South Carolina Oncology Associates, West Columbia, SC
Fred J. Kudrik , Anupama Vasudevan , Sandy English , Mike Gart , Taofikat Oladipo , John Hartman , Laura L. Iadeluca
Background: Chemotherapy (CT) + bevacizumab is a standard-of-care option for first-line (1L) treatment for patients with advanced ovarian cancer (AOC). Real-world approaches to 1L maintenance (1LM) treatment include, among others, bevacizumab monotherapy or switching to poly(ADP-ribose) polymerase inhibitor (PARPi) monotherapy after completing 6–9 cycles of induction CT + bevacizumab. Methods: We identified 61 patients with AOC from the US-based, deidentified Integra PrecisionQ database who received 1LM bevacizumab monotherapy (n=27) or PARPi monotherapy (n=34) after 1L CT + bevacizumab initiated between July 1, 2019, and March 31, 2021, and followed them until the data cut-off of March 31, 2022. Using the start of 1LM therapy as the index date, we examined patient characteristics, time to next treatment or death (TTNT; often used as a real-world proxy for progression-free survival), and overall survival (OS) for these two treatment groups. Results: For patients who received 1LM bevacizumab, the median age was 69 years, 89% had Eastern Cooperative Oncology Group (ECOG) performance status 0–1, 63% had Stage III disease at index, and only 1 (4%) had a recorded/documented homologous recombination deficiency (HRd)-positive tumor. Of the 34 patients who switched to 1LM PARPi monotherapy, 21 (62%) received olaparib, 12 (35%) niraparib, and 1 (3%) rucaparib. The median age of these patients was 63.5 years, 94% had ECOG performance status 0–1, 62% had Stage III disease at index date, and 47% had HRD+ tumors. For patients who switched to 1LM PARPi monotherapy, the median TTNT was 10.8 months (mo) and 97% were still alive at the 12-month mark. For patients who continued with 1LM bevacizumab, the median TTNT was 4.9 mo and 81% remained alive at the 12-month mark. Conclusions: This study suggests that switching to maintenance with PARPi monotherapy following induction CT + bevacizumab is a viable option for the treatment of AOC. A higher prevalence of HRd patients switching to PARPi monotherapy may indicate clinician preference for PARPi monotherapy in biomarker-selected subgroups, and further analysis is needed to examine which patients are most likely to benefit from switch maintenance. Funding: GSK215281.
Bevacizumab (n=27) | PARPi (n=34) | |
---|---|---|
BRCAm, n (%) | 1 (3.7) | 9 (26.5) |
BRCAwt HRd, n (%) | 0 (0.0) | 7 (20.6) |
BRCAwt HRp/HR unknown, n (%) | 19 (70.4) | 14 (41.2) |
BRCA and HR unknown, n (%) | 7 (25.9) | 4 (11.8) |
Median TTNT, months* | 4.9 (2.5, 9.6) | 10.8 (6.7, 17.4) |
12-Month TTNT rate, %* | 19.4 (7.1, 36.2) | 45.2 (27.1, 61.7) |
Median OS, months* | NR (12.9, NR) | NR (21.1, NR) |
12-Month OS rate, %* | 81.2 (60.5, 91.7) | 96.9 (79.8, 99.6) |
*95% confidence intervals in parentheses. BRCA, breast cancer gene; BRCAm, BRCA mutant; BRCAwt, BRCA wild type; HR, homologous recombination; HRd, HR deficiency; HRp, HR proficiency; NR, not reached. Note that this is a non-comparative study.
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