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Arends CM, Kopp K, Hablesreiter R, Estrada N, Christen F, Moll UM, Zeillinger R, Schmitt WD, Sehouli J, Kulbe H, Fleischmann M, Ray-Coquard I, Zeimet A, Raspagliesi F, Zamagni C, Vergote I, Lorusso D, Concin N, Bullinger L, Braicu EI, Damm F. Dynamics of clonal hematopoiesis under DNA-damaging treatment in patients with ovarian cancer. Leukemia 2024; 38:1378-1389. [PMID: 38637689 PMCID: PMC11147769 DOI: 10.1038/s41375-024-02253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
Clonal hematopoiesis (CH) driven by mutations in the DNA damage response (DDR) pathway is frequent in patients with cancer and is associated with a higher risk of therapy-related myeloid neoplasms (t-MNs). Here, we analyzed 423 serial whole blood and plasma samples from 103 patients with relapsed high-grade ovarian cancer receiving carboplatin, poly(ADP-ribose) polymerase inhibitor (PARPi) and heat shock protein 90 inhibitor (HSP90i) treatment within the phase II EUDARIO trial using error-corrected sequencing of 72 genes. DDR-driven CH was detected in 35% of patients and was associated with longer duration of prior PARPi treatment. TP53- and PPM1D-mutated clones exhibited substantially higher clonal expansion rates than DNMT3A- or TET2-mutated clones during treatment. Expansion of DDR clones correlated with HSP90i exposure across the three study arms and was partially abrogated by the presence of germline mutations related to homologous recombination deficiency. Single-cell DNA sequencing of selected samples revealed clonal exclusivity of DDR mutations, and identified DDR-mutated clones as the origin of t-MN in two investigated cases. Together, these results provide unique insights into the architecture and the preferential selection of DDR-mutated hematopoietic clones under intense DNA-damaging treatment. Specifically, PARPi and HSP90i therapies pose an independent risk for the expansion of DDR-CH in a dose-dependent manner.
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Affiliation(s)
- Christopher Maximilian Arends
- Department of Hematology, Oncology, and Cancer Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Klara Kopp
- Department of Hematology, Oncology, and Cancer Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Raphael Hablesreiter
- Department of Hematology, Oncology, and Cancer Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Natalia Estrada
- Department of Hematology, Oncology, and Cancer Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friederike Christen
- Department of Hematology, Oncology, and Cancer Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ute Martha Moll
- Department of Pathology, Stony Brook University Cancer Center, Stony Brook, NY, 11794, USA
| | - Robert Zeillinger
- Department of Obstetrics and Gynaecology, Molecular Oncology Group, Comprehensive Cancer Center-Gynaecologic Cancer Unit, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Daniel Schmitt
- Department of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynaecology, European Competence Center for Ovarian Cancer, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Berlin, Germany
- North Eastern German Society for Gynecological Cancer. Tumor Bank Ovarian Cancer Network, Berlin, Germany
| | - Hagen Kulbe
- Department of Gynaecology, European Competence Center for Ovarian Cancer, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Berlin, Germany
- North Eastern German Society for Gynecological Cancer. Tumor Bank Ovarian Cancer Network, Berlin, Germany
| | - Maximilian Fleischmann
- Klinik für Innere Medizin II, Abteilung Hämatologie und Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Isabelle Ray-Coquard
- Centre Anticancereux Léon Bérard, University Claude Bernard Lyon, GINECO Group, Lyon, France
| | - Alain Zeimet
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Austrian AGO, Innsbruck, Austria
| | | | - Claudio Zamagni
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ignace Vergote
- Division of Gynecological Oncology, Department of Gynecology and Obstetrics, Leuven Cancer Institute, Katholieke Universiteit Leuven, Leuven, Belgium
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven, Belgium
| | | | - Nicole Concin
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Austrian AGO, Innsbruck, Austria
| | - Lars Bullinger
- Department of Hematology, Oncology, and Cancer Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elena Ioana Braicu
- Department of Gynaecology, European Competence Center for Ovarian Cancer, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Berlin, Germany
- North Eastern German Society for Gynecological Cancer. Tumor Bank Ovarian Cancer Network, Berlin, Germany
| | - Frederik Damm
- Department of Hematology, Oncology, and Cancer Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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2
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Lorusso D, Mouret-Reynier MA, Harter P, Cropet C, Caballero C, Wolfrum-Ristau P, Satoh T, Vergote I, Parma G, Nøttrup TJ, Lebreton C, Fasching PA, Pisano C, Manso L, Bourgeois H, Runnebaum I, Zamagni C, Hardy-Bessard AC, Schnelzer A, Fabbro M, Schmalfeldt B, Berton D, Belau A, Lotz JP, Gropp-Meier M, Gladieff L, Lück HJ, Abadie-Lacourtoisie S, Pujade-Lauraine E, Ray-Coquard I. Updated progression-free survival and final overall survival with maintenance olaparib plus bevacizumab according to clinical risk in patients with newly diagnosed advanced ovarian cancer in the phase III PAOLA-1/ENGOT-ov25 trial. Int J Gynecol Cancer 2024; 34:550-558. [PMID: 38129136 PMCID: PMC10982633 DOI: 10.1136/ijgc-2023-004995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE In the PAOLA-1/ENGOT-ov25 trial (NCT02477644), adding maintenance olaparib to bevacizumab provided a substantial progression-free survival benefit in patients with newly diagnosed advanced ovarian cancer and homologous recombination deficiency (HRD)-positive tumors, irrespective of clinical risk. Subsequently, a clinically meaningful improvement in overall survival was reported with olaparib plus bevacizumab in the HRD-positive subgroup. We report updated progression-free survival and overall survival by clinical risk and HRD status. METHODS Patients in clinical response after first-line platinum-based chemotherapy plus bevacizumab received maintenance olaparib (up to 24 months) plus bevacizumab (up to 15 months in total) or placebo plus bevacizumab. This post hoc analysis evaluated 5-year progression-free survival and mature overall survival in patients classified by clinical risk and HRD status. RESULTS Of 806 randomized patients, 74% were higher-risk and 26% were lower-risk. In higher-risk HRD-positive patients, the hazard ratio (HR) for progression-free survival was 0.46 (95% confidence interval (95% CI) 0.34 to 0.61), with 5-year progression-free survival of 35% with olaparib plus bevacizumab versus 15% with bevacizumab alone; and the HR for overall survival was 0.70 (95% CI 0.50 to 1.00), with 5-year overall survival of 55% versus 42%, respectively. In lower-risk HRD-positive patients, the HR for progression-free survival was 0.26 (95% CI 0.15 to 0.45), with 5-year progression-free survival of 72% with olaparib plus bevacizumab versus 28% with bevacizumab alone; and the HR for overall survival was 0.31 (95% CI 0.14 to 0.66), with 5-year overall survival of 88% versus 61%, respectively. No benefit was seen in HRD-negative patients regardless of clinical risk. CONCLUSION This post hoc analysis indicates that in patients with newly diagnosed advanced HRD-positive ovarian cancer, maintenance olaparib plus bevacizumab should not be limited to those considered at higher risk of disease progression. Five-year progression-free survival rates support long-term remission and suggest an increased potential for cure with particular benefit suggested in lower-risk HRD-positive patients.
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Affiliation(s)
- Domenica Lorusso
- Istituto Tumori Milano + Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Milan, Italy
- Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies, (MITO), Italy
| | - Marie-Ange Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, Clermont Ferrand, France
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
| | - Philipp Harter
- Department of Gynaecology & Gynaecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
| | - Claire Cropet
- Department of Biostatistics, Centre Léon Bérard, Lyon, France
| | - Cristina Caballero
- Servicio de Oncología Médica, Hospital General Universitario de Valencia, Valencia, Spain
- Grupo Español de Investigación en Cáncer de Ovario, (GEICO), Spain
| | - Pia Wolfrum-Ristau
- Department of Obstetrics and Gynecology, Paracelsus Medical University Salzburg, Salzburg, Austria
- Arbeitsgemeinschaft Gynaekologische Onkologie Study Group, (AGO-Austria), Austria
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Gynecologic Oncology Trial and Investigation Consortium, (GOTIC), Japan
| | - Ignace Vergote
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium, European Union
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Belgium, European Union
| | - Gabriella Parma
- Gynecologic Oncology Program, European Institute of Oncology IRCCS, Milan, Italy
- Mario Negri Gynecologic Oncology Group, (MANGO), Italy
| | - Trine J Nøttrup
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Nordic Society of Gynecologic Oncology, (NSGO), Denmark
| | - Coriolan Lebreton
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Peter A Fasching
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
- Gynecology and Obstetrics Translational Medicine, Universitätsfrauenklinik Erlangen, Erlangen, Germany
| | - Carmela Pisano
- Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies, (MITO), Italy
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale Napoli, Naples, Italy
| | - Luis Manso
- Grupo Español de Investigación en Cáncer de Ovario, (GEICO), Spain
- Department of Medical Oncology, Hospital 12 de Octubre, Madrid, Spain
| | - Hugues Bourgeois
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Medical Oncology Department, Centre Jean Bernard - Clinique Victor Hugo, Le Mans, France
| | - Ingo Runnebaum
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Claudio Zamagni
- Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies, (MITO), Italy
- IRCCS Azienda Ospedaliero-universitaria di Bologna, Bologna, Italy
| | - Anne-Claire Hardy-Bessard
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Oncologie Médicale, Centre CARIO - HPCA, Plérin Sur Mer, Plérin, France
| | - Andreas Schnelzer
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
- Frauenklinik und Poliklinik Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Michel Fabbro
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Institut du Cancer de Montpellier, Montpellier, France
| | - Barbara Schmalfeldt
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Dominique Berton
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- L'Institut de Cancérologie de l'Ouest (ICO), Centre René Gauducheau, Saint Herblain, France
| | - Antje Belau
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
- Universitätsmedizin Greifswald, Frauenklinik & Frauenarztpraxis, Greifswald, Germany
| | - Jean-Pierre Lotz
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Hôpital Tenon, APHP, Paris, France
| | - Martina Gropp-Meier
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
- Onkologie Ravensburg, Ravensburg, Germany
| | - Laurence Gladieff
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Oncopole CLAUDIUS REGAUD IUCT-Oncopole, Toulouse, France
| | - Hans-Joachim Lück
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
- Gynäkologisch-Onkologische Praxis, Hannover, Germany
| | - Sophie Abadie-Lacourtoisie
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- ICO Paul Papin, Angers, France
| | - Eric Pujade-Lauraine
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Medical Oncology Department, ARCAGY Research, Paris, France
| | - Isabelle Ray-Coquard
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Department of Medical Oncology, Centre Léon Berard, Lyon, France
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3
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Vergote I, Pérez-Fidalgo JA, Hamilton EP, Valabrega G, Van Gorp T, Sehouli J, Cibula D, Levy T, Welch S, Richardson DL, Guerra EM, Scambia G, Henry S, Wimberger P, Miller DS, Klat J, Martínez-Garcia J, Raspagliesi F, Pothuri B, Romero I, Bergamini A, Slomovitz B, Schochter F, Høgdall E, Fariñas-Madrid L, Monk BJ, Michel D, Kauffman MG, Shacham S, Mirza MR, Makker V. Oral Selinexor as Maintenance Therapy After First-Line Chemotherapy for Advanced or Recurrent Endometrial Cancer. J Clin Oncol 2023; 41:5400-5410. [PMID: 37669480 DOI: 10.1200/jco.22.02906] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/18/2023] [Accepted: 07/08/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE Selinexor inhibits exportin-1 (XPO1) resulting in nuclear accumulation of tumor suppressor proteins including p53 and has clinical activity in endometrial cancer (EC). The primary end point was to assess progression-free survival (PFS) with once-weekly oral selinexor in patients with advanced or recurrent EC. PATIENTS AND METHODS ENGOT-EN5/GOG-3055/SIENDO was a randomized, prospective, multicenter, double-blind, placebo-controlled, phase III study at 107 sites in 10 countries. Patients 18 years or older with histologically confirmed EC were enrolled. All had completed a single line of at least 12 weeks of taxane-platinum combination chemotherapy and achieved partial or complete response. Patients were assigned to receive 80 mg oral selinexor once weekly or placebo with 2:1 random assignment (ClinicalTrials.gov identifier: NCT03555422). RESULTS Between January 2018 and December 2021, 263 patients were randomly assigned, with 174 allocated to selinexor and 89 to placebo. The median PFS was 5.7 months (95% CI, 3.81 to 9.20) with selinexor versus 3.8 months (95% CI, 3.68 to 7.39) with placebo (hazard ratio [HR], 0.76 [95% CI, 0.54 to 1.08]; two-sided P = .126), which did not meet the criteria for statistical significance in the intent-to-treat population. Incorrect chemotherapy response stratification data for 7 (2.7%) patients were identified. In a prespecified exploratory analysis of PFS in audited stratification data, PFS for selinexor met the threshold for statistical significance (HR, 0.71; 95% CI, 0.499 to 0.996; two-sided P = .049). Furthermore, patients with the TP53 wild-type (wt) EC had a median PFS of 13.7 and 3.7 months with selinexor and placebo. The most common grade 3 treatment-related adverse events were nausea (9%), neutropenia (9%), and thrombocytopenia (7%). CONCLUSION The significance level for PFS was only met in the audited analysis. However, a preliminary analysis of a prespecified exploratory subgroup of patients with TP53wt EC showed promising results with selinexor maintenance therapy.
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Affiliation(s)
- Ignace Vergote
- BGOG, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Giorgio Valabrega
- MITO and Department of Oncology, University of Torino, Mauriziano Hospital, Turin, Italy
| | - Toon Van Gorp
- BGOG, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Jalid Sehouli
- Department of Gynecology, NOGGO, European Competence Center for Ovarian Cancer, Charité Comprehensive Cancer Center, Charité-Berlin University of Medicine, Berlin, Germany
| | - David Cibula
- CEEGOG, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tally Levy
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ISGO, Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | | | - Debra L Richardson
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Eva M Guerra
- GEICO, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Giovanni Scambia
- MITO, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stéphanie Henry
- CHU UCL Namur Site Ste Elisabeth, Service d'onco-hématologie (SORMN), BGOG and Université Catholique de Louvain, Namur, Belgium
| | - Pauline Wimberger
- Department of Obstetrics and Gynecology, University Hospital Carl Gustav Carus, NOGGO and Technische Universitat Dresden, Dresden, Germany
| | - David S Miller
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jaroslav Klat
- University Hospital Ostrava and University of Ostrava, Ostrava-Poruba, Czech Republic
| | | | | | - Bhavana Pothuri
- NYU Langone Health, Perlmutter Cancer Center, New York University School of Medicine, New York, NY
| | - Ignacio Romero
- Medical Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, San Raffaele Milano, Milano, Italy
- Università Vita-Salute San Raffaele, Milano, Italy
| | - Brian Slomovitz
- Mount Sinai Medical Center, Florida International University, Miami, FL
| | - Fabienne Schochter
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Estrid Høgdall
- Department of Pathology, Herlev Hospital Copenhagen University Hospital, Copenhagen, Denmark
| | - Lorena Fariñas-Madrid
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Bradley J Monk
- GOG, HonorHealth, University of Arizona, Creighton University, Phoenix, AZ
| | | | | | | | | | - Vicky Makker
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
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4
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Pujade-Lauraine E, Selle F, Scambia G, Asselain B, Marmé F, Lindemann K, Colombo N, Mądry R, Glasspool R, Vergote I, Korach J, Lheureux S, Dubot C, Oaknin A, Zamagni C, Heitz F, Gladieff L, Rubio-Pérez MJ, Scollo P, Blakeley C, Shaw B, Ray-Coquard I, Redondo A. Maintenance olaparib rechallenge in patients with platinum-sensitive relapsed ovarian cancer previously treated with a PARP inhibitor (OReO/ENGOT-ov38): a phase IIIb trial. Ann Oncol 2023; 34:1152-1164. [PMID: 37797734 DOI: 10.1016/j.annonc.2023.09.3110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Poly(ADP-ribose) polymerase (PARP) inhibitor maintenance therapy is the standard of care for some patients with advanced ovarian cancer. We evaluated the efficacy and safety of PARP inhibitor rechallenge. PATIENTS AND METHODS This randomized, double-blind, multicenter trial (NCT03106987) enrolled patients with platinum-sensitive relapsed ovarian cancer who had received one prior PARP inhibitor therapy for ≥18 and ≥12 months in the BRCA-mutated and non-BRCA-mutated cohorts, respectively, following first-line chemotherapy or for ≥12 and ≥6 months, respectively, following a second or subsequent line of chemotherapy. Patients were in response following their last platinum-based chemotherapy regimen and were randomized 2 : 1 to maintenance olaparib tablets 300 mg twice daily or placebo. Investigator-assessed progression-free survival (PFS) was the primary endpoint. RESULTS Seventy four patients in the BRCA-mutated cohort were randomized to olaparib and 38 to placebo, and 72 patients in the non-BRCA-mutated cohort were randomized to olaparib and 36 to placebo; >85% of patients in both cohorts had received ≥3 prior lines of chemotherapy. In the BRCA-mutated cohort, the median PFS was 4.3 months with olaparib versus 2.8 months with placebo [hazard ratio (HR) 0.57; 95% confidence interval (CI) 0.37-0.87; P = 0.022]; 1-year PFS rates were 19% versus 0% (Kaplan-Meier estimates). In the non-BRCA-mutated cohort, median PFS was 5.3 months for olaparib versus 2.8 months for placebo (HR 0.43; 95% CI 0.26-0.71; P = 0.0023); 1-year PFS rates were 14% versus 0% (Kaplan-Meier estimates). No new safety signals were identified with olaparib rechallenge. CONCLUSIONS In ovarian cancer patients previously treated with one prior PARP inhibitor and at least two lines of platinum-based chemotherapy, maintenance olaparib rechallenge provided a statistically significant, albeit modest, PFS improvement over placebo in both the BRCA-mutated and non-BRCA-mutated cohorts, with a proportion of patients in the maintenance olaparib rechallenge arm of both cohorts remaining progression free at 1 year.
