Management of platinum-sensitive recurrent ovarian cancer (PSROC) in the era of biologics: Can ASCO’s net health benefits (NHB) inform our decisions?

Authors

null

Jonathan Foote

Division of Gynecologic Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC

Jonathan Foote , Laura Jean Havrilesky , Elizabeth Lin Jewell , Charlotte Gamble , Jessie Ehrisman , Gloria Broadwater , Robert L. Coleman , David E. Cohn , Angeles Alvarez Secord

Organizations

Division of Gynecologic Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, Memorial Sloan-Kettering Cancer Center, New York, NY, Duke University Medical Center, Durham, NC, Department of Biostatistics and Bioinformatics and CALGB Statistical Center, Duke Cancer Institute, Durham, NC, The University of Texas MD Anderson Cancer Center, Houston, TX, The Ohio State University, Columbus, OH, Duke Cancer Institute, Duke University Medical Center, Durham, NC

Research Funding

Other

Background: The ASCO value framework allows assessment of novel cancer therapies based on NHB. We assessed novel biologic therapies in the management of PSROC. Methods: ASCO’s revised value framework NHBs were constructed for key therapies based on randomized clinical trials for PSROC. BRCA-germline and HRD status were included. Additionally, patient-centered NHB calculations were weighted based on results from a prospective patient preferences study (n=54) and compared to ASCO-based NHB. Results: ASCO-centered NHB calculations were: platinum + taxane-based chemotherapy (ICON4) = 35; carboplatin + liposomal doxorubicin (CALYPSO) = 22; platinum-based chemotherapy + bevacizumab (OCEANS = 35; GOG 213 = 26). NHB scores based on germline-BRCA alterations were maintenance niraparib (NOVA) = 50 and maintenance olaparib (Study 19) = 62; wild-type BRCA, maintenance niraparib = 36 and maintenance olaparib = 33; and HRD-positive status, maintenance niraparib = 42. Patients valued clinical benefit as the most important component of NHB. Patients valued OS as the most important component of clinical benefit, followed by response rate (RR), then PFS. Patient-weighted NHB were significantly lower than ASCO-weighted scores (mean NHB 37.8 versus 23.5; p=0.009) due to decreased preference for PFS compared to other clinical benefit measures (Table). Conclusions: NHB scores for treatment of PSROC were highest in women with germline-BRCA and HRD tumor alterations who were treated with maintenance PARPi. Our data suggest that a patient-centered NHBs can be used to inform treatment decisions.

NHB of platinum-sensitive treatment options in the era of biologics.

RegimensASCO NHBPatient-weighted NHBP value
Platinum-based chemotherapy + taxane (ICON4)35270.009
Carbo + liposomal doxorubicin
(CALYPSO)
2217
Platinum-based chemotherapy + bevacizumabOCEANS3520
GOG 2132615
Maintenance olaparib
(Study 19)
gBRCA6238
wBRCA3320
Maintenance niraparib
(NOVA)
gBRCA5030
wBRCA3621
wBRCA HRD+4224

NHB = Net Health Benefit (based on PFS); gBRCA = germline BRCA alteration; wBRCA = wild-type germline BRCA; HRD = homologous recombination deficiency

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Abstract Details

Meeting

2017 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gynecologic Cancer

Track

Gynecologic Cancer

Sub Track

Ovarian Cancer

Citation

J Clin Oncol 35, 2017 (suppl; abstr 5544)

DOI

10.1200/JCO.2017.35.15_suppl.5544

Abstract #

5544

Poster Bd #

366

Abstract Disclosures