITO group study.

The role of cytoreductive surgery in the poly-ADP ribose polymerase inhibitors era is not fully investigated. We evaluated the impact of surgery performed prior to platinum-based chemotherapy followed by olaparib maintenance in platinum-sensitive BRCA-mutated recurrent ovarian cancer. This retrospective study included platinum-sensitive recurrent ovarian cancer BRCA-mutated patients from 13 Multicenter Italian Trials in Ovarian cancer and gynecological malignancies centers treated between September 2015 and May 2019. The primary outcomes were progression-free survival and overall survival. Data on post-progression treatment was also assessed. Among 209 patients, 72 patients (34.5%) underwent cytoreductive surgery followed by platinum-based chemotherapy and olaparib maintenance, while 137 patients (65.5%) underwent chemotherapy treatment alone. After a median follow-up of 37.3 months (95% CI: 33.4 to 40.8), median progression-free survival in the surgery group was not reached, compared with 11 months in patients receiving chemotherapy alone (P<0.001). Median overall survival was nearly double in patients undergoing surgery before chemotherapy (55 vs 28 months, P<0.001). Post-progression therapy was assessed in 127 patients: response rate to chemotherapy was 29.2%, 8.8%, and 9.0% in patients with platinum-free interval >12 months, between 6 and 12 months, and <6 months, respectively. Cytoreductive surgery performed before platinum therapy and olaparib maintenance was associated with longer progression-free survival and overall survival in BRCA-mutated platinum-sensitive relapsed ovarian cancer patients. In accordance with our preliminary results, the response rate to chemotherapy given after progression during olaparib was associated with platinum-free interval.

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Competing interests: VS has been part of advisory boards of GSK, PharmaMar, Roche, MSD, EISAI, Clovis, AstraZeneca. DL reports personal financial interests (advisory roles) with AstraZeneca, Biocad, Clovis Oncology, Genmab, Merck, MSD, Roche, Tesaro-GSK, Amgen, Immunogen, Pharmamar, and institutional financial interests (Study Grants) with AstraZeneca, Clovis Oncology, MSD, Tesaro-GSK, Pharmamar, Roche. Others Global Clinical Lead ENGOT-CX11 Pembrolizumab; Board of Directors, GCIG (Gynecologic Cancer Inter Group). CM reports an advisory role for GSK, Arquer Diagnostic, Pharmamar, Clovis Oncology, and travel grant from Roche. FR reports honoraria from GSK, Pharmamar, Clovis, MSD as sponsors for meetings. GV is an advisor for AstraZeneca, GSK, Amgen, and received speaking honoraria from AstraZeneca, GSK, Roche, Pharmamar. GS reports honoraria from AstraZeneca, MSD, Roche, Clovis, GSK, Pharmamar, Roche (advisory role), and received institutional financial interest (study grants) from AstraZeneca, MSD, GSK, Pharmamar, and he is a member of the board of the National Health Institute. SP reports honoraria from AstraZeneca, MSD, Roche Clovis, GSK Pfizer Pharmamar.