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Monk BJ, Colombo N, Tewari KS, Tekin C, Keefe SM, Lorusso D. Reply to P.-H. Luo et al. J Clin Oncol 2024; 42:1596-1598. [PMID: 38452314 DOI: 10.1200/jco.24.00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Bradley J Monk
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Nicoletta Colombo
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Krishnansu S Tewari
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Cumhur Tekin
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Stephen M Keefe
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Domenica Lorusso
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
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Lorusso D, Raspagliesi F, Ronzulli D, Valabrega G, Colombo N, Pisano C, Cassani C, Tognon G, Tamberi S, Mangili G, Mammoliti S, De Giorgi U, Greco F, Mosconi AM, Breda E, Artioli G, Andreetta C, Casanova C, Ceccherini R, Frassoldati A, Salutari V, Giolitto S, Scambia G. Single-Agent Trabectedin Versus Physician's Choice Chemotherapy in Patients With Recurrent Ovarian Cancer With BRCA-Mutated and/or BRCAness Phenotype: A Randomized Phase III Trial. J Clin Oncol 2024; 42:1488-1498. [PMID: 38315944 DOI: 10.1200/jco.23.01225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/29/2023] [Accepted: 11/03/2023] [Indexed: 02/07/2024] Open
Abstract
PURPOSE Literature evidence suggests that trabectedin monotherapy is effective in patients with recurrent ovarian cancer (OC) presenting BRCA mutation and/or BRCAness phenotype. METHODS A prospective, open-label, randomized phase III MITO-23 trial evaluated the activity and safety of trabectedin 1.3 mg/m2 given once every 3 weeks (arm A) in BRCA 1/2 mutation carriers or patients with BRCAness phenotype (ie, patients who responded to ≥two previous platinum-based treatments) with recurrent OC, primary peritoneal carcinoma, or fallopian tube cancer in comparison with physician's choice chemotherapy in the control arm (arm B; pegylated liposomal doxorubicin, topotecan, gemcitabine, once-weekly paclitaxel, or carboplatin). The primary end point was overall survival (OS) evaluated in the intention-to-treat population. RESULTS Overall, 244 patients from 21 MITO centers were randomly assigned (arm A = 122/arm B = 122). More than 70% of patients received ≥three previous chemotherapy lines and 35.7% had received a poly (ADP-ribose) polymerase inhibitor (PARPi) before enrollment. Median OS was not significantly different between the arms: arm A: 15.8 versus arm B: 17.9 months (P = .304). Median progression-free survival was 4.9 months in arm A versus 4.4 months in arm B (P = .897). Among 208 patients evaluable for efficacy, the objective response rate was 17.1% in arm A and 21.4% in arm B, with comparable median duration of response (5.62 v 5.66 months, respectively). No superior effect was observed for trabectedin in the prespecified subgroup analyses according to BRCA mutational status, chemotherapy type, and pretreatment with a PARPi and/or platinum-free interval. Trabectedin showed a higher frequency of grade ≥3 adverse events (AEs), serious AEs, and serious adverse drug reactions compared with control chemotherapy. CONCLUSION Trabectedin did not improve median OS and showed a worse safety profile in comparison with physician's choice control chemotherapy.