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Affiliation(s)
- E Pujade-Lauraine
- Association de Recherche Cancers Gynécologiques (ARCAGY)-Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Paris; GINECO, Paris.
| | - F Selle
- GINECO, Paris; Department of Medical Oncology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - G Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica, Rome; Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Milan, Italy
| | - B Asselain
- Association de Recherche Cancers Gynécologiques (ARCAGY)-Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Paris; GINECO, Paris
| | - F Marmé
- University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim; Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Studiengruppe, Essen, Germany
| | - K Lindemann
- Department of Gynaecological Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo; Nordic Society of Gynecologic Oncology (NSGO), Oslo, Norway
| | - N Colombo
- University of Milan-Bicocca and IEO European Institute of Oncology IRCCS, Milan; Mario Negri Gynecologic Oncology Group (MANGO), Italy
| | - R Mądry
- Uniwersytet Medyczny im.K.Marcinkowskiego w Poznaniu, Poznań; Polish Gynecologic Oncology Group (PGOG), Poznan, Poland
| | - R Glasspool
- Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; National Cancer Research Institute (NCRI), London; Scottish Gynaecological Cancer Trials Group (SGCTG), Edinburgh, UK
| | - I Vergote
- University Hospitals Leuven, Leuven Cancer Institute, Leuven; Belgian and Luxembourg Gynaecological Oncology Group (BGOG), Leuven, Belgium
| | - J Korach
- Sheba Medical Center, Tel Aviv University, Tel Hashomer, Ramat Gan; Israeli Society of Gynecologic Oncology (ISGO), Tel Aviv, Israel
| | - S Lheureux
- Princess Margaret Hospital, Department of Medical Oncology, Toronto; Princess Margaret Consortium, Toronto, Canada
| | - C Dubot
- GINECO, Paris; Oncologie Médicale, Institut Curie Saint Cloud, Paris, France
| | - A Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona; Grupo Español de Investigación en Cáncer de Ovario (GEICO), Madrid, Spain
| | - C Zamagni
- Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Milan, Italy; IRCCS Azienda Ospedaliero-universitaria di Bologna, Bologna, Italy
| | - F Heitz
- Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen; Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin; Berlin Institute of Health, Berlin; AGO Studiengruppe, Wiesbaden, Germany
| | - L Gladieff
- GINECO, Paris; Institut Claudius Regaud IUCT-Oncopole, Toulouse, France
| | - M J Rubio-Pérez
- Grupo Español de Investigación en Cáncer de Ovario (GEICO), Madrid, Spain; Reina Sofia University Hospital, Cordoba, Spain
| | - P Scollo
- Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Milan, Italy; Kore University Enna, Enna; Dipartimento di Ginecologia e Ostetricia, Ospedale Cannizzaro, Catania, Italy
| | | | - B Shaw
- AstraZeneca, Cambridge, UK
| | - I Ray-Coquard
- GINECO, Paris; Medical Oncology Department, Centre Léon Bérard and University Claude Bernard Lyon, Lyon, France
| | - A Redondo
- Grupo Español de Investigación en Cáncer de Ovario (GEICO), Madrid, Spain; La Paz University Hospital-IdiPAZ, Madrid, Spain
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5
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Kurtz JE, Pujade-Lauraine E, Oaknin A, Belin L, Leitner K, Cibula D, Denys H, Rosengarten O, Rodrigues M, de Gregorio N, Martinez García J, Petru E, Kocián R, Vergote I, Pautier P, Schmalfeldt B, Gaba L, Polterauer S, Mouret Reynier MA, Sehouli J, Churruca C, Selle F, Joly F, D'Hondt V, Bultot-Boissier É, Lebreton C, Lotz JP, Largillier R, Heudel PE, Heitz F. Atezolizumab Combined With Bevacizumab and Platinum-Based Therapy for Platinum-Sensitive Ovarian Cancer: Placebo-Controlled Randomized Phase III ATALANTE/ENGOT-ov29 Trial. J Clin Oncol 2023; 41:4768-4778. [PMID: 37643382 PMCID: PMC10602539 DOI: 10.1200/jco.23.00529] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/23/2023] [Accepted: 07/08/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE Platinum-based doublets with concurrent and maintenance bevacizumab are standard therapy for ovarian cancer (OC) relapsing after a platinum-free interval (PFI) >6 months. Immunotherapy may be synergistic with bevacizumab and chemotherapy. PATIENTS AND METHODS ATALANTE/ENGOT-ov29 (ClinicalTrials.gov identifier: NCT02891824), a placebo-controlled double-blinded randomized phase III trial, enrolled patients with recurrent epithelial OC, one to two previous chemotherapy lines, and PFI >6 months. Eligible patients were randomly assigned 2:1 to atezolizumab (1,200 mg once every 3 weeks or equivalent) or placebo for up to 24 months, combined with bevacizumab and six cycles of chemotherapy doublet, stratified by PFI, PD-L1 status, and chemotherapy regimen. Coprimary end points were investigator-assessed progression-free survival (PFS) in the intention-to-treat (ITT) and PD-L1-positive populations (alpha .025 for each population). RESULTS Between September 2016 and October 2019, 614 patients were randomly assigned: 410 to atezolizumab and 204 to placebo. Only 38% had PD-L1-positive tumors. After 3 years' median follow-up, the PFS difference between atezolizumab and placebo did not reach statistical significance in the ITT (hazard ratio [HR], 0.83; 95% CI, 0.69 to 0.99; P = .041; median 13.5 v 11.3 months, respectively) or PD-L1-positive (HR, 0.86; 95% CI, 0.63 to 1.16; P = .30; median 15.2 v 13.1 months, respectively) populations. The immature overall survival (OS) HR was 0.81 (95% CI, 0.65 to 1.01; median 35.5 v 30.6 months with atezolizumab v placebo, respectively). Global health-related quality of life did not differ between treatment arms. Grade ≥3 adverse events (AEs) occurred in 88% of atezolizumab-treated and 87% of placebo-treated patients; grade ≥3 AEs typical of immunotherapy were more common with atezolizumab (13% v 8%, respectively). CONCLUSION ATALANTE/ENGOT-ov29 did not meet its coprimary PFS objectives in the ITT or PD-L1-positive populations. OS follow-up continues. Further research on biopsy samples is warranted to decipher the immunologic landscape of late-relapsing OC.
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Affiliation(s)
- Jean-Emmanuel Kurtz
- Department of Medical and Surgical Oncology & Hematology, ICANS, Strasbourg, France
| | - Eric Pujade-Lauraine
- Association de Recherche sur les CAncers dont GYnécologiques (ARCAGY)-GINECO, Paris, France
| | - Ana Oaknin
- Gynaecologic Cancer Programme, Vall D'Hebron Institute of Oncology (VHIO), Hospital Universitario Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Lisa Belin
- Biostatistics and Public Health Department, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpětriére – Charles Foix, Paris, France
| | - Katharina Leitner
- Gynecology and Obstetrics Department, Medical University of Innsbruck, Innsbruck, Austria
| | - David Cibula
- Department of Obstetrics and Gynecology, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Hannelore Denys
- Department of Medical Oncology, University Hospital Ghent, Ghent, Belgium
| | - Ora Rosengarten
- Oncology Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Manuel Rodrigues
- Department of Medical Oncology and INSERM U830, Institut Curie, PSL Research University, Paris, France
| | - Nikolaus de Gregorio
- Department of Obstetrics and Gynaecology, University Hospital Ulm, Ulm, Germany
- SLK Klinikum Heilbronn, Heilbronn, Germany
| | - Jeronimo Martinez García
- Medical Oncology Department, Hospital Universitario Virgen Arrixaca (El Palmar) and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Edgar Petru
- Department of Gynecology and Obstetrics, Division of Gynecology, Medical University of Graz, Graz, Austria
| | - Roman Kocián
- Department of Obstetrics and Gynecology, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Ignace Vergote
- Department of Gynecology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Barbara Schmalfeldt
- Department of Gynaecology and Gynaecologic Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Lydia Gaba
- Department of Medical Oncology, Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Clínic de Barcelona, Institut D'Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Cristina Churruca
- Department of Medical Oncology, Hospital Universitario Donostia, Donostia, Spain
| | - Frédéric Selle
- Oncology Department, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Florence Joly
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Véronique D'Hondt
- Medical Oncology Department, Institut Régional du Cancer Montpellier (ICM), Montpellier, France
| | - Émilie Bultot-Boissier
- Oncology Department, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Jean-Pierre Lotz
- Medical Oncology Service, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Rémy Largillier
- Department of Medical Oncology, Centre Azuréen de Cancérologie, Mougins, France
| | | | - Florian Heitz
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité Medical University, Berlin, Germany
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
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6
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Ray-Coquard I, Leary A, Pignata S, Cropet C, González-Martin A, Marth C, Nagao S, Vergote I, Colombo N, Mäenpää J, Selle F, Sehouli J, Lorusso D, Alia EMG, Bogner G, Yoshida H, Lefeuvre-Plesse C, Buderath P, Mosconi AM, Lortholary A, Burges A, Medioni J, El-Balat A, Rodrigues M, Park-Simon TW, Dubot C, Denschlag D, You B, Pujade-Lauraine E, Harter P. Olaparib plus bevacizumab first-line maintenance in ovarian cancer: final overall survival results from the PAOLA-1/ENGOT-ov25 trial. Ann Oncol 2023:S0923-7534(23)00686-5. [PMID: 37211045 DOI: 10.1016/j.annonc.2023.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND In the PAOLA-1/ENGOT-ov25 primary analysis, maintenance olaparib plus bevacizumab demonstrated a significant progression-free survival (PFS) benefit in newly diagnosed advanced ovarian cancer patients in clinical response after first-line platinum-based chemotherapy plus bevacizumab, irrespective of surgical status. Prespecified, exploratory analyses by molecular biomarker status showed substantial benefit in patients with a BRCA1/BRCA2 mutation (BRCAm) or homologous recombination deficiency (HRD; BRCAm and/or genomic instability). We report the prespecified final overall survival (OS) analysis, including analyses by HRD status. PATIENTS AND METHODS Patients were randomized 2:1 to olaparib (300 mg bid; up to 24 months) plus bevacizumab (15 mg/kg q3w; 15 months total) or placebo plus bevacizumab. Analysis of OS, a key secondary endpoint in hierarchical testing, was planned for ∼60% maturity or 3 years after the primary analysis. RESULTS After median follow-up of 61.7 and 61.9 months in the olaparib and placebo arms, respectively, median OS was 56.5 versus 51.6 months in the ITT (hazard ratio [HR]=0.92, 95% CI 0.76-1.12; P=0.4118). Subsequent poly(ADP-ribose) polymerase (PARP) inhibitor therapy was received by 105 (19.6%) olaparib patients versus 123 (45.7%) placebo patients. In the HRD-positive population, OS was longer with olaparib plus bevacizumab (HR=0.62, 95% CI 0.45-0.85; 5-year OS rate, 65.5% versus 48.4%); at 5 years, updated PFS also showed a higher proportion of olaparib plus bevacizumab patients without relapse (HR=0.41, 95% CI 0.32-0.54; 5-year PFS rate, 46.1% versus 19.2%). Myelodysplastic syndrome, acute myeloid leukemia, aplastic anemia, and new primary malignancy incidence remained low and balanced between arms. CONCLUSIONS Olaparib plus bevacizumab provided clinically meaningful OS improvement for first-line patients with HRD-positive ovarian cancer. These prespecified exploratory analyses demonstrated improvement despite a high proportion of patients in the placebo arm receiving PARP inhibitors post-progression, confirming the combination as one of the standards of care in this setting with the potential to enhance cure.
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Affiliation(s)
- I Ray-Coquard
- Department of Medical Oncology, Centre Léon BERARD, Lyon, and GINECO, France;.
| | - A Leary
- Gynecological Cancer Unit, Department of Medicine, Institut Gustave Roussy, Villejuif, and GINECO, France
| | - S Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori 'Fondazione G Pascale', IRCCS, Napoli, and MITO, Italy
| | - C Cropet
- Department of Biostatistics Centre Léon BERARD, Lyon, and GINECO, France
| | - A González-Martin
- Department of Medical Oncology, Clínica Universidad de Navarra, Program in Solid Tumors (CIMA), Pamplona, and GEICO, Spain
| | - C Marth
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, and AGO Austria, Austria
| | - S Nagao
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, and GOTIC, Japan
| | - I Vergote
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven Cancer Institute, Leuven, and BGOG, Belgium, European Union
| | - N Colombo
- University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS Milan, and MANGO, Italy
| | - J Mäenpää
- Department of Obstetrics and Gynecology and Cancer Center, Tampere University and University Hospital, Tampere, and NSGO, Finland
| | - F Selle
- Department of Medical Oncology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, and GINECO, France
| | - J Sehouli
- Charité - Department of Gynecology with Center of Oncological Surgery, Universitätsmedizin Berlin, Berlin, and AGO, Germany
| | - D Lorusso
- (3)Gynecologic Oncology Unit, Catholic University of Sacred Heart and Fondazione Policlinico Gemelli IRCCS, Rome, and MITO, Italy
| | - E M Guerra Alia
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, and GEICO, Spain
| | - G Bogner
- Department of Obstetrics and Gynecology, Paracelsus Medical University Salzburg, Salzburg, and AGO Austria, Austria
| | - H Yoshida
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, and GOTIC, Japan
| | - C Lefeuvre-Plesse
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, and GINECO, France
| | - P Buderath
- Universitätsklinikum Essen, University Hospital Essen, West German Cancer Center, Department of Gynecology and Obstetrics, Essen and AGO, Germany
| | - A M Mosconi
- S.C. di Oncologia Medica Osp. S. Maria della Misericordia - AO di Perugia, and MITO, Italy
| | - A Lortholary
- Centre Catherine de Sienne Hopital privé du Confluent, Nantes, and GINECO, France
| | - A Burges
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, and AGO, Germany
| | - J Medioni
- Hôpital Européen Georges Pompidou, Universite de Paris Cite, Paris, and GINECO, France
| | - A El-Balat
- Spital Uster, Frauenklinik, Uster, Switzerland, and Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt, and AGO, Germany
| | - M Rodrigues
- Department of Medical Oncology, Institut Curie, Hopital Claudius Régaud, PSL Research University, Paris, France, and GINECO, France
| | - T-W Park-Simon
- Department of Gynaecology and Obstetrics, Hannover Medical School, Hannover, and AGO, Germany
| | - C Dubot
- Oncologie Médicale, Institut Curie, Hôpital René Huguenin, Saint Cloud, Paris, and GINECO, France
| | - D Denschlag
- Hochtaunuskliniken, Bad Homburg, and AGO, Germany
| | - B You
- HCL - Hospices Civils de Lyon IC-HCL, CITOHL, Université Claude Bernard Lyon 1, CICLY,Lyon, and GINECO, France
| | | | - P Harter
- Department of Gynaecology & Gynaecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, and AGO, Germany
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7
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Vergote I, Van Nieuwenhuysen E, Casado A, Laenen A, Lorusso D, Braicu EI, Guerra-Alia E, Zola P, Wimberger P, Debruyne PR, Falcó E, Ferrero A, Muallem MZ, Kerger J, García-Martinez E, Pignata S, Sehouli J, Van Gorp T, Gennigens C, Rubio MJ. Randomized phase II BGOG/ENGOT-cx1 study of paclitaxel-carboplatin with or without nintedanib in first-line recurrent or advanced cervical cancer. Gynecol Oncol 2023; 174:80-88. [PMID: 37167896 DOI: 10.1016/j.ygyno.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/19/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Nintedanib is an oral tyrosine kinase inhibitor targeting, among others, vascular endothelial growth factor receptor. The aim was to establish the role of nintedanib in addition to paclitaxel and carboplatin in first-line recurrent/metastatic cervical cancer. METHODS Double-blind phase II randomized study in patients with first-line recurrent or primary advanced (FIGO stage IVB) cervical cancer. Patients received carboplatin-paclitaxel with oral nintedanib 200 mg BID/placebo. The primary endpoint was progression-free survival (PFS) at 1.5 years and α = 0.15, β = 80%, one sided. RESULTS 120 patients (62 N, 58C) were randomized. Median follow-up was 35 months. Baseline characteristics were similar in both groups (total population: squamous cell carcinoma 62%, prior radiotherapy 64%, primary advanced 25%, recurrent 75%). The primary endpoint was met with a PFS at 1.5 years of 15.1% versus 12.8% in favor of the nintedanib arm (p = 0.057). Median overall survival (OS) was 21.7 and 16.4 months for N and C, respectively. Confirmed RECIST response rate was 48% for N and 39% for C. No new adverse events were noted for N. However, N was associated with numerically more serious adverse events for anemia and febrile neutropenia. Global health status during and at the end of the study was similar in both arms. CONCLUSION The study met its primary endpoint with a prolonged PFS in the N arm. No new safety signals were observed.
