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Li H, Peng Z, Zhu J, Zhao W, Huang Y, An R, Zheng H, Qu P, Wang L, Zhou Q, Wang D, Lou G, Wang J, Wang K, Kong B, Xie X, Yin R, Low J, Rozita AM, Sen LC, Meng YC, Kiong KS, Liu J, Liang Z, Lv W, Zhu Y, Hu W, Sun W, Su J, Wang Q, Zang R, Ma D, Gao Q. Exploratory biomarker analysis in the phase III L-MOCA study of olaparib maintenance therapy in patients with platinum-sensitive relapsed ovarian cancer. BMC Med 2024; 22:199. [PMID: 38755585 PMCID: PMC11100112 DOI: 10.1186/s12916-024-03409-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/29/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The prospective phase III multi-centre L-MOCA trial (NCT03534453) has demonstrated the encouraging efficacy and manageable safety profile of olaparib maintenance therapy in the Asian (mainly Chinese) patients with platinum-sensitive relapsed ovarian cancer (PSROC). In this study, we report the preplanned exploratory biomarker analysis of the L-MOCA trial, which investigated the effects of homologous recombination deficiency (HRD) and programmed cell death ligand 1 (PD-L1) expression on olaparib efficacy. METHODS HRD status was determined using the ACTHRD assay, an enrichment-based targeted next-generation sequencing assay. PD-L1 expression was assessed by SP263 immunohistochemistry assay. PD-L1 expression positivity was defined by the PD-L1 expression on ≥ 1% of immune cells. Kaplan-Meier method was utilised to analyse progression-free survival (PFS). RESULTS This exploratory biomarker analysis included 225 patients and tested HRD status [N = 190; positive, N = 125 (65.8%)], PD-L1 expression [N = 196; positive, N = 56 (28.6%)], and BRCA1/2 mutation status (N = 219). The HRD-positive patients displayed greater median PFS than the HRD-negative patients [17.9 months (95% CI: 14.5-22.1) versus 9.2 months (95% CI: 7.5-13.8)]. PD-L1 was predominantly expressed on immune cells. Positive PD-L1 expression on immune cells was associated with shortened median PFS in the patients with germline BRCA1/2 mutations [14.5 months (95% CI: 7.4-18.2) versus 22.2 months (95% CI: 18.3-NA)]. Conversely, positive PD-L1 expression on immune cells was associated with prolonged median PFS in the patients with wild-type BRCA1/2 [20.9 months (95% CI: 13.9-NA) versus 8.3 months (95% CI: 6.7-13.8)]. CONCLUSIONS HRD remained an effective biomarker for enhanced olaparib efficacy in the Asian patients with PSROC. Positive PD-L1 expression was associated with decreased olaparib efficacy in the patients with germline BRCA1/2 mutations but associated with improved olaparib efficacy in the patients with wild-type BRCA1/2. TRIAL REGISTRATION NCT03534453. Registered at May 23, 2018.