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Affiliation(s)
- Domenica Lorusso
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
| | | | | | - Giorgio Valabrega
- Department of Oncology, Oncology Unit, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Nicoletta Colombo
- European Institute of Oncology IRCCS and Università degli Studi di Milano Bicocca, Milan, Italy
| | - Carmela Pisano
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, Naples, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Unit of Obstetrics and Gynecology, University of Pavia, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Germana Tognon
- ASST Spedali Civili di Brescia, Università di Brescia, Brescia, Italy
| | | | | | | | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Filippo Greco
- Oncology Unit, Mater Salutis Hospital, Ulss 9 Veneto Region, Legnago, Italy
| | | | | | | | - Claudia Andreetta
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Claudia Casanova
- Department of Oncology, Ospedale Civile Santa Maria delle Croci, Ravenna, Italy
| | - Rita Ceccherini
- Department of Oncology, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | | | - Vanda Salutari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Serena Giolitto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
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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 2024:10.1038/s41375-024-02253-3. [PMID: 38637689 DOI: 10.1038/s41375-024-02253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [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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Lorusso D, Xiang Y, Hasegawa K, Scambia G, Leiva M, Ramos-Elias P, Acevedo A, Sukhin V, Cloven N, Pereira de Santana Gomes AJ, Contreras Mejía F, Reiss A, Ayhan A, Lee JY, Saevets V, Zagouri F, Gilbert L, Sehouli J, Tharavichitkul E, Lindemann K, Lazzari R, Chang CL, Lampé R, Zhu H, Oaknin A, Christiaens M, Polterauer S, Usami T, Li K, Yamada K, Toker S, Keefe SM, Pignata S, Duska LR. Pembrolizumab or placebo with chemoradiotherapy followed by pembrolizumab or placebo for newly diagnosed, high-risk, locally advanced cervical cancer (ENGOT-cx11/GOG-3047/KEYNOTE-A18): a randomised, double-blind, phase 3 clinical trial. Lancet 2024; 403:1341-1350. [PMID: 38521086 DOI: 10.1016/s0140-6736(24)00317-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Pembrolizumab has shown efficacy in persistent, recurrent, or metastatic cervical cancer. The effect of chemoradiotherapy might be enhanced by immunotherapy. In this phase 3 trial, we assessed the efficacy and safety of adding pembrolizumab to chemoradiotherapy in locally advanced cervical cancer. METHODS In this randomised, double-blind, placebo-controlled, phase 3 ENGOT-cx11/GOG-3047/KEYNOTE-A18 clinical trial, adults (age ≥18 years) at 176 medical centres in 30 countries with newly diagnosed, high-risk, locally advanced cervical cancer were randomly assigned (1:1) using an interactive voice-response system with integrated web response to receive 5 cycles of pembrolizumab (200 mg) or placebo every 3 weeks plus chemoradiotherapy, followed by 15 cycles of pembrolizumab (400 mg) or placebo every 6 weeks. Randomisation was stratified by planned external beam radiotherapy type (intensity-modulated radiotherapy or volumetric-modulated arc therapy vs non-intensity-modulated radiotherapy or non-volumetric-modulated arc therapy), cervical cancer stage at screening (International Federation of Gynecology and Obstetrics 2014 stage IB2-IIB node positive vs stage III-IVA), and planned total radiotherapy (external beam radiotherapy plus brachytherapy) dose (<70 Gy vs ≥70 Gy equivalent dose in 2 Gy fractions). Primary endpoints were progression-free survival per Response Evaluation Criteria in Solid Tumours version 1.1-by investigator or by histopathologic confirmation of suspected disease progression-and overall survival. Primary analysis was conducted in the intention-to-treat population, which included all randomly allocated participants. Safety was assessed in the as-treated population, which included all randomly allocated patients who received at least one dose of study treatment. This study is registered with ClinicalTrials.gov, NCT04221945, and is closed to new participants. FINDINGS Between June 9, 2020, and Dec 15, 2022, 1060 participants were randomly assigned to treatment, with 529 assigned to the pembrolizumab-chemoradiotherapy group and 531 to the placebo-chemoradiotherapy group. At data cutoff (Jan 9, 2023), median follow-up was 17·9 months (IQR 11·3-22·3) in both treatment groups. Median progression-free survival was not reached in either group; rates at 24 months were 68% in the pembrolizumab-chemoradiotherapy group versus 57% in the placebo-chemoradiotherapy group. The hazard ratio (HR) for disease progression or death was 0·70 (95% CI 0·55-0·89, p=0·0020), meeting the protocol-specified primary objective. Overall survival at 24 months was 87% in the pembrolizumab-chemoradiotherapy group and 81% in the placebo-chemoradiotherapy group (information fraction 42·9%). The HR for death was 0·73 (0·49-1·07); these data have not crossed the boundary of statistical significance. Grade 3 or higher adverse event rates were 75% in the pembrolizumab-chemoradiotherapy group and 69% in the placebo-chemoradiotherapy group. INTERPRETATION Pembrolizumab plus chemoradiotherapy significantly improved progression-free survival in patients with newly diagnosed, high-risk, locally advanced cervical cancer. FUNDING Merck Sharp & Dohme, a subsidiary of Merck & Co (MSD).