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Affiliation(s)
- I Vergote
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG) and University Hospitals Leuven, Division of Gynaecological Oncology, Leuven, European Union, Belgium.
| | - E Van Nieuwenhuysen
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG) and University Hospitals Leuven, Division of Gynaecological Oncology, Leuven, European Union, Belgium
| | - A Casado
- Hospital Clínico San Carlos, Spain and Grupo Español de Cáncer de Ovario (GEICO), Madrid, Spain
| | - A Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium
| | - D Lorusso
- Multicentre Italian Trials in Ovarian Cancer and Gynecologic malignancies (MITO) and Fondazione Policlinico Universitario Gemelli IRCCS and Catholic University of Sacred Heart, Roma, Italy
| | - E I Braicu
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V (NOGGO) and Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, Berlin, Germany; Stanford University, Department of Obstetrics and Gynecology, CA, USA
| | - E Guerra-Alia
- Hospital Universitario Ramón y Cajal, and GEICO, Madrid, Spain
| | - P Zola
- Mario Negri Gynecologic Oncology Group (MaNGO) and Department of Surgical Sciences Università degli Studi di Torino, Italy
| | - P Wimberger
- NOGGO and Technische Universität Dresden and NCT Dresden, Dresden, Germany
| | - P R Debruyne
- BGOG and Kortrijk Cancer Centre, AZ Groeninge, Kortrijk, Belgium; School of Life Sciences, Anglia Ruskin University, Cambridge, UK; School of Nursing & Midwifery, University of Plymouth, Plymouth, UK
| | - E Falcó
- GEICO and Policlinica Miramar, Palma de Mallorca, Spain
| | - A Ferrero
- MaNGO and Mauriziano Hospital and University of Torino, Torino, Italy
| | - M Z Muallem
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V (NOGGO) and Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - J Kerger
- BGOG and Instituut Jules Bordet, Brussels, Belgium
| | - E García-Martinez
- Hospital General Universitario Morales Meseguer, Murcia, Spain and GEICO
| | - S Pignata
- MITO and Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Italy
| | - J Sehouli
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V (NOGGO) and Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - T Van Gorp
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG) and University Hospitals Leuven, Division of Gynaecological Oncology, Leuven, European Union, Belgium
| | | | - M J Rubio
- Hospital Reina Sofía, Córdoba, Spain and GEICO
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8
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Herzog TJ, Pignata S, Ghamande SA, Rubio MJ, Fujiwara K, Vulsteke C, Armstrong DK, Sehouli J, Coleman RL, Gabra H, Scambia G, Monk BJ, Arranz JA, Ushijima K, Hanna R, Zamagni C, Wenham RM, González-Martín A, Slomovitz B, Jia Y, Ramsay L, Tewari KS, Weil SC, Vergote IB. Randomized phase II trial of farletuzumab plus chemotherapy versus placebo plus chemotherapy in low CA-125 platinum-sensitive ovarian cancer. Gynecol Oncol 2023; 170:300-308. [PMID: 36758420 DOI: 10.1016/j.ygyno.2023.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/19/2022] [Accepted: 01/04/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The primary purpose of this study was to determine if farletuzumab, an antifolate receptor-α monoclonal antibody, improved progression-free survival (PFS) versus placebo when added to standard chemotherapy regimens in patients with platinum-sensitive recurrent ovarian cancer (OC) in first relapse (platinum-free interval: 6-36 months) with low cancer antigen 125 (CA-125) levels. METHODS Eligibility included CA-125 ≤ 3 x upper limit of normal (ULN, 105 U/mL), high-grade serous, platinum-sensitive recurrent OC, previous treatment with debulking surgery, and first-line platinum-based chemotherapy with 1st recurrence between 6 and 36 months since frontline platinum-based treatment. Patients received investigator's choice of either carboplatin (CARBO)/paclitaxel (PTX) every 3 weeks or CARBO/pegylated liposomal doxorubicin (PLD) every 4 weeks x6 cycles in combination with either farletuzumab [5 mg/kg weekly] or placebo randomized in a 2:1 ratio. Maintenance treatment with farletuzumab (5 mg/kg weekly) or placebo was given until disease progression or intolerance. RESULTS 214 patients were randomly assigned to farletuzumab+chemotherapy (142 patients) versus placebo+chemotherapy (72 patients). The primary efficacy endpoint, PFS, was not significantly different between treatment groups (1-sided α = 0.10; p-value = 0.25; hazard ratio [HR] = 0.89, 80% confidence interval [CI]: 0.71, 1.11), a median of 11.7 months (95% CI: 10.2, 13.6) versus 10.8 months (95% CI: 9.5, 13.2) for farletuzumab+chemotherapy and placebo+chemotherapy, respectively. No new safety concerns were identified with the combination of farletuzumab+chemotherapy. CONCLUSIONS Adding farletuzumab to standard chemotherapy does not improve PFS in patients with OC who were platinum-sensitive in first relapse with low CA-125 levels. Folate receptor-α expression was not measured in this study. (Clinical Trial Registry NCT02289950).
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Affiliation(s)
- Thomas J Herzog
- University of Cincinnati Cancer Center, Cincinnati, OH, USA.
| | - Sandro Pignata
- Instituto Nazionale Tumori di Napoli IRCCS, Fondazione Pascale (MITO), Napoli, Italy
| | | | - Maria-Jesús Rubio
- Hospital Universitario Reina Sofia, Grupo Español de Investigación en Cáncer de Ovario (GEICO) Group, Cordoba, Spain
| | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, Hidaka-City, Saitama, Japan
| | - Christof Vulsteke
- Center for Oncological Research (CORE), Antwerp University and Integrated Cancer Center, Ghent, Belgium
| | | | - Jalid Sehouli
- Charité-Universitätsmedizin Berlin and North-Eastern German Society for Gynecological Oncology (NOGGO), NOGGO, Germany
| | | | | | - Giovanni Scambia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Rome, Italy
| | - Bradley J Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ, USA
| | | | | | | | | | | | - Antionio González-Martín
- GEICO, Medical Oncology Department, Clínica Universidad de Navarra, Madrid, Spain; Program in Solid Tumors, Center for Applied Medical Research (CIMA), Pamplona, Spain
| | - Brian Slomovitz
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | | | | | | | | | - Ignace B Vergote
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG) and University Hospitals Leuven, Leuven, Belgium
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9
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INOVATYON/ ENGOT-ov5 study: Randomized phase III international study comparing trabectedin/pegylated liposomal doxorubicin (PLD) followed by platinum at progression vs carboplatin/PLD in patients with recurrent ovarian cancer progressing within 6-12 months after last platinum line. Br J Cancer 2023; 128:1503-1513. [PMID: 36759720 PMCID: PMC10070417 DOI: 10.1038/s41416-022-02108-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND This trial investigated the hypothesis that the treatment with trabectedin/PLD (TP) to extend the platinum-free interval (TFIp) can improve overall survival (OS) in patients with recurrent ovarian cancer (OC). METHODS Patients with OC (up to two previous platinum-based lines), with a TFIp of 6-12 months, were randomised to receive carboplatin/PLD (CP) or TP followed by platinum therapy at relapse. The primary endpoint was OS (HR: 0.75). RESULTS The study enrolled 617 patients. The median TFIp was 8.3 months and 30.3% of patients had received two previous platinum lines. 74% and 73.9% of patients, respectively, received a subsequent therapy (ST) in the CP and TP arm; in the latter TP arm 87.2% of ST was platinum-based, as per protocol. The median OS was 21.4 for CP and 21.9 months for TP (HR 1.13; 95% CI: 0.94-1.35; p = 0.197). Grade 3-5 adverse reactions occurred in 37.1% of patients in the CP arm and 69.7% of patients in the TP arm, and the most frequent were neutropenia (22.8% CP, 39.5% TP), gastrointestinal (7.1% CP, 17.4% TP), hepatic (0.7% CP, 19.1% TP). CONCLUSIONS This study did not meet the primary endpoint. CP combination remains the standard for patients with recurrent OC and a 6-12 months TFIp; TP is an effective treatment in patients suffering from persistent platinum toxicities. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, number NCT01379989.
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Pfisterer J, Joly F, Kristensen G, Rau J, Mahner S, Pautier P, El-Balat A, Kurtz JE, Canzler U, Sehouli J, Heubner ML, Hartkopf AD, Baumann K, Hasenburg A, Hanker LC, Belau A, Schmalfeldt B, Denschlag D, Park-Simon TW, Selle F, Jackisch C, Burges A, Lück HJ, Emons G, Meier W, Gropp-Meier M, Schröder W, de Gregorio N, Hilpert F, Harter P. Optimal Treatment Duration of Bevacizumab as Front-Line Therapy for Advanced Ovarian Cancer: AGO-OVAR 17 BOOST/GINECO OV118/ENGOT Ov-15 Open-Label Randomized Phase III Trial. J Clin Oncol 2023; 41:893-902. [PMID: 36332161 DOI: 10.1200/jco.22.01010] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To compare standard versus extended duration of bevacizumab treatment in combination with front-line chemotherapy in women with newly diagnosed stage IIB-IV ovarian cancer. METHODS In this multicenter, open-label, randomized phase III trial (ClinicalTrials.gov identifier: NCT01462890), patients with newly diagnosed International Federation of Gynecology and Obstetrics stage IIB-IV epithelial ovarian, fallopian tube, or peritoneal cancer underwent primary cytoreductive surgery followed by six cycles of chemotherapy (paclitaxel 175 mg/m2 plus carboplatin area under the curve 5 once every 3 weeks) and bevacizumab (15 mg/kg once every 3 weeks). Patients were randomly assigned 1:1 to receive bevacizumab for either 15 or 30 months, stratified by International Federation of Gynecology and Obstetrics stage/residual tumor. The primary end point was investigator-assessed progression-free survival (PFS) according to RECIST version 1.1. Secondary end points included overall survival (OS), safety, and tolerability. RESULTS Between November 11, 2011, and August 6, 2013, 927 women were randomly assigned. There was no difference in PFS between treatment arms (hazard ratio, 0.99; 95% CI, 0.85 to 1.15; unstratified log-rank P = .90). Median PFS was 24.2 versus 26.0 months with standard versus extended duration of bevacizumab, respectively; restricted mean PFS was 39.5 versus 39.3 months, respectively. There was no OS difference between treatment arms (hazard ratio, 1.04; 95% CI, 0.87 to 1.23; P = .68). Serious/nonserious adverse events of special interest occurred in 29% versus 34% of patients in the standard versus experimental arms, respectively, and were consistent with the known safety profile of standard bevacizumab. CONCLUSION Longer treatment duration with bevacizumab for up to 30 months did not improve PFS or OS in patients with primary epithelial ovarian, fallopian tube, or peritoneal cancer. A bevacizumab treatment duration of 15 months remains the standard of care.
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Affiliation(s)
- Jacobus Pfisterer
- Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) Study Group and Gynecologic Oncology Center, Kiel, Germany
| | - Florence Joly
- Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du sein (GINECO) and Centre François Baclesse, University Caen Normandie, Caen, France
| | - Gunnar Kristensen
- Nordic Society of Gynaecological Oncology (NSGO) and Oslo University Hospital, Oslo, Norway
| | - Joern Rau
- AGO Study Group and Coordinating Center for Clinical Trials, Philipps-University Marburg, Marburg, Germany
| | - Sven Mahner
- AGO Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Obstetrics and Gynecology, University Hospital LMU Munich, Munich, Germany
| | | | - Ahmed El-Balat
- AGO Study Group and University Hospital Frankfurt, Frankfurt, Germany.,Spital Uster, Uster, Switzerland
| | | | - Ulrich Canzler
- AGO Study Group and University Hospital Carl Gustav Carus, Technische Universität Dresden and National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
| | - Jalid Sehouli
- AGO Study Group and Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Martin L Heubner
- AGO Study Group and University Hospital Essen, Essen, Germany.,Cantonal Hospital Baden AG, Baden, Switzerland
| | - Andreas D Hartkopf
- AGO Study Group and University Hospital Tübingen, Tübingen, Germany.,University Hospital Ulm, Ulm, Germany
| | - Klaus Baumann
- AGO Study Group and University Hospital Gießen and Marburg, Site Marburg, Marburg, Germany.,Hospital Ludwigshafen, Ludwigshafen, Germany
| | - Annette Hasenburg
- AGO Study Group and University Hospital Freiburg, Freiburg, Germany.,University Medical Center Mainz, Mainz, Germany
| | - Lars C Hanker
- AGO Study Group and University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Antje Belau
- AGO Study Group and University Hospital Greifswald, Greifswald, Germany.,Frauenarztpraxis Dr. Belau, Greifswald, Germany
| | - Barbara Schmalfeldt
- AGO Study Group and Hospital Rechts der Isar, Technical University Munich, Munich, Germany.,University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominik Denschlag
- AGO Study Group and Hochtaunus-Kliniken, Hospital Bad Homburg, Bad Homburg, Germany
| | | | - Frédéric Selle
- GINECO and Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | | | - Alexander Burges
- Department of Obstetrics and Gynecology, University Hospital LMU Munich, Munich, Germany
| | - Hans-Joachim Lück
- AGO Study Group and Gynäkologisch-Onkologische Praxis Hannover, Hannover, Germany
| | - Günter Emons
- AGO Study Group and University Medical Center Göttingen, Göttingen, Germany
| | - Werner Meier
- AGO Study Group and Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.,University Hospital Düsseldorf, Düsseldorf, Germany
| | | | | | - Nikolaus de Gregorio
- AGO Study Group and University Hospital Ulm, Ulm, Germany.,SLK-Kliniken Heilbronn, Klinikum am Gesundbrunnen, Heilbronn, Germany
| | - Felix Hilpert
- AGO Study Group and University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.,Krankenhaus Jerusalem, Mammazentrum Hamburg, Hamburg, Germany
| | - Philipp Harter
- AGO Study Group and Evangelische Kliniken Essen-Mitte, Essen, Germany
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11
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Vergote I, Van Nieuwenhuysen E, De Waele S, Vulsteke C, Lamot C, Van den Bulck H, Claes N, Graas MP, Debrock G, Spoormans I, Vuylsteke P, Honhon B, Verhoeven D, De Maeseneer D, Dirix L, Mebis J, Vroman P, Denys H, Martinez Mena C, Pelgrims G, Van Steenberghe M, van Gorp T, Gennigens C. Prospective non-interventional BELOVA/BGOG-ov16 study on safety of frontline bevacizumab in elderly patients with FIGO stage IV ovarian cancer: a study of the Belgian and Luxembourg Gynaecological Oncology Group. Int J Gynecol Cancer 2022; 32:753-760. [DOI: 10.1136/ijgc-2021-003190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectiveBecause elderly patients with ovarian cancer are underrepresented in randomized studies, this study aimed to expand our knowledge on the safety and effectiveness of frontline treatment with bevacizumab in combination with standard carboplatin and paclitaxel chemotherapy in patients aged 70 years and older with a diagnosis of Federation of Gynecology and Obstetrics (FIGO) stage IV ovarian cancer in routine clinical practice in Belgium.MethodsPatients aged 70 years and older with FIGO stage IV ovarian cancer were included in a multicenter, non-interventional prospective studyto evaluate the safety and effectiveness of treatment with bevacizumab in combination with frontline carboplatin and paclitaxel chemotherapy. Comprehensive geriatric assessments were performed at baseline and during treatment.ResultsThe most frequently reported adverse events for bevacizumab were hypertension (55%), epistaxis (32%) and proteinuria (21%). The Kaplan-Meier estimate of progression-free survival was 14.5 months. The results of the comprehensive geriatric assessments during treatment indicated a slight improvement in the geriatric eight health status screening tool score for general health status and the mini-nutritional assessment score for nutritional status. The median change from baseline score was close to zero for the instruments measuring independency, activity of daily living and instrumental activities of daily living, and for the mobility-tiredness test measuring self-perceived fatigue.ConclusionsNo new safety signals were registered in this study in patients aged 70 years and older treated with bevacizumab and frontline carboplatin and paclitaxel for FIGO stage IV ovarian cancer. Elderly patients should not be excluded from treatment for advanced ovarian cancer based on age alone.EU PAS registerENCEPP/SDPP/13849.ClinicalTrials.gov identifierNCT02393898.
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12
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Harter P, Mouret-Reynier MA, Pignata S, Cropet C, González-Martín A, Bogner G, Fujiwara K, Vergote I, Colombo N, Nøttrup TJ, Floquet A, El-Balat A, Scambia G, Guerra Alia EM, Fabbro M, Schmalfeldt B, Hardy-Bessard AC, Runnebaum I, Pujade-Lauraine E, Ray-Coquard I. Efficacy of maintenance olaparib plus bevacizumab according to clinical risk in patients with newly diagnosed, advanced ovarian cancer in the phase III PAOLA-1/ENGOT-ov25 trial. Gynecol Oncol 2021; 164:254-264. [PMID: 34952708 DOI: 10.1016/j.ygyno.2021.12.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Adding maintenance olaparib to bevacizumab provided a significant progression-free survival (PFS) benefit in patients with newly diagnosed, advanced ovarian cancer in the randomized, double-blind PAOLA-1/ENGOT-ov25 trial (NCT02477644). We analyzed PFS by clinical risk and biomarker status. METHODS Patients received olaparib 300 mg twice daily for up to 24 months plus bevacizumab 15 mg/kg every 3 weeks for up to 15 months in total, or placebo plus bevacizumab. This post hoc exploratory analysis evaluated PFS in patients classified as higher risk (stage III with upfront surgery and residual disease or neoadjuvant chemotherapy; stage IV) or lower risk (stage III with upfront surgery and no residual disease), and by biomarker status. RESULTS Of 806 randomized patients, 74% were higher risk and 26% were lower risk. After a median 22.9 months of follow-up, PFS favored olaparib plus bevacizumab versus placebo plus bevacizumab in higher-risk patients (hazard ratio [HR] 0.60; 95% confidence interval [CI] 0.49-0.74) and lower-risk patients (0.46; 0.30-0.72). Olaparib plus bevacizumab provided a substantial PFS benefit versus bevacizumab alone in the homologous recombination deficiency (HRD)-positive subgroup (higher risk: HR 0.39; 95% CI 0.28-0.54 and lower risk: 0.15; 0.07-0.30), with 24-month PFS rates in lower-risk patients of 90% versus 43%, respectively (Kaplan-Meier estimates). CONCLUSIONS In PAOLA-1, maintenance olaparib plus bevacizumab provided a substantial PFS benefit in HRD-positive patients with a reduction of risk of progression or death of 61% in the higher-risk group and of 85% in the lower-risk group compared with bevacizumab alone.