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Affiliation(s)
- Huayi Li
- Department of Obstetrics and Gynaecology, National Clinical Research Centre for Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Hankou, Wuhan, 430030, China
- Key Laboratory of Cancer Invasion and Metastasis (Ministry of Education), Hubei Key Laboratory of Tumour Invasion and Metastasis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Hankou, Wuhan, 430030, China
| | - Zikun Peng
- Department of Obstetrics and Gynaecology, National Clinical Research Centre for Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Hankou, Wuhan, 430030, China
- Key Laboratory of Cancer Invasion and Metastasis (Ministry of Education), Hubei Key Laboratory of Tumour Invasion and Metastasis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Hankou, Wuhan, 430030, China
| | - Jianqing Zhu
- Department of Gynaecologic Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Weidong Zhao
- Department of Gynaecologic Oncology, Anhui Provincial Cancer Hospital, Hefei, China
| | - Yi Huang
- Department of Gynaecologic Oncology, Hubei Cancer Hospital, Wuhan, China
| | - Ruifang An
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hong Zheng
- Department of Gynaecology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital, Beijing, China
| | - Pengpeng Qu
- Department of Gynaecology Oncology, Tianjin Central Hospital of Gynaecology Obstetrics, Tianjin, China
| | - Li Wang
- Department of Gynaecologic Oncology, Affiliated Cancer Hospital of Zhengzhou University, (Henan Cancer Hospital), Zhengzhou, China
| | - Qi Zhou
- Department of Gynaecologic Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Danbo Wang
- Department of Gynaecologic Oncology, Liaoning Cancer Hospital, Shenyang, China
| | - Ge Lou
- Department of Gynaecologic Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jing Wang
- Department of Gynaecologic Oncology, Hunan Cancer Hospital, Changsha, China
| | - Ke Wang
- Department of Gynaecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Beihua Kong
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, China
| | - Xing Xie
- Department of Gynaecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Rutie Yin
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Chengdu, China
| | - John Low
- Cancer Centre @ PHKL, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Abdul Malik Rozita
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lim Chun Sen
- Oncology Department, Hospital Sultan Ismail, Johor Bahru, Malaysia
| | | | - Kho Swee Kiong
- Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Jihong Liu
- Department of Gynaecologic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China
| | - Zhiqing Liang
- Department of Gynaecologic Oncology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Weiguo Lv
- Department of Gynaecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yaping Zhu
- Department of Gynaecology, Shanghai General Hospital, Shanghai, China
| | - Weiguo Hu
- Fudan University Shanghai Cancer Centre and Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Sun
- Department of Gynaecologic Oncology, Anhui Provincial Cancer Hospital, Hefei, China
| | - Jingya Su
- Department of Medical Affairs, AstraZeneca, Shanghai, China
| | - Qiqi Wang
- Department of Medical Affairs, AstraZeneca, Shanghai, China
| | - Rongyu Zang
- Department of Gynaecologic Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Ding Ma
- Department of Obstetrics and Gynaecology, National Clinical Research Centre for Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Hankou, Wuhan, 430030, China.
- Key Laboratory of Cancer Invasion and Metastasis (Ministry of Education), Hubei Key Laboratory of Tumour Invasion and Metastasis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Hankou, Wuhan, 430030, China.
| | - Qinglei Gao
- Department of Obstetrics and Gynaecology, National Clinical Research Centre for Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Hankou, Wuhan, 430030, China.
- Key Laboratory of Cancer Invasion and Metastasis (Ministry of Education), Hubei Key Laboratory of Tumour Invasion and Metastasis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Hankou, Wuhan, 430030, China.
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Sowamber R, Lukey A, Huntsman D, Hanley G. Ovarian Cancer: From Precursor Lesion Identification to Population-Based Prevention Programs. Curr Oncol 2023; 30:10179-10194. [PMID: 38132375 PMCID: PMC10742141 DOI: 10.3390/curroncol30120741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Epithelial ovarian cancer (EOC) is a heterogeneous group of malignancies, including high-grade serous ovarian cancer (HGSC). HGSC is often diagnosed at advanced stages and is linked to TP53 variants. While BRCA variants elevate risk, most HGSC cases occur in individuals without known genetic variants, necessitating prevention strategies for people without known high-risk genetic variants. Effective prevention programs are also needed due to the lack of traditional screening options. An emerging primary prevention strategy is opportunistic salpingectomy, which involves removing fallopian tubes during another planned pelvic surgery. Opportunistic salpingectomy offers a safe and cost-effective preventative option that is gaining global adoption. With the publication of the first cohort study of patients who underwent salpingectomy, specifically for cancer prevention, attention has turned to broadening opportunities for salpingectomy in addition to more targeted approaches. Prevention opportunities are promising with increasing adoption of salpingectomy and the increased understanding of the etiology of the distinct histotypes of ovarian cancer. Yet, further research on targeted risk-reducing salpingectomy with thoughtful consideration of equity is necessary to reduce death and suffering from ovarian cancer.
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Affiliation(s)
- Ramlogan Sowamber
- Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, BC V6T 1Z4, Canada
| | - Alexandra Lukey
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - David Huntsman
- Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, BC V6T 1Z4, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Gillian Hanley
- Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
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