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Affiliation(s)
- Domenica Lorusso
- Gynaecology Oncology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy.
| | - Yang Xiang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Kosei Hasegawa
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Giovanni Scambia
- Scientific Directorate, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
| | - Manuel Leiva
- Instituto de Oncologia y Radioterapia Clinica Ricardo Palma, Lima, Peru
| | - Pier Ramos-Elias
- Integra Cancer Institute, Edificio Integra Medical Center, Guatemala City, Guatemala
| | | | - Vladyslav Sukhin
- Grigoriev Institute for Medical Radiology and Oncology NAMS Ukraine, Kharkiv, Ukraine
| | - Noelle Cloven
- Texas Oncology-Fort Worth Cancer Center, Fort Worth, TX, USA
| | | | | | - Ari Reiss
- Rambam Medical Center, Gyneco-oncology Unit, Haifa, Israel
| | - Ali Ayhan
- Turkish Society of Gynecologic Oncology, Başkent University, Ankara, Türkiye
| | - Jung-Yun Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Valeriya Saevets
- Chelyabinsk Regional Clinical Center for Oncology and Nuclear Medicine, Chelyabinsk, Russia
| | - Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - Lucy Gilbert
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Jalid Sehouli
- Charité Universitätsmedizin, Berlin, Germany; North-Eastern German Society of Gynecological Oncology, Berlin, Germany
| | - Ekkasit Tharavichitkul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kristina Lindemann
- Department of Gynecological Oncology, Oslo University Hospital and the Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Nordic Society of Gynaecological Oncology Clinical Trial Unit, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Roberta Lazzari
- Division of Radiotherapy, European Institute of Oncology IRCCS, Milan, Italy
| | - Chih-Long Chang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Hong Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Hunan, China
| | - Ana Oaknin
- Medical Oncology Service, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Melissa Christiaens
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria; AGO Austria, Austria
| | | | - Kan Li
- Merck & Co, Rahway, NJ, USA
| | | | | | | | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Naples, Italy
| | - Linda R Duska
- University of Virginia School of Medicine, Charlottesville, VA, USA
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Rognoni C, Lorusso D, Costa F, Armeni P. Cost-Effectiveness Analysis of HRD Testing for Previously Treated Patients with Advanced Ovarian Cancer in Italy. Adv Ther 2024; 41:1385-1400. [PMID: 38329713 PMCID: PMC10960911 DOI: 10.1007/s12325-024-02791-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Ovarian cancer (OC) is the eighth most common cancer among women, and homologous recombination deficiency (HRD) is present in approximately 50% of these patients. For this group, poly(ADP-ribose) polymerase (PARP) inhibitors are more likely to be effective. The aim of the study was to investigate the cost-effectiveness of HRD testing versus BRCA testing (which identifies mutations present only in 25% of patients) in Italy to optimize the treatment management, possibly with PARP inhibitors. METHODS A cost-effectiveness partition survival model was developed to estimate the expected costs and outcomes (life years, LYs; quality-adjusted life years, QALYs) with lifetime horizon of HRD testing versus BRCA testing alone in women with high-grade serous or endometrioid advanced ovarian cancer. The option to perform the tests in sequence, that is, the BRCA test followed by the HRD test, in patients with BRCA-negative test was also considered, and the model accounted for the National Healthcare Service (NHS) perspective in Italy. The treatments represented the best available options according to the initial test results and according to PARP inhibitors available in Italy. A 3% discount rate was applied. Both deterministic and probabilistic sensitivity analyses were performed to test the robustness of the model results. RESULTS HRD testing was shown to be a cost-effective strategy compared to BRCA testing (incremental cost-utility ratio 22,610€/QALY) and a cost-saving strategy compared to the sequence of tests. The probabilistic sensitivity analysis showed that the HRD test is cost-effective compared to BRCA testing in 98.5% of model simulations considering a willingness-to-pay threshold of 50,000€/QALY. CONCLUSION The identification of genetic anomalies in patients with advanced OC is a costly process. Regardless, HRD upfront testing compared to BRCA testing had a cost-effective profile, allowing the efficient use of healthcare resources and better life expectancy and quality of life for patients.