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Affiliation(s)
- Philipp Harter
- Ev. Kliniken Essen Mitte, Essen, and Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Studiengruppe, Germany.
| | - Marie Ange Mouret-Reynier
- Centre Jean Perrin, Clermont, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), France
| | - Sandro Pignata
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Italy
| | | | - Antonio González-Martín
- MD Anderson Cancer Center Madrid, and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Spain
| | - Gerhard Bogner
- Paracelsus Medical University Salzburg, Salzburg, and Arbeitsgemeinschaft Gynaekologische Onkologie (AGO Austria), Austria
| | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, Hidaka, and Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Japan
| | - Ignace Vergote
- University Hospital Leuven, Leuven Cancer Institute, Leuven, and Belgian Gynaecological Oncology Group (BGOG), Belgium
| | - Nicoletta Colombo
- University of Milan-Bicocca and IEO European Institute of Oncology IRCCS, Milan, and Mario Negri Gynecologic Oncology Group (MANGO), Italy
| | - Trine Jakobi Nøttrup
- Copenhagen University Hospital, Copenhagen, and Nordic Society of Gynecologic Oncology (NSGO), Denmark
| | - Anne Floquet
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, and GINECO, France
| | - Ahmed El-Balat
- Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt, and AGO, Germany
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica, Rome, and MITO, Italy
| | | | | | | | | | | | - Eric Pujade-Lauraine
- Association de Recherche Cancers Gynécologiques (ARCAGY), Paris, and GINECO, France
| | - Isabelle Ray-Coquard
- Centre Léon BERARD and University Claude Bernard Lyon 1, Lyon, and GINECO, France
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13
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Borčinová M, Ragosch V, Jarkovský J, Bajsová S, Pilka R, Glickman A, Garrido-Mallach S, Raspagliesi F, Szatkowski W, Pakiz M, Snyman LC, Kocián R, Tamussino K, Kalist V, Michal M, Segovia MG, Poka R, Kipp B, Szewczyk G, Wydra D, Tóth R, Vinnytska A, Fischerová D, Siegler K, Cibula D. Challenges in lower limb lymphoedema assessment based on limb volume change: Lessons learnt from the SENTIX prospective multicentre study. Gynecol Oncol 2021; 164:76-84. [PMID: 34763939 DOI: 10.1016/j.ygyno.2021.10.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Lower limb lymphoedema (LLL) is the most disabling adverse effect of surgical staging of pelvic lymph nodes. However, the lack of standardisation of volumetric LLL assessment hinders direct comparison between the studies and makes LLL reporting unreliable. The aim of our study is to report outcomes from a prospective trial that have implications for LLL assessment standardisation. METHODS In the prospective international multicentre trial SENTIX, a group of 150 patients with stage IA1-IB2 cervical cancer treated by uterine surgery with bilateral sentinel lymph node biopsy was prospectively evaluated by objective LLL assessment, based on limb volume change (LVC) using circumferrential limb measurements and subjective patient-reported swelling. The assessments were conducted in six-month periods over 24 months post-surgery. RESULTS Patient LVC substantially fluctuated in both positive and negative directions, which were comparable in frequency up to ±14% change. Thirty-eight patients experienced persistent LVC increase >10% classified as LLL, with nine months median time to onset. Some 34.2% of cases experienced onset later than one year after the surgery. Thirty-three patients (22%) experienced transient oedema characterised as LVC >10%, which resolved without intervention between two consequent follow-up visits. No significant correlation between LVC >10% and a patient-reported swelling was observed. CONCLUSIONS Given that we observed comparable fluctuations of the the lower-limb volumes after surgical treatment of cervical cancer in both positive and negative direction up to ±14%, the diagnostic threshold for LLL diagnosis based on LVC should be increased to >15% LVC. The distinction of transient oedema from persistent LLL requires repeated measurements. Also, as one-third of LLL cases are diagnosed >1-year post-surgery, a sufficient follow-up duration needs to be ensured. Patient-reported swelling correlated poorly with LVC and should only be used as an adjunct to objective LLL assessment. TRIAL REGISTRATION ClinicalTrials.gov: NCT02494063.
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Affiliation(s)
- Martina Borčinová
- Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Prague, Czech Republic
| | - Volker Ragosch
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Sylva Bajsová
- Department of Obstetrics and Gynecology, University Hospital Ostrava, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Ostrava Poruba, Czech Republic
| | - Radovan Pilka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Olomouc, Czech Republic
| | - Ariel Glickman
- Unit of Gynecological Oncology, Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clinic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | | | | | - Maja Pakiz
- University medical Centre Maribor, Slovenia
| | | | - Roman Kocián
- Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Prague, Czech Republic
| | | | | | | | | | - Robert Poka
- Department of obstetrics and Gynecology, University of Debrecen, Hungary
| | - Barbara Kipp
- Neue Freuenklinik, Luzerner Kantonsspital, Switzerland
| | | | | | - Róbert Tóth
- Oncology Institute of East Slovakia, Košice, Slovakia
| | | | - Daniela Fischerová
- Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Prague, Czech Republic
| | - Kathrin Siegler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
| | - David Cibula
- Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Prague, Czech Republic.
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14
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Cibula D, Borčinová M, Marnitz S, Jarkovský J, Klát J, Pilka R, Torné A, Zapardiel I, Petiz A, Lay L, Sehnal B, Ponce J, Felsinger M, Arencibia-Sánchez O, Kaščák P, Zalewski K, Presl J, Palop-Moscardó A, Tingulstad S, Vergote I, Redecha M, Frühauf F, Köhler C, Kocián R. Lower-Limb Lymphedema after Sentinel Lymph Node Biopsy in Cervical Cancer Patients. Cancers (Basel) 2021; 13:cancers13102360. [PMID: 34068399 PMCID: PMC8153612 DOI: 10.3390/cancers13102360] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Lower-limb lymphedema (LLL) is a well-recognized adverse outcome of the surgical management of cervical cancer. Recently, sentinel lymph node (SLN) biopsy has emerged as an alternative procedure to systematic pelvic lymphadenectomy (PLND) aiming to decrease the risk of complications, especially LLL development. Our study represents the first prospective analysis of LLL incidence in cervical cancer patients after a uterine procedure with SLN biopsy, without systematic PLND. In an international multicenter trial SENTIX, the group of 150 patients was prospectively evaluated using both objective and subjective LLL assessments in 6 months intervals for 2 years. Contrary to the expectations, our results showed that SLN biopsy does not eliminate the risk of LLL development which occurred in a mild or moderate stage in about 26% of patients with a median interval to the onset of 9 months. Abstract Background: To prospectively assess LLL incidence among cervical cancer patients treated by uterine surgery complemented by SLN biopsy, without PLND. Methods: A prospective study in 150 patients with stage IA1–IB2 cervical cancer treated by uterine surgery with bilateral SLN biopsy. Objective LLL assessments, based on limb volume increase (LVI) between pre- and postoperative measurements, and subjective patient-perceived swelling were conducted in six-month periods over 24-months post-surgery. Results: The cumulative incidence of LLL at 24 months was 17.3% for mild LLL (LVI 10–19%), 9.2% for moderate LLL (LVI 20–39%), while only one patient (0.7%) developed severe LLL (LVI > 40%). The median interval to LLL onset was nine months. Transient edema resolving without intervention within six months was reported in an additional 22% of patients. Subjective LLL was reported by 10.7% of patients, though only a weak and partial correlation between subjective-report and objective-LVI was found. No risk factor directly related to LLL development was identified. Conclusions: The replacement of standard PLND by bilateral SLN biopsy in the surgical treatment of cervical cancer does not eliminate the risk of mild to moderate LLL, which develops irrespective of the number of SLN removed.
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Affiliation(s)
- David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (M.B.); (F.F.); (R.K.)
- Correspondence: ; Tel.: +420-224-967-451
| | - Martina Borčinová
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (M.B.); (F.F.); (R.K.)
| | - Simone Marnitz
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany; (S.M.); (C.K.)
| | - Jiří Jarkovský
- Data Analysis Department, Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic;
| | - Jaroslav Klát
- Department of Obstetrics and Gynecology, University Hospital Ostrava, 70800 Ostrava Poruba, Czech Republic;
| | - Radovan Pilka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, 77900 Olomouc, Czech Republic;
| | - Aureli Torné
- Unit of Gynecological Oncology, Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clinic-Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain;
| | - Almerinda Petiz
- Serviço de Ginecologia, Instituto Portugues de Oncologia do Porto, 1099-023 Porto, Portugal;
| | - Laura Lay
- Department of Gynaecology, Institute of Oncology Angel H Roffo University of Bueno s Aires, Buenos Aires C1417 DTB, Argentina;
| | - Borek Sehnal
- Department of Obstetrics and Gynecology, First Faculty of Medicine, University Hospital Bulovka, Charles University, 18081 Prague, Czech Republic;
| | - Jordi Ponce
- Department of Gynecology, Biomedical Research Institute of Bellvitge (IDIBELL), University Hospital of Bellvitge, University of Barcelona, 08908 Barcelona, Spain;
| | - Michal Felsinger
- Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, 60177 Brno, Czech Republic;
| | - Octavio Arencibia-Sánchez
- Departments of Gynecologic Oncology, University Hospital of the Canary Islands, 35016 Las Palmas de Gran Canaria, Spain;
| | - Peter Kaščák
- Department of Obstetrics and Gynecology, Faculty Hospital Trencin, 911 71 Trencin, Slovakia;
| | - Kamil Zalewski
- Department of Gynecologic Oncology, Holycross Cancer Center, 25-734 Kielce, Poland;
| | - Jiri Presl
- Department of Obstetrics and Gynecology, Faculty of Medicine Pilsen, University Hospital in Pilsen and Charles University, 30460 Pilsen, Czech Republic;
| | - Alicia Palop-Moscardó
- Gynecology Department, Instituto Valenciano de Oncologia (IVO), 46009 Valencia, Spain;
| | - Solveig Tingulstad
- Department of Obstetrics and Gynecology, Trondheim University Hospital, 7030 Trondheim, Norway;
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Leuven Cancer Institute, University Hospital Leuven, 3000 Leuven, Belgium;
| | - Mikuláš Redecha
- Department of Gynaecology and Obstetrics, University Hospital, Comenius University, 814 99 Bratislava, Slovakia;
| | - Filip Frühauf
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (M.B.); (F.F.); (R.K.)
| | - Christhardt Köhler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany; (S.M.); (C.K.)
| | - Roman Kocián
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (M.B.); (F.F.); (R.K.)
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15
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Razumova Z, Bizzarri N, Kacperczyk-Bartnik J, Pletnev A, Gonzalez Martin A, Persson J. Report from the European Society of Gynaecological Oncology (ESGO) 2020 State-of-the-Art Virtual Meeting. Int J Gynecol Cancer 2021; 31:658-669. [PMID: 33811109 DOI: 10.1136/ijgc-2021-002577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/04/2022] Open
Abstract
This is a report from the European Society of Gynaecological Oncology State-of-the-Art Virtual Meeting held December 14-16, 2020. The unique 3-day conference offered comprehensive state-of-the-art summaries on the major advances in the treatment of different types of gynecological cancers. Sessions opened with a case presentation followed by a keynote lecture and interactive debates with opinion leaders in the field. The speakers also presented scientific reviews on the clinical trial landscape in collaboration with the European Network of Gynecological Oncological Trial (ENGOT) groups. In addition, the new ESGO-ESRTO-ESP endometrial cancer guidelines were officially presented in public. This paper describes the key information and latest studies that were presented for the first time at the conference.
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Affiliation(s)
- Zoia Razumova
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Nicolò Bizzarri
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | - Andrei Pletnev
- Department of Gynaecological Oncology, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus
| | | | - Jan Persson
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Faculty of Medicine at Lund University, Lund, Sweden
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16
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Poveda A, Floquet A, Ledermann JA, Asher R, Penson RT, Oza AM, Korach J, Huzarski T, Pignata S, Friedlander M, Baldoni A, Park-Simon TW, Tamura K, Sonke GS, Lisyanskaya A, Kim JH, Filho EA, Milenkova T, Lowe ES, Rowe P, Vergote I, Pujade-Lauraine E. Olaparib tablets as maintenance therapy in patients with platinum-sensitive relapsed ovarian cancer and a BRCA1/2 mutation (SOLO2/ENGOT-Ov21): a final analysis of a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol 2021; 22:620-631. [PMID: 33743851 DOI: 10.1016/s1470-2045(21)00073-5] [Citation(s) in RCA: 182] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/26/2021] [Accepted: 02/03/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Olaparib, a poly (ADP-ribose) polymerase (PARP) inhibitor, has previously been shown to extend progression-free survival versus placebo when given to patients with relapsed high-grade serous or endometrioid ovarian cancer who were platinum sensitive and who had a BRCA1 or BRCA2 (BRCA1/2) mutation, as part of the SOLO2/ENGOT-Ov21 trial. The aim of this final analysis is to investigate the effect of olaparib on overall survival. METHODS This double-blind, randomised, placebo-controlled, phase 3 trial was done across 123 medical centres in 16 countries. Eligible patients were aged 18 years or older, had an Eastern Cooperative Oncology Group performance status at baseline of 0-1, had histologically confirmed, relapsed, high-grade serous or high-grade endometrioid ovarian cancer, including primary peritoneal or fallopian tube cancer, and had received two or more previous platinum regimens. Patients were randomly assigned (2:1) to receive olaparib tablets (300 mg in two 150 mg tablets twice daily) or matching placebo tablets using an interactive web or voice-response system. Stratification was by response to previous chemotherapy and length of platinum-free interval. Treatment assignment was masked to patients, treatment providers, and data assessors. The primary endpoint of progression-free survival has been reported previously. Overall survival was a key secondary endpoint and was analysed in all patients as randomly allocated. Safety was assessed in all patients who received at least one treatment dose. This trial is registered with ClinicalTrials.gov, NCT01874353, and is no longer recruiting patients. FINDINGS Between Sept 3, 2013 and Nov 21, 2014, 295 patients were enrolled. Patients were randomly assigned to receive either olaparib (n=196 [66%]) or placebo (n=99 [34%]). One patient, randomised in error, did not receive olaparib. Median follow-up was 65·7 months (IQR 63·6-69·3) with olaparib and 64·5 months (63·4-68·7) with placebo. Median overall survival was 51·7 months (95% CI 41·5-59·1) with olaparib and 38·8 months (31·4-48·6) with placebo (hazard ratio 0·74 [95% CI 0·54-1·00]; p=0·054), unadjusted for the 38% of patients in the placebo group who received subsequent PARP inhibitor therapy. The most common grade 3 or worse treatment-emergent adverse event was anaemia (which occurred in 41 [21%] of 195 patients in the olaparib group and two [2%] of 99 patients in the placebo group). Serious treatment-emergent adverse events were reported in 50 (26%) of 195 patients receiving olaparib and eight (8%) of 99 patients receiving placebo. Treatment-emergent adverse events with a fatal outcome occurred in eight (4%) of the 195 patients receiving olaparib, six of which were judged to be treatment-related (attributed to myelodysplastic syndrome [n=3] and acute myeloid leukaemia [n=3]). INTERPRETATION Olaparib provided a median overall survival benefit of 12·9 months compared with placebo in patients with platinum-sensitive, relapsed ovarian cancer and a BRCA1/2 mutation. Although statistical significance was not reached, these findings are arguably clinically meaningful and support the use of maintenance olaparib in these patients. FUNDING AstraZeneca and Merck.
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Affiliation(s)
- Andrés Poveda
- Initia Oncology, Hospital Quirónsalud, Valencia, Spain; Grupo Español de Investigación en Cáncer de Ovario, Madrid, Spain.
| | - Anne Floquet
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France; Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Paris, France
| | - Jonathan A Ledermann
- UCL Cancer Institute, University College London, London, UK; National Cancer Research Institute, London, UK
| | - Rebecca Asher
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Richard T Penson
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Amit M Oza
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jacob Korach
- Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel; Israeli Society of Gynecologic Oncology, Ramat Gan, Israel
| | - Tomasz Huzarski
- International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; Read-Gene SA, Grzepnica, Szczecin, Poland
| | - Sandro Pignata
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy; Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies, Naples, Italy
| | - Michael Friedlander
- University of New South Wales Clinical School, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Alessandra Baldoni
- Istituto Oncologico Veneto, Padova, Italy; Mario Negri Gynecologic Oncology Group, Milan, Italy
| | - Tjoung-Won Park-Simon
- Hannover Medical School, Hannover, Germany; German Society of Gynecological Oncology, Essen, Germany
| | | | - Gabe S Sonke
- The Netherlands Cancer Institute, Amsterdam, Netherlands; Dutch Gynecological Oncology Group, Amsterdam, Netherlands
| | - Alla Lisyanskaya
- St Petersburg City Clinical Oncology Dispensary, St Petersburg, Russia
| | - Jae-Hoon Kim
- Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea; Korean Gynecologic Oncology Group, Seoul, South Korea
| | - Elias Abdo Filho
- Instituto do Câncer do Estado São Paulo-Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Ignace Vergote
- University Hospital Leuven, Leuven Cancer Institute, Belgium; Belgium and Luxembourg Gynaecological Oncology Group, Leuven, Belgium
| | - Eric Pujade-Lauraine
- Association de Recherche Contre les Cancers dont Gynécologiques-ARCAGY, Paris, France
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Carboplatin-based doublet plus bevacizumab beyond progression versus carboplatin-based doublet alone in patients with platinum-sensitive ovarian cancer: a randomised, phase 3 trial. Lancet Oncol 2021; 22:267-276. [PMID: 33539744 DOI: 10.1016/s1470-2045(20)30637-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bevacizumab is approved in combination with chemotherapy for the treatment of ovarian cancer, either in first-line therapy or for patients with recurrent disease not previously treated with the same drug. We aimed to test the value of continuing bevacizumab beyond progression after first-line treatment with the same drug. METHODS In our open-label, randomised, phase 3 trial done at 82 sites in four countries, we enrolled women (aged ≥18 years) who had previously received first-line platinum-based therapy including bevacizumab, and had recurrent (≥6 months since last platinum dose), International Federation of Gynaecology and Obstetrics stage IIIB-IV ovarian cancer with an Eastern Cooperative Oncology Group performance status 0-2. Patients were randomly assigned (1:1) to receive a carboplatin-based doublet intravenously (carboplatin area under the concentration curve [AUC] 5 on day 1 plus paclitaxel 175 mg/m2 on day 1, every 21 days; carboplatin AUC 4 on day 1 plus gemcitabine 1000 mg/m2 on days 1 and 8, every 21 days; or carboplatin AUC 5 on day 1 plus pegylated liposomal doxorubicin 30 mg/m2 on day 1, every 28 days), or a carboplatin-based doublet plus bevacizumab (10 mg/kg intravenous every 14 days combined with pegylated liposomal doxorubicin-carboplatin, or 15 mg/kg every 21 days combined with gemcitabine-carboplatin or paclitaxel-carboplatin). Evaluable disease according to RECIST 1.1 guidelines was required before randomisation. Randomisation was done through the trial website with a minimisation procedure, stratified by centre, time of recurrence, performance status, and type of second-line chemotherapy. The primary endpoint was investigator-assessed progression-free survival, analysed on an intention-to-treat basis. Safety was assessed in all participants who received at least one dose. This trial is registered with ClinicalTrials.gov, NCT01802749 and EudraCT 2012-004362-17. FINDINGS Between Dec 6, 2013, and Nov 11, 2016, 406 patients were recruited (203 [50%] assigned to the bevacizumab group and 203 [50%] to the standard chemotherapy group). 130 patients (64%) in the bevacizumab group and 131 (65%) in the standard chemotherapy group had progressed after receiving a last dose of platinum more than 12 months before, and 146 patients (72%) in the bevacizumab group and 147 (72%) in the standard chemotherapy group had progressed after completion of first-line bevacizumab maintenance. 161 participants (79%) progressed in the standard chemotherapy group, as did 143 (70%) in the bevacizumab group. Median progression-free survival was 8·8 months (95% CI 8·4-9·3) in the standard chemotherapy group and 11·8 months (10·8-12·9) in the bevacizumab group (hazard ratio 0·51, 95% CI 0·41-0·65; log-rank p<0·0001). Most common grade 3-4 adverse events were hypertension (20 [10%] in the standard chemotherapy group vs 58 (29%) in the bevacizumab group), neutrophil count decrease (81 [41%] vs 80 [40%]), and platelet count decrease (43 [22%] vs 61 [30%]). 68 patients (33%) died in the standard chemotherapy group and 79 (39%) died in the bevacizumab group; two deaths (1%) in the standard chemotherapy group and one death (<1%) in the bevacizumab group were deemed to be treatment-related. INTERPRETATION Continuing bevacizumab beyond progression combined with chemotherapy in patients with platinum-sensitive recurrent ovarian cancer improves progression-free survival compared with standard chemotherapy alone and might be considered in clinical practice. FUNDING Hoffmann-La Roche and Associazione Italiana per la Ricerca sul Cancro.
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Fujiwara K, Fujiwara H, Yoshida H, Satoh T, Yonemori K, Nagao S, Matsumoto T, Kobayashi H, Bourgeois H, Harter P, Mosconi AM, Vazquez IP, Reinthaller A, Fujita T, Rowe P, Pujade-Lauraine E, Ray-Coquard I. Olaparib plus bevacizumab as maintenance therapy in patients with newly diagnosed, advanced ovarian cancer: Japan subset from the PAOLA-1/ENGOT-ov25 trial. J Gynecol Oncol 2021; 32:e82. [PMID: 34378365 PMCID: PMC8362816 DOI: 10.3802/jgo.2021.32.e82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The addition of maintenance olaparib to bevacizumab demonstrated a significant progression-free survival (PFS) benefit in patients with newly diagnosed, advanced ovarian cancer in the PAOLA-1/ENGOT-ov25 trial (NCT02477644). We evaluated maintenance olaparib plus bevacizumab in the Japan subset of PAOLA-1. METHODS PAOLA-1 was a randomized, double-blind, phase III trial. Patients received maintenance olaparib tablets 300 mg twice daily or placebo twice daily for up to 24 months, plus bevacizumab 15 mg/kg every 3 weeks for up to 15 months in total. This prespecified subgroup analysis evaluated investigator-assessed PFS (primary endpoint). RESULTS Of 24 randomized Japanese patients, 15 were assigned to olaparib and 9 to placebo. After a median follow-up for PFS of 27.7 months for olaparib plus bevacizumab and 24.0 months for placebo plus bevacizumab, median PFS was 27.4 versus 19.4 months, respectively (hazard ratio [HR]=0.34; 95% confidence interval [CI]=0.11-1.00). In patients with tumors positive for homologous recombination deficiency, the HR for PFS was 0.57 (95% CI=0.16-2.09). Adverse events in the Japan subset were generally consistent with those of the PAOLA-1 overall population and with the established safety and tolerability profiles of olaparib and bevacizumab. CONCLUSION Results in the Japan subset of PAOLA-1 support the overall conclusion of the PAOLA-1 trial demonstrating that the addition of maintenance olaparib to bevacizumab provides a PFS benefit in patients with newly diagnosed, advanced ovarian cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02477644.
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Affiliation(s)
- Keiichi Fujiwara
- Saitama Medical University International Medical Center, Saitama, Japan.
| | | | - Hiroyuki Yoshida
- Saitama Medical University International Medical Center, Saitama, Japan
| | | | | | | | | | | | - Hughes Bourgeois
- Centre Jean Bernard - Clinique Victor Hugo, GINECO, Le Mans, France
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Gonzalez Martin A, Sanchez Lorenzo L, Colombo N, dePont Christensen R, Heitz F, Meirovitz M, Selle F, van Gorp T, Alvarez N, Sanchez J, Marqués C. A phase III, randomized, double blinded trial of platinum based chemotherapy with or without atezolizumab followed by niraparib maintenance with or without atezolizumab in patients with recurrent ovarian, tubal, or peritoneal cancer and platinum treatment free interval of more than 6 months: ENGOT-Ov41/GEICO 69-O/ANITA Trial. Int J Gynecol Cancer 2020; 31:617-622. [PMID: 33318079 DOI: 10.1136/ijgc-2020-001633] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Platinum based chemotherapy is the treatment of choice for ovarian cancer patients with a platinum treatment free interval of >6 months. Niraparib is an oral poly (ADP-ribose) polymerase inhibitor approved as maintenance therapy after a response to platinum rechallenge, regardless of BRCA status. Atezolizumab is a humanized monoclonal antibody targeting programmed death-ligand 1 (PD-L1). A combination of poly (ADP-ribose) polymerase inhibitor and anti-PD-L1/programmed cell death protein 1 (PD-1) has shown synergy in preclinical models and promising clinical activity. PRIMARY OBJECTIVE To determine whether the addition of atezolizumab to carboplatin based chemotherapy and to subsequent maintenance with niraparib improves progression free survival compared with placebo in patients with recurrent disease and a platinum treatment free interval of >6 months. TRIAL DESIGN The Atezolizumab and NIraparib Treatment Association (ANITA) trial is a GEICO (Grupo Español de Investigación en Cáncer de Ovario) led phase III, randomized, double-blinded, multicenter European Network for Gynecological Oncological Trials (ENGOT) study. Patients will be randomized to arm A (control arm) consisting of platinum based chemotherapy (investigator's choice) plus a placebo of atezolizumab followed by maintenance niraparib plus a placebo of atezolizumab, or to arm B (experimental arm) consisting of platinum based chemotherapy (investigator's choice) plus atezolizumab followed by maintenance niraparib plus atezolizumab. MAJOR INCLUSION/EXCLUSION CRITERIA Inclusion criteria are women aged over 18 years, diagnosed with relapsed high grade serous, endometrioid, or undifferentiated ovarian, fallopian tube, or primary peritoneal carcinoma. Patients are eligible if they received no more than two previous lines of chemotherapy, relapsed ≥6 months after the last platinum containing regimen, and have at least one measurable lesion according to the response evaluation criteria in solid tumors, version 1.1. PRIMARY ENDPOINT The primary endpoint for this study is progression free survival. SAMPLE SIZE Approximately 414 patients will be recruited and randomized in a 1:1 ratio, with the aim of demonstrating a benefit in progression free survival for the experimental arm with a hazard ratio of O.7, using a two sided alpha of 0.05 and a power of 80%. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS The trial was launched in the fourth quarter of 2018 and is estimated to close in the second quarter of 2021. Mature results for progression free survival are expected to be presented by 2023. TRIAL REGISTRATION Clinicaltrials.gov NCT03598270.
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Affiliation(s)
- Antonio Gonzalez Martin
- Medical Oncology, Clinica Universidad de Navarra, Madrid, Spain .,GEICO (Grupo Español de Investigación en Cáncer de Ovario), Madrid, Spain
| | | | - Nicoletta Colombo
- Medical Gynecologic Oncology Unit, University of Milan Bicocca, European Institute of Oncology IRCCS, Milano, Italy
| | - René dePont Christensen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Florian Heitz
- Gynäkologie und Gynäkologische Onkologie, Evangelische Kliniken Essen-Mitte Klinik für, Essen, Germany
| | - Mihai Meirovitz
- Department of Gynecologic Oncology, Soroka University Medical Center and Ben Gurion University, Beer Sheva, Israel
| | - Frederic Selle
- Service d'Oncologie Medicale, Groupe Hospitalier Diaconesses Croix Saint Simon and Alliance Pour la Recherche en Cancerologie, Paris, France
| | - Toon van Gorp
- Gynecologic Oncology, Universitair Ziekenhuis, Leuven, Belgium
| | - Nuria Alvarez
- GEICO (Grupo Español de Investigación en Cáncer de Ovario), Madrid, Spain
| | - Javier Sanchez
- GEICO (Grupo Español de Investigación en Cáncer de Ovario), Madrid, Spain
| | - Carmen Marqués
- GEICO (Grupo Español de Investigación en Cáncer de Ovario), Madrid, Spain
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20
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Ray-Coquard I, Harter P, Lorusso D, Dalban C, Vergote I, Fujiwara K, Gladieff L, Lück HJ, Floquet A, Chevalier-Place A, Schnelzer A, Pignata S, Selle F, Sehouli J, Brocard F, Mangili G, Pautier P, De Giorgi U, Provansal M, Heudel PE. Effect of Weekly Paclitaxel With or Without Bevacizumab on Progression-Free Rate Among Patients With Relapsed Ovarian Sex Cord-Stromal Tumors: The ALIENOR/ENGOT-ov7 Randomized Clinical Trial. JAMA Oncol 2020; 6:1923-1930. [PMID: 33030515 DOI: 10.1001/jamaoncol.2020.4574] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance To our knowledge, this is the first randomized trial in sex cord-stromal tumors, and it establishes weekly paclitaxel as standard-of-care therapy after platinum-based therapy in this setting. Objective To determine the efficacy of weekly paclitaxel with or without bevacizumab as treatment for relapsed sex cord-stromal tumors and evaluate whether the addition of bevacizumab to weekly paclitaxel improves 6-month progression-free rate. Design, Setting, and Participants This open-label, academic, international, randomized phase 2 trial (ALIENOR) was conducted at 28 referral centers in France, Germany, Italy, Japan, and Belgium in collaboration with the Rare Tumor committee of the Gynecologic Cancer InterGroup and used an adaptive bayesian design. It included 60 women with sex cord-stromal tumors that had relapsed after at least 1 platinum-based chemotherapy. Enrollment occurred from 2013 to 2016, and the final analysis database lock was on March 27, 2020 (median follow-up, 38.9 months). Interventions Participants were randomized to receive either paclitaxel (80 mg/m2, days 1, 8, and 15 every 4 weeks) alone or paclitaxel with bevacizumab (10 mg/kg, every 2 weeks) for 6 cycles followed by maintenance bevacizumab (15 mg/kg, every 3 weeks) for up to 1 year or until progression or unacceptable toxicity. Crossover to bevacizumab was permitted after progression during or following paclitaxel alone. Main Outcomes and Measures Six-month progression-free rate. Results Sixty patients (predominantly with granulosa cell tumors) were randomized, 32 to receive single-agent paclitaxel (median [interquartile range] age at inclusion, 60 [53-64] years) and 28 to receive paclitaxel-bevacizumab (median [interquartile range] age at inclusion, 55 [47-61] years; 1 did not receive treatment). The estimated 6-month progression-free rate was 71% (95% credible interval, 55%-84%) with paclitaxel alone and 72% (95% credible interval, 55%-87%) with paclitaxel-bevacizumab. The bayesian estimate for the probability that the 6-month progression-free rate distribution was higher with the combination than with paclitaxel alone was 57%, less than the predefined superiority threshold. The objective response rate increased from 25% (95% CI, 12%-43%) to 44% (95% CI, 26%-65%) with the addition of bevacizumab. One patient discontinued combination therapy within 6 months because of toxicity. Conclusions and Relevance Weekly paclitaxel is a new option for relapsed sex cord-stromal tumors. In this international randomized clinical trial of patients with relapsed sex cord-stromal tumors unsuitable for surgery, adding bevacizumab to weekly paclitaxel does not improve clinical benefit. Trial Registration ClinicalTrials.gov Identifier: NCT01770301.
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Affiliation(s)
| | - Philipp Harter
- AGO Study Group and Ev Kliniken Essen-Mitte, Essen, Germany
| | | | - Cécile Dalban
- GINECO and Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Ignace Vergote
- BGOG and University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Keiichi Fujiwara
- GOTIC and Saitama Medical University International Medical Center, Hidaka, Japan
| | - Laurence Gladieff
- GINECO and Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | | | | | | | - Andreas Schnelzer
- AGO Study Group and Frauenklinik Technical University Munich, Munich, Germany.,Current, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Sandro Pignata
- MITO and Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Frédéric Selle
- GINECO and Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Jalid Sehouli
- AGO Study Group and Medical University of Berlin, Charité-CVK, Berlin, Germany
| | | | | | | | - Ugo De Giorgi
- MITO and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRST IRCCS, Meldola, Italy
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21
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Monk BJ, Grisham RN, Banerjee S, Kalbacher E, Mirza MR, Romero I, Vuylsteke P, Coleman RL, Hilpert F, Oza AM, Westermann A, Oehler MK, Pignata S, Aghajanian C, Colombo N, Drill E, Cibula D, Moore KN, Christy-Bittel J, Del Campo JM, Berger R, Marth C, Sehouli J, O'Malley DM, Churruca C, Boyd AP, Kristensen G, Clamp A, Ray-Coquard I, Vergote I. MILO/ENGOT-ov11: Binimetinib Versus Physician's Choice Chemotherapy in Recurrent or Persistent Low-Grade Serous Carcinomas of the Ovary, Fallopian Tube, or Primary Peritoneum. J Clin Oncol 2020; 38:3753-3762. [PMID: 32822286 PMCID: PMC7655017 DOI: 10.1200/jco.20.01164] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Low-grade serous ovarian carcinomas (LGSOCs) have historically low chemotherapy responses. Alterations affecting the MAPK pathway, most commonly KRAS/BRAF, are present in 30%-60% of LGSOCs. The purpose of this study was to evaluate binimetinib, a potent MEK1/2 inhibitor with demonstrated activity across multiple cancers, in LGSOC. METHODS This was a 2:1 randomized study of binimetinib (45 mg twice daily) versus physician's choice chemotherapy (PCC). Eligible patients had recurrent measurable LGSOC after ≥ 1 prior platinum-based chemotherapy but ≤ 3 prior chemotherapy lines. The primary end point was progression-free survival (PFS) by blinded independent central review (BICR); additional assessments included overall survival (OS), overall response rate (ORR), duration of response (DOR), clinical-benefit rate, biomarkers, and safety. RESULTS A total of 303 patients were randomly assigned to an arm of the study at the time of interim analysis (January 20, 2016). Median PFS by BICR was 9.1 months (95% CI, 7.3 to 11.3) for binimetinib and 10.6 months (95% CI, 9.2 to 14.5) for PCC (hazard ratio,1.21; 95%CI, 0.79 to 1.86), resulting in early study closure according to a prespecified futility boundary after 341 patients had enrolled. Secondary efficacy end points were similar in the two groups: ORR 16% (complete response [CR]/partial responses[PRs], 32) versus 13% (CR/PRs, 13); median DOR, 8.1 months (range, 0.03 to ≥ 12.0 months) versus 6.7 months (0.03 to ≥ 9.7 months); and median OS, 25.3 versus 20.8 months for binimetinib and PCC, respectively. Safety results were consistent with the known safety profile of binimetinib; the most common grade ≥ 3 event was increased blood creatine kinase level (26%). Post hoc analysis suggests a possible association between KRAS mutation and response to binimetinib. Results from an updated analysis (n = 341; January 2019) were consistent. CONCLUSION Although the MEK Inhibitor in Low-Grade Serous Ovarian Cancer Study did not meet its primary end point, binimetinib showed activity in LGSOC across the efficacy end points evaluated. A higher response to chemotherapy than expected was observed and KRAS mutation might predict response to binimetinib.