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Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Via Sarfatti 10, 20136, Milan, Italy.
| | - Domenica Lorusso
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Costa
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Via Sarfatti 10, 20136, Milan, Italy
| | - Patrizio Armeni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Via Sarfatti 10, 20136, Milan, Italy
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Kacperczyk-Bartnik J, Bizzarri N, Zwimpfer TA, El Hajj H, Angeles MA, Tóth R, Theofanakis C, Bilir E, Gasimli K, Strojna AN, Nikolova T, Ayhan A, Lorusso D, Chiva L. Best original research presented at the 24 th European Congress on Gynaecological Oncology-Best of ESGO 2023. Int J Gynecol Cancer 2024; 34:610-618. [PMID: 38088184 DOI: 10.1136/ijgc-2023-005132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
The 'Best of ESGO 2023' manuscript comprises a compilation of the best original research presented during the European Society of Gynaecologic Oncology annual congress held in Istanbul between September 28 and October 1, 2023. Out of 1030 submitted abstracts, 33 studies presented during the Best Oral Sessions, Mini Oral Sessions, and Young Investigator Session were selected by the ESGO Abstract Committee and the European Network of Young Gynae Oncologists (ENYGO) authors. There was a strong focus on surgical de-escalation, immunotherapy, maintenance therapy, and molecular profiling in gynecologic oncology. With this manuscript, ENYGO and ESGO aim to disseminate the valuable research results to readers interested in our field.
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Affiliation(s)
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Tibor Andrea Zwimpfer
- Cancer Research, Peter MacCallum Cancer Centre, East Melbourne, 3002, Victoria, Australia
- Department of Gynecological Oncology, University Hospital Basel, 4031 Basel, Switzerland
| | - Houssein El Hajj
- Department of Surgical Oncology, Curie Institute Hospital Group, Saint Cloud, France
| | - Martina Aida Angeles
- Gynecologic Oncology Unit, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Richard Tóth
- Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary
| | - Charalampos Theofanakis
- Division of Gynaecologic Oncology, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Esra Bilir
- Department of Gynecologic Oncology, Koc University School of Medicine, Istanbul, Turkey
- Department of Global Health, Koc University Graduate School of Health Sciences, Istanbul, Turkey
- Department of Obstetrics and Gynaecology, Die Klinik in Preetz, Preetz, Germany
| | - Khayal Gasimli
- Department of Obstetrics and Gynecology, J.W. Goethe Frankfurt University, Frankfurt am Main, Germany
| | | | - Tanja Nikolova
- Department of Obstetrics and Gynecology, Klinikum Mittelbaden, Academic Teaching Hospital of Heidelberg University, Baden-Baden, Germany
| | - Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Başkent University Hospital, Ankara, Turkey
| | - Domenica Lorusso
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luis Chiva
- Gynaecology and Obstetrics Department, Clinica Universidad de Navarra, Madrid, Spain
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7
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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8