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Affiliation(s)
- Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ
| | - Rachel N Grisham
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, NY
| | - Susana Banerjee
- Royal Marsden National Health Service Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Elsa Kalbacher
- Centre Hospitalier Régional et Universitaire de Besançon, CHRU de Besançon, Besançon, France
| | - Mansoor Raza Mirza
- Nordic Society of Gynaecological Oncology and Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ignacio Romero
- Servicio de Oncologıa Medica, Fundacion Instituto Valenciano de Oncologıa, Valencia, Spain
| | - Peter Vuylsteke
- CHU Université catholique de Louvain Namur, Sainte-Elisabeth, Namur, Belgium.,University of Botswana, Gaborone, Botswana
| | | | - Felix Hilpert
- Onkologisches Therapiezentrum am Krankenhaus Jerusalem, Hamburg, Germany
| | - Amit M Oza
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Anneke Westermann
- Dutch Gynaecological Oncology Group, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Martin K Oehler
- Department of Gynaecological Oncology, Royal Adelaide Hospital, Adelaide, South Australia 5005, Australia
| | - Sandro Pignata
- Istituto Nazionale Tumori Fondazione Pascale IRCCS, Naples, Italy
| | - Carol Aghajanian
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ
| | - Nicoletta Colombo
- Dipartimento Medicina e Chirurgia, Università Milano-Bicocca, Programma Ginecologia Oncologica Istituto Europeo Oncologia, IRCCS, Milan, Italy
| | - Esther Drill
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, NY
| | - David Cibula
- First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Kathleen N Moore
- Stephenson Cancer Center at The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | - Regina Berger
- University Clinic for Gynaecology and Obstetrics, Medical University of Innsbruck, Innsbruck 6020, Austria
| | - Christian Marth
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Austrian AGO, Innsbruck, Austria
| | - Jalid Sehouli
- Center for Oncological Surgery, European Competence Center for Ovarian Cancer Campus Virchow Klinikum and Benjamin Franklin Charité Comprehensive Cancer Center , Medical University of Berlin, Berlin, Germany
| | - David M O'Malley
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Cristina Churruca
- Biodonostia HRI, Osasun Ikerketa Insitutua, Insituto de Investigacion Sanitaria, San Sebastián, Gipuzkoa, Spain
| | | | - Gunnar Kristensen
- Department for Gynecologic Oncology and Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
| | - Andrew Clamp
- Department of Medical Oncology, The Christie National Health Service Foundation Trust, and University of Manchester, Manchester, United Kingdom
| | - Isabelle Ray-Coquard
- Centre Léon Bérard, Netsarc Network, Université Claude Bernard Lyon 1, Lyon, France
| | - Ignace Vergote
- Belgium and Luxemburg Gynaecological Oncology Group, University Hospitals Leuven, Leuven, Belgium
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Cibula D, Kocian R, Plaikner A, Jarkovsky J, Klat J, Zapardiel I, Pilka R, Torne A, Sehnal B, Ostojich M, Petiz A, Sanchez OA, Presl J, Buda A, Raspagliesi F, Kascak P, van Lonkhuijzen L, Barahona M, Minar L, Blecharz P, Pakiz M, Wydra D, Snyman LC, Zalewski K, Zorrero C, Havelka P, Redecha M, Vinnytska A, Vergote I, Tingulstad S, Michal M, Kipp B, Slama J, Marnitz S, Bajsova S, Hernandez A, Fischerova D, Nemejcova K, Kohler C. Sentinel lymph node mapping and intraoperative assessment in a prospective, international, multicentre, observational trial of patients with cervical cancer: The SENTIX trial. Eur J Cancer 2020; 137:69-80. [PMID: 32750501 DOI: 10.1016/j.ejca.2020.06.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND SENTIX (ENGOT-CX2/CEEGOG-CX1) is an international, multicentre, prospective observational trial evaluating sentinel lymph node (SLN) biopsy without pelvic lymph node dissection in patients with early-stage cervical cancer. We report the final preplanned analysis of the secondary end-points: SLN mapping and outcomes of intraoperative SLN pathology. METHODS Forty-seven sites (18 countries) with experience of SLN biopsy participated in SENTIX. We preregistered patients with stage IA1/lymphovascular space invasion-positive to IB2 (4 cm or smaller or 2 cm or smaller for fertility-sparing treatment) cervical cancer without suspicious lymph nodes on imaging before surgery. SLN frozen section assessment and pathological ultrastaging were mandatory. Patients were registered postoperatively if SLN were bilaterally detected in the pelvis, and frozen sections were negative. TRIAL REGISTRATION ClinicalTrials.gov (NCT02494063). RESULTS We analysed data for 395 preregistered patients. Bilateral detection was achieved in 91% (355/395), and it was unaffected by tumour size, tumour stage or body mass index, but it was lower in older patients, in patients who underwent open surgery, and in sites with fewer cases. No SLN were found outside the seven anatomical pelvic regions. Most SLN and positive SLN were localised below the common iliac artery bifurcation. Single positive SLN above the iliac bifurcation were found in 2% of cases. Frozen sections failed to detect 54% of positive lymph nodes (pN1), including 28% of cases with macrometastases and 90% with micrometastases. INTERPRETATION SLN biopsy can achieve high bilateral SLN detection in patients with tumours of 4 cm or smaller. At experienced centres, all SLN were found in the pelvis, and most were located below the iliac vessel bifurcation. SLN frozen section assessment is an unreliable tool for intraoperative triage because it only detects about half of N1 cases.
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Affiliation(s)
- David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - Roman Kocian
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Andrea Plaikner
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jaroslav Klat
- Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava Poruba, Czech Republic
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Radovan Pilka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, Olomouc, Czech Republic
| | - Aureli Torne
- Unit of Gynecological Oncology, Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clinic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Borek Sehnal
- Department of Obstetrics and Gynecology, Bulovka Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marcela Ostojich
- Department of Gynecology, Institute of Oncology Angel H. Roffo, University of Buenos Aires, Buenos Aires Autonomous City, Argentina
| | - Almerinda Petiz
- Department of Gynecology, Francisco Gentil Portuguese Oncology Institute, Porto, Portugal
| | - Octavio A Sanchez
- Department of Gynecologic Oncology, University Hospital of the Canary Islands, Las Palmas de Gran Canaria, Spain
| | - Jiri Presl
- Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, Prague, Czech Republic
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology Surgery, San Gerardo Hospital, Monza, Italy
| | | | - Peter Kascak
- Department of Obstetrics and Gynecology, Faculty Hospital Trencin, Trencin, Slovakia
| | - Luc van Lonkhuijzen
- Center for Gynecologic Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marc Barahona
- Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, Barcelona, Spain
| | - Lubos Minar
- Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Pawel Blecharz
- Department of Gynecologic Oncology, Centre of Oncology, M. Sklodowska-Curie Memorial Institute, Cracow Department, Cracow, Poland
| | - Maja Pakiz
- University Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Dariusz Wydra
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, Poland
| | - Leon C Snyman
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Kamil Zalewski
- Department of Gynecologic Oncology, Holycross Cancer Center, Kielce, Poland
| | - Cristina Zorrero
- Gynecology Department, Instituto Valenciano de Oncologia (IVO), Valencia, Spain
| | - Pavel Havelka
- Department of Obstetrics and Gynecology, KNTB a.s Zlin, Czech Republic
| | - Mikulas Redecha
- Department of Gynaecology and Obstetrics, University Hospital, Comenius University, Bratislava, Slovakia
| | | | - Ignace Vergote
- Department of Gynecology and Obstetrics, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Martin Michal
- Department of Obstetrics and Gynaecology, Hospital Ceske Budejovice, JSC, Ceske Budejovice, Czech Republic
| | - Barbara Kipp
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Jiri Slama
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Simone Marnitz
- Department of Radiation Oncology, CyberKnife and Radiotherapy University Hospital Cologne, Cologne, Germany
| | - Sylva Bajsova
- Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava Poruba, Czech Republic
| | - Alicia Hernandez
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Daniela Fischerova
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Kristyna Nemejcova
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Christhardt Kohler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
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23
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Concin N, Ray-Coquard I, Glasspool RM, Braicu E, Farrelly L, Votan B, Mirza MR, Gonzalez Martin A, Vergote I, Pignata S. European Network of Gynaecological Oncological Trial Groups’ requirements for trials between academic groups and industry partners – a new Model D for drug and medical device development. Int J Gynecol Cancer 2020; 30:730-734. [DOI: 10.1136/ijgc-2020-001464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 11/04/2022] Open
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24
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Nemejcova K, Kocian R, Kohler C, Jarkovsky J, Klat J, Berjon A, Pilka R, Sehnal B, Gil-Ibanez B, Lupo E, Petiz A, Arencibia Sanchez O, Kascak P, Martinelli F, Buda A, Presl J, Barahona M, van Lonkhuijzen L, Szatkowski W, Minar L, Pakiz M, Havelka P, Zorrero C, Misiek M, Snyman LC, Wydra D, Vergote I, Vinnytska A, Redecha M, Michal M, Tingulstad S, Kipp B, Szewczyk G, Toth R, de Santiago Garcia FJ, Coronado Martin PJ, Poka R, Tamussino K, Luyckx M, Fastrez M, Staringer JC, Germanova A, Plaikner A, Bajsova S, Dundr P, Mallmann-Gottschalk N, Cibula D. Central Pathology Review in SENTIX, A Prospective Observational International Study on Sentinel Lymph Node Biopsy in Patients with Early-Stage Cervical Cancer (ENGOT-CX2). Cancers (Basel) 2020; 12:cancers12051115. [PMID: 32365651 PMCID: PMC7281480 DOI: 10.3390/cancers12051115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023] Open
Abstract
The quality of pathological assessment is crucial for the safety of patients with cervical cancer if pelvic lymph node dissection is to be replaced by sentinel lymph node (SLN) biopsy. Central pathology review of SLN pathological ultrastaging was conducted in the prospective SENTIX/European Network of Gynaecological Oncological Trial (ENGOT)-CX2 study. All specimens from at least two patients per site were submitted for the central review. For cases with major or critical deviations, the sites were requested to submit all samples from all additional patients for second-round assessment. From the group of 300 patients, samples from 83 cases from 37 sites were reviewed in the first round. Minor, major, critical, and no deviations were identified in 28%, 19%, 14%, and 39% of cases, respectively. Samples from 26 patients were submitted for the second-round review, with only two major deviations found. In conclusion, a high rate of major or critical deviations was identified in the first round of the central pathology review (28% of samples). This reflects a substantial heterogeneity in current practice, despite trial protocol requirements. The importance of the central review conducted prospectively at the early phase of the trial is demonstrated by a substantial improvement of SLN ultrastaging quality in the second-round review.
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Affiliation(s)
- Kristyna Nemejcova
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (K.N.); (P.D.)
| | - Roman Kocian
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (R.K.); (A.G.)
| | - Christhardt Kohler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany; (C.K.); (A.P.)
| | - Jiri Jarkovsky
- Institute for Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic;
| | - Jaroslav Klat
- Department of Obstetrics and Gynecology, University Hospital Ostrava, 708 52 Ostrava Poruba, Czech Republic; (J.K.); (S.B.)
| | - Alberto Berjon
- Department of Pathology, La Paz University Hospital, 28046 Madrid, Spain;
- Molecular Pathology and Therapeutic Targets Group, IdiPAZ, 28046 Madrid, Spain
| | - Radovan Pilka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, 77520 Olomouc, Czech Republic;
| | - Borek Sehnal
- Department of Obstetrics and Gynecology, Bulovka Hospital, First Faculty of Medicine, Charles University, 18081 Prague, Czech Republic;
| | - Blanca Gil-Ibanez
- Unit of Gynecological Oncology, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, 08036 Barcelona, Spain;
| | - Ezequiel Lupo
- Department of Pathology, Institute of Oncology Angel H. Roffo, University of Buenos Aires, Buenos Aires Autonomous City 1214, Argentina;
| | - Almerinda Petiz
- Department of Gynecology, Francisco Gentil Portuguese Oncology Institute, 4200-072 Porto, Portugal;
| | - Octavio Arencibia Sanchez
- Departments of Gynecologic Oncology, University Hospital of the Canary Islands, 35016 Las Palmas de Gran Canaria, Spain;
| | - Peter Kascak
- Department of Obstetrics and Gynecology, Faculty Hospital Trencin, 91171 Trencin, Slovakia;
| | - Fabio Martinelli
- IRCCS Foundation National Cancer Institute in Milan, 20133 Milan, Italy;
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology Surgery, San Gerardo Hospital, 20900 Monza, Italy;
| | - Jiri Presl
- Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, 30460 Prague, Czech Republic;
| | - Marc Barahona
- Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, 08907 Barcelona, Spain;
| | - Luc van Lonkhuijzen
- Center for Gynecologic Oncology, Academic Medical Centre, 1100DD Amsterdam, The Netherlands;
| | - Wiktor Szatkowski
- Department of Gynecologic Oncology, Centre of Oncology, M. Sklodowska-Curie Memorial Institute, Cracow Department, 31-115 Cracow, Poland;
| | - Lubos Minar
- Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, 60200 Brno, Czech Republic;
| | - Maja Pakiz
- University Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, 2000 Maribor, Slovenia;
| | | | - Cristina Zorrero
- Gynecology Department, Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain;
| | - Marcin Misiek
- Department of Gynecologic Oncology, Holycross Cancer Center, 25-734 Kielce, Poland;
| | - Leon Cornelius Snyman
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria 0001, South Africa;
| | - Dariusz Wydra
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, 80-402 Gdansk, Poland;
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, University Hospital Leuven, Leuven Cancer Institute, 3000 Leuven, Belgium;
| | - Alla Vinnytska
- LISOD-Israeli Oncological Hospital, 08720 Plyuty, Ukraine;
| | - Mikulas Redecha
- Department of Gynaecology and Obstetrics, University Hospital, Comenius University, 82101 Bratislava, Slovakia;
| | - Martin Michal
- Department of Obstetrics and Gynaecology, Hospital Ceske Budejovice, JSC, 37001 Ceske Budejovice, Czech Republic;
| | | | - Barbara Kipp
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland;
| | - Grzegorz Szewczyk
- Department of Obstetrics and Gynecology, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Robert Toth
- Oncology Institute of East Slovakia, 04191 Košice, Slovakia;
| | | | | | - Robert Poka
- Institute of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | | | - Mathieu Luyckx
- Department of Gynecology, Universite catholique de Louvain, Cliniques Universitaires St Luc, 1200 Brussels, Belgium;
| | - Maxime Fastrez
- Department of Obstetrics and Gynaecology, St Pierre University Hospital, Universite Libre de Bruxelles, 1000 Brussels, Belgium;
| | - Juan Carlos Staringer
- Department of Gynecology and Obstetrics, Hospital Español de Buenos Aires, Buenos Aires 2975, Argentina;
| | - Anna Germanova
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (R.K.); (A.G.)
| | - Andrea Plaikner
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany; (C.K.); (A.P.)
| | - Sylva Bajsova
- Department of Obstetrics and Gynecology, University Hospital Ostrava, 708 52 Ostrava Poruba, Czech Republic; (J.K.); (S.B.)
| | - Pavel Dundr
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (K.N.); (P.D.)
| | | | - David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (R.K.); (A.G.)
- Correspondence: ; Tel.: +420-224967451
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25
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Ray-Coquard I, Pautier P, Pignata S, Pérol D, González-Martín A, Berger R, Fujiwara K, Vergote I, Colombo N, Mäenpää J, Selle F, Sehouli J, Lorusso D, Guerra Alía EM, Reinthaller A, Nagao S, Lefeuvre-Plesse C, Canzler U, Scambia G, Lortholary A, Marmé F, Combe P, de Gregorio N, Rodrigues M, Buderath P, Dubot C, Burges A, You B, Pujade-Lauraine E, Harter P. Olaparib plus Bevacizumab as First-Line Maintenance in Ovarian Cancer. N Engl J Med 2019; 381:2416-2428. [PMID: 31851799 DOI: 10.1056/nejmoa1911361] [Citation(s) in RCA: 1030] [Impact Index Per Article: 206.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Olaparib has shown significant clinical benefit as maintenance therapy in women with newly diagnosed advanced ovarian cancer with a BRCA mutation. The effect of combining maintenance olaparib and bevacizumab in patients regardless of BRCA mutation status is unknown. METHODS We conducted a randomized, double-blind, international phase 3 trial. Eligible patients had newly diagnosed, advanced, high-grade ovarian cancer and were having a response after first-line platinum-taxane chemotherapy plus bevacizumab. Patients were eligible regardless of surgical outcome or BRCA mutation status. Patients were randomly assigned in a 2:1 ratio to receive olaparib tablets (300 mg twice daily) or placebo for up to 24 months; all the patients received bevacizumab at a dose of 15 mg per kilogram of body weight every 3 weeks for up to 15 months in total. The primary end point was the time from randomization until investigator-assessed disease progression or death. RESULTS Of the 806 patients who underwent randomization, 537 were assigned to receive olaparib and 269 to receive placebo. After a median follow-up of 22.9 months, the median progression-free survival was 22.1 months with olaparib plus bevacizumab and 16.6 months with placebo plus bevacizumab (hazard ratio for disease progression or death, 0.59; 95% confidence interval [CI], 0.49 to 0.72; P<0.001). The hazard ratio (olaparib group vs. placebo group) for disease progression or death was 0.33 (95% CI, 0.25 to 0.45) in patients with tumors positive for homologous-recombination deficiency (HRD), including tumors that had BRCA mutations (median progression-free survival, 37.2 vs. 17.7 months), and 0.43 (95% CI, 0.28 to 0.66) in patients with HRD-positive tumors that did not have BRCA mutations (median progression-free survival, 28.1 vs. 16.6 months). Adverse events were consistent with the established safety profiles of olaparib and bevacizumab. CONCLUSIONS In patients with advanced ovarian cancer receiving first-line standard therapy including bevacizumab, the addition of maintenance olaparib provided a significant progression-free survival benefit, which was substantial in patients with HRD-positive tumors, including those without a BRCA mutation. (Funded by ARCAGY Research and others; PAOLA-1 ClinicalTrials.gov number, NCT02477644.).
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Affiliation(s)
- Isabelle Ray-Coquard
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Patricia Pautier
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Sandro Pignata
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - David Pérol
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Antonio González-Martín
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Regina Berger
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Keiichi Fujiwara
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Ignace Vergote
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Nicoletta Colombo
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Johanna Mäenpää
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Frédéric Selle
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Jalid Sehouli
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Domenica Lorusso
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Eva M Guerra Alía
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Alexander Reinthaller
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Shoji Nagao
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Claudia Lefeuvre-Plesse
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Ulrich Canzler
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Giovanni Scambia
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Alain Lortholary
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Frederik Marmé
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Pierre Combe
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Nikolaus de Gregorio
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Manuel Rodrigues
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Paul Buderath
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Coraline Dubot
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Alexander Burges
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Benoît You
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Eric Pujade-Lauraine
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
| | - Philipp Harter
- From Centre Léon Bérard (I.R.-C., D.P.), University Claude Bernard Lyon 1 (I.R.-C.), and Centre Hospitalier Lyon-Sud (B.Y.), Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) (I.R.-C., P.P., F.S., C.L.-P., A.L., P.C., M.R., C.D., B.Y., E.P.-L.), Groupe Hospitalier Diaconesses Croix Saint-Simon (F.S.), Hôpital Européen Georges Pompidou (P.C.), Institut Curie, Hôpital Claudius Régaud (M.R.), and Association de Recherche Cancers Gynécologiques (ARCAGY) (E.P.-L.), Paris, Gustave Roussy, Villejuif (P.P.), Centre Eugène Marquis, Rennes (C.L.-P.), Centre Catherine de Sienne Hôpital Privé du Confluent, Nantes (A.L.), and Institut Curie, Hôpital René Huguenin, Saint Cloud (C.D.) - all in France; the Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples (S.P.), University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO) (N.C.), and Fondazione IRCCS Istituto Nazionale Tumori and MITO (D.L.), Milan, and Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, and MITO, Rome (G.S.) - all in Italy; M.D. Anderson Cancer Center Madrid (A.G.-M.), Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M., E.M.G.A.), and Hospital Universitario Ramón y Cajal (E.M.G.A.) - all in Madrid; Medical University of Innsbruck, University Clinic for Gynecology and Obstetrics (R.B.), and Arbeitsgemeinschaft Gynäkologische Onkologie Study Group (AGO)-Austria (R.B., A.R.), Innsbruck, and Medical University of Vienna, Vienna (A.R.) - all in Austria; Saitama Medical University International Medical Center, Hidaka (K.F.), Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Moroyama-cho (K.F., S.N.), and Hyogo Cancer Center, Akashi (S.N.) - all in Japan; University Hospital Leuven, Leuven Cancer Institute, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG) - both in Leuven, Belgium (I.V.); Tampere University and University Hospital, Tampere, Finland (J.M.); the Nordic Society of Gynecologic Oncology (NSGO), Copenhagen (J.M.); and Charité-Medical University of Berlin (Campus Virchow Klinikum), Berlin (J.S.), German Society of Gynecologic Oncology (AGO) (J.S., U.C., F.M., N.G., P.B., A.B., P.H.), Universitätsklinikum Essen (P.B.), and Kliniken Essen Mitte (P.H.), Essen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden (U.C.), Universitätsklinikum Heidelberg, Heidelberg (F.M.), Universitätsklinikum Ulm, Ulm (N.G.), and Klinikum der Universität München, Munich (A.B.) - all in Germany
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Piccirillo MC, Scambia G, Bologna A, Signoriello S, Vergote I, Baumann K, Lorusso D, Murgia V, Sorio R, Ferrandina G, Sacco C, Cormio G, Breda E, Cinieri S, Natale D, Mangili G, Pisano C, Cecere SC, Di Napoli M, Salutari V, Raspagliesi F, Arenare L, Bergamini A, Bryce J, Daniele G, Gallo C, Pignata S, Perrone F. Quality-of-life analysis of the MITO-8, MaNGO, BGOG-Ov1, AGO-Ovar2.16, ENGOT-Ov1, GCIG study comparing platinum-based versus non-platinum-based chemotherapy in patients with partially platinum-sensitive recurrent ovarian cancer. Ann Oncol 2019; 29:1189-1194. [PMID: 29462248 DOI: 10.1093/annonc/mdy062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background MITO-8 showed that prolonging platinum-free interval by introducing non-platinum-based chemotherapy (NPBC) does not improve prognosis of patients with partially platinum-sensitive recurrent ovarian cancer. Quality of life (QoL) was a secondary outcome. Patients and methods Ovarian cancer patients recurring or progressing 6-12 months after previous platinum-based chemotherapy (PBC) were randomized to receive PBC or NPBC as first treatment. QoL was assessed at baseline, third and sixth cycles, with the EORTC C-30 and OV-28 questionnaires. Mean changes and best response were analysed. Progression-free survival, response rate, and toxicity are also reported for proper interpretation of data. All analyses were based on intention-to-treat. Results Out of the 215 patients, 151 (70.2%) completed baseline questionnaire, balanced between the arms; thereafter, missing rate was higher in the NPBC arm. At mean change analysis, C30 scores were prevalently worse in the NPBC than PBC arm, statistical significance being attained for emotional functioning, global health status/QoL, fatigue, and dyspnoea (effect sizes ranging from 0.30 to 0.51). Conversely, as for OV28 scale, the other chemotherapy side-effects item was significantly worse with PBC at three and six cycles, with a larger effect size (0.70 and 0.54, respectively). At best response analysis, improvement of emotional functioning and pain and worsening of peripheral neuropathy and other chemotherapy side-effects were significantly more frequent in the PBC arm. Progression-free survival (median 9 versus 5 months, P = 0.001) and objective response rate (51.6% versus 19.4%, P = 0.0001) were significantly better with PBC. Allergy, blood cell count, alopecia, nausea, musculoskeletal, and neurological side-effects were more frequent and severe with PBC; hand-foot skin reaction, rash/desquamation, mucositis, and vascular events were more frequent with NPBC. Conclusion MITO-8 QoL analysis shows that deterioration of some functioning and symptom scales is lower with PBC, with improvement of emotional functioning and pain, despite worsening of toxicity-related items. ClinicalTrials.gov NCT00657878.
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Affiliation(s)
- M C Piccirillo
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli
| | - G Scambia
- Department of Protection of Women's Health, Rising Life, Child and Adolescent, Università Cattolica del Sacro Cuore, Roma
| | - A Bologna
- Medical Oncology Unit, Azienda Unità Sanitaria Locale/IRCCS di Reggio Emilia, Reggio Emilia
| | - S Signoriello
- Medical Statistics, Università degli Studi della Campania "Luigi Vanvitelli", Napoli
| | - I Vergote
- University Hospital Leuven, Leuven; Leuven Cancer Institute, Leuven, Belgium
| | - K Baumann
- UKGM Gynecology, Frauenklinik, Marburg, Germany
| | - D Lorusso
- Department of Protection of Women's Health, Rising Life, Child and Adolescent, Università Cattolica del Sacro Cuore, Roma; Gynaecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano
| | - V Murgia
- Medical Oncology, Ospedale S. Chiara, Trento
| | - R Sorio
- Medical Oncology C, Centro di Riferimento Oncologico, Aviano, PN
| | - G Ferrandina
- Department of Protection of Women's Health, Rising Life, Child and Adolescent, Università Cattolica del Sacro Cuore, Roma; Gynaecologic Oncology, Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso
| | - C Sacco
- Oncology Department, AO S. Maria della Misericordia, Udine
| | - G Cormio
- Università di Bari, Bari; Ginecoloy Oncology, Istituto Oncologico "Giovanni Paolo II", Bari
| | - E Breda
- Medical Oncology, Ospedale S.Giovanni Calibita Fatebenefratelli, Roma
| | - S Cinieri
- Medical Oncology, Ospedale Antonio Perrino, Brindisi
| | - D Natale
- Medical Oncology, Ospedale San Massimo, Penne, PE
| | - G Mangili
- Obstertic and Gynaecologic Department, Ospedale San Raffaele, Milano
| | - C Pisano
- Uro-Gynaecologic Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli, Italy
| | - S C Cecere
- Uro-Gynaecologic Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli, Italy
| | - M Di Napoli
- Uro-Gynaecologic Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli, Italy
| | - V Salutari
- Department of Protection of Women's Health, Rising Life, Child and Adolescent, Università Cattolica del Sacro Cuore, Roma
| | | | - L Arenare
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli
| | - A Bergamini
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli; Obstertic and Gynaecologic Department, Ospedale San Raffaele, Milano
| | - J Bryce
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli
| | - G Daniele
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli
| | - C Gallo
- Medical Statistics, Università degli Studi della Campania "Luigi Vanvitelli", Napoli
| | - S Pignata
- Uro-Gynaecologic Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli, Italy.
| | - F Perrone
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli
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Vergote I, Coleman RL, Pignata S, Bookman MA, Marth C, Herzog TJ, Gonzalez-Martin A, Copeland LJ. Joint ENGOT and GOG Foundation requirements for trials with industry partners. Gynecol Oncol 2019; 154:255-258. [PMID: 31331494 DOI: 10.1016/j.ygyno.2019.04.677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/16/2019] [Accepted: 04/21/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Ignace Vergote
- ENGOT/BGOG and University Hospital Leuven, Gynaecological Oncology, Leuven Cancer Institute, Herestraat 49, 3000 Leuven, Belgium, European Union.
| | - Robert L Coleman
- GOG-F and Gynecologic Oncology & Reproductive Medicine, University of Texas, M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Sandro Pignata
- ENGOT/MITO Istituto Nazionale Tumori IRCCS Fondazione Pascale Napoli, Italy
| | - Michael A Bookman
- GOG-F and Gynecologic Oncology Therapeutics, Kaiser Permanente San Francisco, San Francisco, USA
| | - Christian Marth
- ENGOT/A-AGO and Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Thomas J Herzog
- GOG-F and Gynecologic Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Larry J Copeland
- GOG-F and Gynecologic Oncology, Ohio State University Wexner Medical Center and JamesCare Gynecologic Oncology at Mill Run, Columbus, Ohio, USA
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Vergote I, Coleman RL, Pignata S, Bookman MA, Marth C, Herzog TJ, Gonzalez Martin A, Copeland LJ. Joint ENGOT and GOG Foundation requirements for trials with industry partners. Int J Gynecol Cancer 2019; 29:1094-1097. [PMID: 31320391 DOI: 10.1136/ijgc-2019-000441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ignace Vergote
- ENGOT/BGOG and University Hospital Leuven, Gynaecological Oncology Leuven Cancer Institute, Leuven, Belgium, European Union
| | - Robert L Coleman
- GOG-F and Gynecologic Oncology & Reproductive Medicine, University of Texas; M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Sandro Pignata
- ENGOT/MITO Gynaecological Oncology, National Cancer Institute Napels, Naples, Italy
| | - Michael A Bookman
- GOG-F and Gynecologic Oncology Therapeutics, Kaiser Permanente San Francisco, San Francisco, California, USA
| | - Christian Marth
- ENGOT/A-AGO and Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Thomas J Herzog
- GOG-F and Gynecologic Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Larry J Copeland
- GOG-F and Gynecologic Oncology, Ohio State University Wexner Medical Center and JamesCare Gynecologic Oncology at Mill Run, Columbus, Ohio, USA
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Vergote I, Scambia G, O'Malley DM, Van Calster B, Park SY, Del Campo JM, Meier W, Bamias A, Colombo N, Wenham RM, Covens A, Marth C, Raza Mirza M, Kroep JR, Ma H, Pickett CA, Monk BJ. Trebananib or placebo plus carboplatin and paclitaxel as first-line treatment for advanced ovarian cancer (TRINOVA-3/ENGOT-ov2/GOG-3001): a randomised, double-blind, phase 3 trial. Lancet Oncol 2019; 20:862-876. [PMID: 31076365 DOI: 10.1016/s1470-2045(19)30178-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Angiopoietin 1 and 2 regulate angiogenesis and vascular remodelling by interacting with the tyrosine kinase receptor Tie2, and inhibition of angiogenesis has shown promise in the treatment of ovarian cancer. We aimed to assess whether trebananib, a peptibody that inhibits binding of angiopoietin 1 and 2 to Tie2, improved progression-free survival when added to carboplatin and paclitaxel as first-line therapy in advanced epithelial ovarian, primary fallopian tube, or peritoneal cancer in a phase 3 clinical trial. METHODS TRINOVA-3, a multicentre, multinational, phase 3, double-blind study, was done at 206 investigational sites (hospitals and cancer centres) in 14 countries. Eligible patients were aged 18 years or older with biopsy-confirmed International Federation of Gynecology and Obstetrics (FIGO) stage III to IV epithelial ovarian, primary peritoneal, or fallopian tube cancers, and an ECOG performance status of 0 or 1. Eligible patients were randomly assigned (2:1) using a permuted block method (block size of six patients) to receive six cycles of paclitaxel (175 mg/m2) and carboplatin (area under the serum concentration-time curve 5 or 6) every 3 weeks, plus weekly intravenous trebananib 15 mg/kg or placebo. Maintenance therapy with trebananib or placebo continued for up to 18 additional months. The primary endpoint was progression-free survival, as assessed by the investigators, in the intention-to-treat population. Safety analyses included patients who received at least one dose of study treatment. This trial is registered with ClinicalTrials.gov, number NCT01493505, and is complete. FINDINGS Between Jan 30, 2012, and Feb 25, 2014, 1164 patients were screened and 1015 eligible patients were randomly allocated to treatment (678 to trebananib and 337 to placebo). After a median follow-up of 27·4 months (IQR 17·7-34·2), 626 patients had progression-free survival events (405 [60%] of 678 in the trebananib group and 221 [66%] of 337 in the placebo group). Median progression-free survival did not differ between the trebananib group (15·9 months [15·0-17·6]) and the placebo group (15·0 months [12·6-16·1]) groups (hazard ratio 0·93 [95% CI 0·79-1·09]; p=0·36). 512 (76%) of 675 patients in the trebananib group and 237 (71%) of 336 in the placebo group had grade 3 or worse treatment-emergent adverse events; of which the most common events were neutropenia (trebananib 238 [35%] vs placebo 126 [38%]) anaemia (76 [11%] vs 40 [12%]), and leucopenia (81 [12%] vs 35 [10%]). 269 (40%) patients in the trebananib group and 104 (31%) in the placebo group had serious adverse events. Two fatal adverse events in the trebananib group were considered related to trebananib, paclitaxel, and carboplatin (lung infection and neutropenic colitis); two were considered to be related to paclitaxel and carboplatin (general physical health deterioration and platelet count decreased). No treatment-related fatal adverse events occurred in the placebo group. INTERPRETATION Trebananib plus carboplatin and paclitaxel did not improve progression-free survival as first-line treatment for advanced ovarian cancer. The combination of trebananib plus carboplatin and paclitaxel did not produce new safety signals. These results show that trebananib in combination with carboplatin and paclitaxel is minimally effective in this patient population. FUNDING Amgen.