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Bartoletti M, Montico M, Lorusso D, Mazzeo R, Oaknin A, Musacchio L, Scambia G, Puglisi F, Pignata S. Incorporation of anti-PD1 or anti PD-L1 agents to platinum-based chemotherapy for the primary treatment of advanced or recurrent endometrial cancer. A meta-analysis. Cancer Treat Rev 2024; 125:102701. [PMID: 38422895 DOI: 10.1016/j.ctrv.2024.102701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
IMPORTANCE Various randomized trials have explored the efficacy of combining immune checkpoint inhibitors (ICIs) with first-line chemotherapy in advanced endometrial cancer. We aimed to summarize available data and clarify the benefit of adding immunotherapy according to the DNA mismatch repair status (deficient, dMMR or proficient, pMMR) and the specific type of agent used (anti-PD1 or anti-PD-L1). OBJECTIVE To assess whether the addition of ICIs to standard platinum-based chemotherapy enhances progression-free survival (PFS) for patients with advanced endometrial cancer both overall and based on DNA mismatch repair status. DATA SOURCES Electronic databases (PubMed, Embase and Cochrane Library) and conference proceedings were searched for first line, randomized and controlled trials integrating ICIs with chemotherapy for the treatment of advanced endometrial cancer published or presented by November 1, 2023. STUDY SELECTION Five studies, comprising 2456 patients (1308 received ICIs with chemotherapy and 1148 treated with chemotherapy alone) met the selection criteria and were included in the analysis. Experimental arms included pembrolizumab, dostarlimab (anti-PD1) and durvalumab, atezolizumab and avelumab (anti-PD-L1) combined with standard three-weekly carboplatin-paclitaxel chemotherapy backbone. Endometrial carcinosarcoma were included in 3 out of 5 trials. DATA EXTRACTION AND SYNTHESIS For comparison of PFS outcomes, extrapolation of hazard ratios (HRs), 95% confidence intervals (CI) and PFS events was performed for each included study in the overall population and according to subgroups. Data analysis was conducted using a random-effects model. RESULTS The addition of ICIs to chemotherapy improved PFS compared to chemotherapy alone in the overall population (pooled HR, 0.63; 95 % CI, 0.52--0.76; P <.001). In the dMMR subgroup the benefit was more pronounced (pooled HR, 0.34; 95 % CI, 0.27--0.44; P <.001) and not affected by drugs used with pooled HRs of 0.39 (95 % CI, 0.28--0.55; P <.001) and 0.34 (95 % CI, 0.27--0.44; P <.001) for PD-L1 and PD1 inhibitors, respectively. For pMMR patients, a statistically significant benefit in terms of PFS was confirmed only when anti-PD1 were used (anti-PD-1: HR 0.64, 95 % CI: 0.46-0.90, P =.010 vs anti-PD-L1: HR 0.87, 95 % CI: 0.73-1.03, P =.104) CONCLUSIONS AND RELEVANCE: This meta-analysis confirmed the advantage in terms of PFS of adding ICIs to standard platinum-based chemotherapy. While dMMR patients benefit from the incorporation of both anti PD-1 or anti PD-L1, this benefit is confined to the association of anti-PD1 agents in pMMR patients. Updated analysis of trials is awaited to clarify the impact of immunotherapy on overall survival.
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Affiliation(s)
- Michele Bartoletti
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.