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Affiliation(s)
- Ignace Vergote
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven, Belgium; European Network of Gynaecological Oncological Trial groups (ENGOT), Divison of Gynecologic Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium.
| | - Giovanni Scambia
- Multicenter Italian Trials in Ovarian Cancer Society (MITO), Rome, Italy; Fondazione Policlinico Universitario A Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica, Rome, Italy
| | - David M O'Malley
- Gynecologic Oncology Group, James Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
| | - Ben Van Calster
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Josep M Del Campo
- Grupo Español de Investigación en Cáncer de Ovario (GEICO), Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Werner Meier
- Arbeitsgemeinschaft Gynaekologische Onkologie Study Group (AGO), Department of Gynecology and Obstetrics, AGO-Germany and Evangelic Hospital Düsseldorf, Düsseldorf, Germany
| | - Aristotelis Bamias
- Department of Clinical Therapeutics, Alexandra Hospital, National & Kapodistrian University of Athens, Athens, Greece; Hellenic Cooperative Oncology Group (HECOG), Athens, Greece
| | - Nicoletta Colombo
- Mario Negri Gynecologic Oncology Group (MANGO), European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy; Università Milano Bicocca, Milan, Italy
| | - Robert M Wenham
- Gynecologic Oncology Group, Department of Gynecologic Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Al Covens
- Division of Gynecologic Oncology, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Christian Marth
- Arbeitsgemeinschaft Gynaekologische Onkologie Study Group (AGO)-Austria, Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Mansoor Raza Mirza
- Nordic Society of Gynaecological Oncology (NSGO), Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Judith R Kroep
- Dutch Gynecological Oncology Group (DCOG), Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Haijun Ma
- Global Development Oncology, Amgen, Thousand Oaks, CA, USA
| | | | - Bradley J Monk
- Gynecologic Oncology Group, Arizona Oncology (US Oncology Network), University of Arizona, Phoenix, AZ, USA; Creighton University, Phoenix, AZ, USA
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Pignata S, Scambia G, Bologna A, Signoriello S, Vergote IB, Wagner U, Lorusso D, Murgia V, Sorio R, Ferrandina G, Sacco C, Cormio G, Breda E, Cinieri S, Natale D, Mangili G, Pisano C, Cecere SC, Di Napoli M, Salutari V, Raspagliesi F, Arenare L, Bergamini A, Bryce J, Daniele G, Piccirillo MC, Gallo C, Perrone F. Randomized Controlled Trial Testing the Efficacy of Platinum-Free Interval Prolongation in Advanced Ovarian Cancer: The MITO-8, MaNGO, BGOG-Ov1, AGO-Ovar2.16, ENGOT-Ov1, GCIG Study. J Clin Oncol 2017; 35:3347-3353. [PMID: 28825853 DOI: 10.1200/jco.2017.73.4293] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Platinum-based chemotherapy (PBC) for patients with progressing ovarian cancer (OC) is more effective with a longer time interval from previous platinum treatment (platinum-free interval [PFI]). In 1999, it was hypothesized that prolonging PFI with single-agent non-PBC (NPBC) may offer a strategy to improve overall outcome. MITO-8 aimed to verify this hypothesis commonly used in clinical practice although it has not been prospectively tested. Methods MITO-8 is an open-label, prospective, randomized, superiority trial. Patients with OC who experienced disease progression 6 to 12 months after their last platinum treatment were randomly assigned 1:1 to the experimental sequence of NPBC followed by PBC at subsequent relapse or the standard reverse treatment sequence. Overall survival (OS) was the primary end point. Results Two hundred fifteen patients were enrolled (standard arm [n = 108]; experimental arm [n = 107]). The trial ended before planned because of slow enrollment. PFI was prolonged in the experimental arm (median, 7.8 v 0.01 months). There was no OS benefit in the experimental arm (median, 21.8 v 24.5 months; hazard ratio, 1.38; 95% CI, 0.99 to 1.94; P = .06). Progression-free survival after the sequence was significantly shorter in the experimental arm (median, 12.8 v 16.4 months; hazard ratio, 1.41; 95% CI, 1.04 to 1.92; P = .025). Global quality-of-life change after three cycles was worse in the experimental arm. Slight differences were observed in the incidence of adverse effects. Conclusion MITO-8 supports the recommendation that PBC not be delayed in favor of an NPBC in patients with partially platinum-sensitive OC. PBC should be used as a control arm in future trials of new drugs in this setting.
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Affiliation(s)
- Sandro Pignata
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Giovanni Scambia
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Alessandra Bologna
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Simona Signoriello
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Ignace B Vergote
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Uwe Wagner
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Domenica Lorusso
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Viviana Murgia
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Roberto Sorio
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Gabriella Ferrandina
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Cosimo Sacco
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Gennaro Cormio
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Enrico Breda
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Saverio Cinieri
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Donato Natale
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Giorgia Mangili
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Carmela Pisano
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Sabrina Chiara Cecere
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Marilena Di Napoli
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Vanda Salutari
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Francesco Raspagliesi
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Laura Arenare
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Alice Bergamini
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Jane Bryce
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Gennaro Daniele
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Maria Carmela Piccirillo
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Ciro Gallo
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
| | - Francesco Perrone
- Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Laura Arenare, Alice Bergamini, Jane Bryce, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione G. Pascale, IRCCS; Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli, Naples; Giovanni Scambia, Domenica Lorusso, Gabriella Ferrandina, and Vanda Salutari, Università Cattolica del Sacro Cuore; Enrico Breda, Ospedale San Giovanni Calibita Fatebenefratelli, Rome; Alessandra Bologna, Azienda Ospedaliea Santa Maria Nuova, IRCCS, Reggio Emilia; Domenica Lorusso and Francesco Raspagliesi, Fondazione IRCCS Istituto Nazionale dei Tumori; Giorgia Mangili and Alice Bergamini, Ospedale San Raffaele, Milan; Viviana Murgia, Ospedale Santa Chiara, Trento; Roberto Sorio, Centro di Riferimento Oncologico, Aviano; Gabriella Ferrandina, Centro di Ricerca e Formazione Ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso; Cosimo Sacco, Azienda Ospedaliera di Perugia Santa Maria della Misericordia, Udine; Gennaro Cormio, Ginecologia Oncologica, Università di Bari e Istituto Oncologico "Giovanni Paolo II" Bari; Saverio Cinieri, Ospedale Antonio Perrino, Brindisi; Donato Natale, Ospedale San Massimo, Penne, Italy; Ignace B. Vergote, University Hospital Leuven and Belgian and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, Leuven, Belgium; and Uwe Wagner, Uniklinkum Giessen und Marburg Gynäkologie, Marburg, Germany
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Marth C, Vergote I, Scambia G, Oberaigner W, Clamp A, Berger R, Kurzeder C, Colombo N, Vuylsteke P, Lorusso D, Hall M, Renard V, Pignata S, Kristeleit R, Altintas S, Rustin G, Wenham RM, Mirza MR, Fong PC, Oza A, Monk BJ, Ma H, Vogl FD, Bach BA. ENGOT-ov-6/TRINOVA-2: Randomised, double-blind, phase 3 study of pegylated liposomal doxorubicin plus trebananib or placebo in women with recurrent partially platinum-sensitive or resistant ovarian cancer. Eur J Cancer 2016; 70:111-121. [PMID: 27914241 DOI: 10.1016/j.ejca.2016.09.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/26/2016] [Accepted: 09/01/2016] [Indexed: 10/20/2022]
Abstract
AIMS Trebananib, a peptide-Fc fusion protein, inhibits angiogenesis by inhibiting binding of angiopoietin-1/2 to the receptor tyrosine kinase Tie2. This randomised, double-blind, placebo-controlled phase 3 study evaluated whether trebananib plus pegylated liposomal doxorubicin (PLD) improved progression-free survival (PFS) in patients with recurrent epithelial ovarian cancer. METHODS Women with recurrent ovarian cancer (platinum-free interval ≤12 months) were randomised to intravenous PLD 50 mg/m2 once every 4 weeks plus weekly intravenous trebananib 15 mg/kg or placebo. PFS was the primary end-point; key secondary end-points were objective response rate (ORR) and duration of response (DOR). Owing to PLD shortages, enrolment was paused for 13 months; the study was subsequently truncated. RESULTS Two hundred twenty-three patients were enrolled. Median PFS was 7.6 months (95% CI, 7.2-9.0) in the trebananib arm and 7.2 months (95% CI, 4.8-8.2) in the placebo arm, with a hazard ratio of 0.92 (95% CI, 0.68-1.24). However, because the proportional hazards assumption was not fulfilled, the standard Cox model did not provide a reliable estimate of the hazard ratio. ORR in the trebananib arm was 46% versus 21% in the placebo arm (odds ratio, 3.43; 95% CI, 1.78-6.64). Median DOR was improved (trebananib, 7.4 months [95% CI, 5.7-7.6]; placebo, 3.9 months [95% CI, 2.3-6.5]). Adverse events with a greater incidence in the trebananib arm included localised oedema (61% versus 32%), ascites (29% versus 9%) and vomiting (45% versus 33%). CONCLUSIONS Trebananib demonstrated anticancer activity in this phase 3 study, indicated by improved ORR and DOR. Median PFS was not improved. No new safety signals were identified. TRIAL REGISTRATION ClinicalTrials.gov, NCT01281254.
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Affiliation(s)
- Christian Marth
- AGO-Austria and Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Ignace Vergote
- BGOG and Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven Cancer Institute, KU Leuven, Belgium
| | - Giovanni Scambia
- MITO and Dipartimento per la Tutela della Salute della Donna e della Vita Nascente del Bambino e Adolescente, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Willi Oberaigner
- AGO-Austria and Department of Clinical Epidemiology of the Tirol Kliniken Ltd., Cancer Registry of Tyrol, Innsbruck, Austria
| | - Andrew Clamp
- Department of Medical Oncology, Institute of Cancer Sciences, University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - Regina Berger
- AGO-Austria and Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kurzeder
- AGO-Study Group and Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte/Evang. Huyssens Stiftung/Knappschaft GmbH, Essen, Germany
| | - Nicoletta Colombo
- MANGO and Istituto Europeo di Oncologia and Università Milano Bicocca, Milano, Italy
| | - Peter Vuylsteke
- BGOG and Department of Medical Oncology, CHU Université Catholique de Louvain, Site Sainte Elisabeth, Namur, Belgium
| | - Domenica Lorusso
- MITO and Unità di Ginecologia Oncologica, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Marcia Hall
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Vincent Renard
- BGOG and Department of Oncology, AZ St. Lucas, Ghent, Belgium
| | - Sandro Pignata
- MITO and Department of Urology and Gynecology, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Rebecca Kristeleit
- Department of Medical Oncology, University College London Cancer Institute, London, UK
| | - Sevilay Altintas
- BGOG and Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Gordon Rustin
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Robert M Wenham
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Peter C Fong
- Medical Oncology Department, Auckland City Hospital, Auckland, New Zealand
| | - Amit Oza
- Department of Medicine, Princess Margaret Hospital, University of Toronto, ON, Canada
| | - Bradley J Monk
- Department of Obstetrics and Gynecology, University of Arizona Cancer Center at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Haijun Ma
- Global Development Oncology, Amgen Inc., Thousand Oaks, CA, USA
| | - Florian D Vogl
- Global Development Oncology, Amgen Inc., Thousand Oaks, CA, USA
| | - Bruce A Bach
- Global Development Oncology, Amgen Inc., Thousand Oaks, CA, USA
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European Network of Gynaecological Oncological Trial Groups' Requirements for Trials Between Academic Groups and Industry Partners--First Update 2015. Int J Gynecol Cancer 2016; 25:1328-30. [PMID: 26067859 DOI: 10.1097/igc.0000000000000478] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The first version of ENGOT's Requirements for Trials Between Academic Groups and Industry Partners in Europe was published 2010. This first update integrates the experiences made by the ENGOT network and the cooperative group studies while performing, analyzing, and publishing -among others - three large phase III trials. Furthermore, progress in European legislation and its impact on clinical studies in Europe have been considered in this update process.
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Phase II study of weekly paclitaxel/carboplatin in combination with prophylactic G-CSF in the treatment of gynecologic cancers: A study in 108 patients by the Belgian Gynaecological Oncology Group. Gynecol Oncol 2015; 138:278-84. [DOI: 10.1016/j.ygyno.2015.05.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 01/08/2023]
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Evaluation of the fallopian tubes after neoadjuvant chemotherapy: persistence of serous tubal intraepithelial carcinoma. Int J Gynecol Pathol 2015; 33:463-9. [PMID: 25083961 DOI: 10.1097/pgp.0b013e3182a142c2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The origin of pelvic serous carcinoma continues to be controversial. Recent studies of patients undergoing primary surgery for ovarian, primary peritoneal, and uterine serous carcinomas have indicated the value of complete fimbrial sampling for detecting occult serous tubal intraepithelial carcinoma (STIC). Evidence suggests that a significant proportion of pelvic serous carcinomas may arise from in situ lesions on the distal fallopian tube. In this study, 14 consecutive cases of interval debulking surgery after neoadjuvant chemotherapy were reviewed, using both hematoxylin and eosin staining and, as needed, immunohistochemistry for p53 and MIB-1. The degree of fimbrial sampling was evaluated, and cases were examined for tumor involvement in the endosalpinx and the presence of STIC. Tumor treatment response was classified using a semiquantitative 4-tier scale. The results indicate that STIC can persist despite chemotherapy and can be readily identified during microscopic examination. These results are expected to improve the quality of the pathology evaluation by providing data-driven recommendations for sampling in interval surgery cases and showing the value of a systematic approach to evaluating the fallopian tube (sectioning and extensively examining the fimbria protocol). These results demonstrate that a tubal primary can still be assigned in these situations. Finally, this study raises interesting biologic questions about the sensitivity of cells originating from serous cancer tumor to chemotherapy. The presence or absence of STIC in specimens from interval surgery after neoadjuvant treatment has not previously, to our knowledge, been addressed.
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Roadmap for the European Network of Gynaecological Trial Groups (ENGOT) Trials. Int J Gynecol Cancer 2013; 23:1339-43. [DOI: 10.1097/igc.0b013e31829b87da] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AbstractThe European Network for Gynaecological Oncological Trial groups (ENGOT) is a research network of the European Society of Gynaecological Oncology and was founded in Berlin in October 2007. Earlier, we reported on the ENGOT minimal requirements for trials between academic groups and pharmaceutical companies. In this paper, we summarize the roadmap for performing trials in the ENGOT framework. In this roadmap, we define how an ENGOT trial should be set up and discuss the following items: What are the conditions to classify a study as an ENGOT trial? What is an ENGOT protocol? How are an ENGOT protocol, informed consent (ICF), and case report form (CRF) produced? How is the center selection and feasibility performed in ENGOT trials? How are regulatory and operational tasks handled? How should a confidentiality agreement between the industry and the whole ENGOT network be negotiated? How are contracts made between the industry and ENGOT and between ENGOT groups? How are funding, insurance, and communication flow arranged in ENGOT trials? What are the requirements for conducting substudies and what are the tasks for the leading group in an ENGOT trial? A template of a confidentiality agreement, a checklist of ENGOT criteria for new study proposals, and guidelines for authorship are also provided.
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Brantnerova R, Manchanda R, Colombo N. The European society of gynaecological oncology: update on objectives and educational and research activities. Am Soc Clin Oncol Educ Book 2012:335-338. [PMID: 24451759 DOI: 10.14694/edbook_am.2012.32.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The European Society of Gynaecological Oncology (ESGO) is the principal European society contributing to the study, prevention, and treatment of gynecologic cancers. Founded in 1983, ESGO has more than 1,300 members in more than 40 European countries and worldwide who benefit from ESGO's innovative education and research initiatives and networking opportunities. ESGO objectives have been recently identified through a strategic planning process and include education, care, research, collaboration, awareness, and sustainability. As a leading gynecologic oncology society, ESGO holds biennial meetings where experts meet to discuss latest advances in gynecologic treatment and care. The 17(th) International Meeting of ESGO (ESGO 17) proved to be a resounding success, with 2,700 delegates and speakers who gathered from around the world in the cultured city of Milan, Italy. The structure of the congress included keynote lectures, debates, state-of-the art sessions, and focused sunrise sessions, together with oral and poster presentations and satellite symposia sponsored by pharmaceutical companies. For the first time, during ESGO 17 the Society organized a seminar for European patient groups with an interest in gynecologic cancers with the aim of facilitating different patientrelated activities across Europe. Moreover, The European Network of Young Gynaecologic Oncologists (ENYGO), the European Network of Gynaecologic Oncology Trial Groups (ENGOT), and the European Network of Translational Research in Gynaecological Oncology (ENTRIGO) had their own section during ESGO 17. ESGO also holds numerous workshops throughout the calendar year and provides clinical and research grants, online educational materials, webcasts, and numerous networking opportunities.
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Affiliation(s)
- Renata Brantnerova
- From the European Society of Gynaecological Oncology, the UCL Elizabeth Garrett Anderson Institute for Women's Health, and the University of Milan Bicocca, European Institute of Oncology
| | - Ranjit Manchanda
- From the European Society of Gynaecological Oncology, the UCL Elizabeth Garrett Anderson Institute for Women's Health, and the University of Milan Bicocca, European Institute of Oncology
| | - Nicoletta Colombo
- From the European Society of Gynaecological Oncology, the UCL Elizabeth Garrett Anderson Institute for Women's Health, and the University of Milan Bicocca, European Institute of Oncology
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Trimble EL, Birrer MJ, Hoskins WJ, Marth C, Petryshyn R, Quinn M, Thomas GM, Kitchener HC, Aghajanian C, Alberts DS, Armstrong D, Brown J, Coleman RL, Colombo N, Eisenhauer E, Friedlander M, Fujiwara K, Hunsberger S, Kaye S, Ledermann JA, Lee S, Look K, Mannel R, McNeish IA, Minasian L, Oza A, Paul J, Poveda A, Pujade-Lauraine E, Schoenfeldt M, Swart AM, von Gruenigen V, Wenzel L. Current academic clinical trials in ovarian cancer: Gynecologic Cancer Intergroup and US National Cancer Institute Clinical Trials Planning Meeting, May 2009. Int J Gynecol Cancer 2011; 20:1290-8. [PMID: 21151709 DOI: 10.1111/igc.0b013e3181ee1c01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To review the current status of large phase academic clinical trials for women with ovarian cancer, address cross-cutting issues, and identify promising areas for future collaboration. METHODS In May 2009, the Gynecologic Cancer Intergroup, which represents 19 Cooperative Groups conducting trials for women with gynecologic cancer, and the US National Cancer Institute convened a Clinical Trials Planning Meeting. RESULTS The topics covered included the impact of new developments in cancer biology upon molecular targets and novel agents, pharmacogenomics, advances in imaging, the potential benefit of diet and exercise to reduce the risk of recurrence, academic partnership with industry, statistical considerations for phases 2 and 3 trials, trial end points, and symptom benefit and health-related quality-of-life issues. The clinical trials discussed spanned the spectrum of ovarian cancer from initial diagnosis, staging, and cytoreductive surgery to consolidation chemotherapy, and treatment of recurrent disease. CONCLUSIONS Ongoing and effective collaboration with industry, government, and patients aims to ensure that the most important scientific questions can be answered rapidly. We encourage women with ovarian cancer and their oncologists to consider participation in the academic clinical trials conducted by the member groups of the Gynecologic Cancer Intergroup.
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Affiliation(s)
- Edward L Trimble
- National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-7436, USA.
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