| | - Marcella Montico
- Clinical Trial Office, Scientific Direction, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Domenica Lorusso
- Gynecologic oncology unit, Humanitas San Pio X, Italy; Humanitas university, Milan, Italy
| | - Roberta Mazzeo
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy; Department of Medicine, University of Udine, Udine, Italy; Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ana Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Lucia Musacchio
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Giovanni Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome, Italy
| | - Fabio Puglisi
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
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9
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Passarelli A, Carbone V, Pignata S, Mazzeo R, Lorusso D, Scambia G, Canova S, Di Palma T, Tasca G, Mantiero M, Naglieri E, Andreetta C, Rauso M, Brunetti AE, Laera L, Abeni C, Scandurra G, Gambaro AR, Pastore A, Bengala C, Gunnellini M, Farolfi A, Spinello M, Bartoletti M. Alpelisib for PIK3CA-mutated advanced gynecological cancers: First clues of clinical activity. Gynecol Oncol 2024; 183:61-67. [PMID: 38518529 DOI: 10.1016/j.ygyno.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Recurrent gynecological tumors (e.g., endometrial, and ovarian cancers) are incurable diseases; therefore, new treatment options are urgently needed. The PTEN-AKT-PI3K pathway is frequently altered in these tumors, representing a potential treatment target. Alpelisib is an α-specific PI3K inhibitor approved in PIK3CA-mutated advanced breast cancer. We report outcomes from a large series of patients with PIK3CA-mutated gynecological cancers prospectively treated with alpelisib within a controlled program. METHODS From April 2021 to December 2022, 36 patients with PIK3CA-mutated advanced gynecological cancers received alpelisib 300 mg orally once daily. Objective response (ORR) and disease control (DCR) rates provided measure of the antitumor activity of alpelisib, the primary objective of the study. RESULTS Included patients had endometrial (17/36 [47%]), ovarian (10/36 [28%]), or other gynecological cancers (9/36 [25%]). Most patients had received 2-3 prior systemic treatments (endometrial, 47·2%; ovarian, 60%; other, 56%), and presented with visceral metastases at baseline (82%, 70%, and 56%, respectively). Overall, 17 different PIK3CA mutations were found, including 53% in the kinase domain (most commonly H1047R) and 36% in the helical domain (most commonly E545K). Overall, the ORR was 28% and DCR was 61%, with the greatest benefit observed in patients with endometrial cancer (35% and 71%, respectively). CONCLUSION Alpelisib represents an active treatment option in patients with recurrent gynecological cancers harboring a PIK3CA mutation. These findings support the need of biomarker-driven randomized trials of PI3K inhibitors in gynecological cancers.
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Affiliation(s)
- Anna Passarelli
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Vittoria Carbone
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy.
| | - Roberta Mazzeo
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Aviano, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome, Italy
| | - Giovanni Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome, Italy
| | - Stefania Canova
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Teresa Di Palma
- Medical Oncology Unit, Ospedale S Maria Goretti, Latina, Italy
| | - Giulia Tasca
- Division of Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Mara Mantiero
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuele Naglieri
- Department of Oncology, Istituto Oncologico Giovanni Paolo II, Bari, Italy
| | - Claudia Andreetta
- Department of Oncology, ASU FC S. Maria della Misericordia, Udine, Italy
| | - Martina Rauso
- Oncological Medical and Specialists Department, Oncology Unit, University Hospital of Ferrara, Ferrara, Italy
| | | | - Letizia Laera
- Department of Medical Oncology, Miulli General Regional Hospital, Acquaviva delle Fonti, Italy
| | - Chiara Abeni
- Department of Clinical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | | | - Anna Rita Gambaro
- Medical Oncology Unit, ASST Fatebenefratelli Sacco, Ospedale Sacco Polo Universitario, Milano, Italy
| | - Alessia Pastore
- Medical Oncology Unit, Azienda Ospedaliera S. Anna, Como, Italy
| | - Carmelo Bengala
- Medical Oncology Unit, Misericordia Hospital, Grosseto, Italy
| | - Marco Gunnellini
- Medical Oncology Unit, Presidio Ospedaliero Alto Chiascio, Gubbio, Italy
| | - Alberto Farolfi
- Department of Medical Oncology, IRCCS- Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Emilia-Romagna, Italy
| | | | - Michele Bartoletti
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Aviano, Italy
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10
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González-Martín A, Pothuri B, Vergote I, Graybill W, Lorusso D, McCormick CC, Freyer G, Backes F, Heitz F, Redondo A, Moore RG, Vulsteke C, O'Cearbhaill RE, Malinowska IA, Shtessel L, Compton N, Mirza MR, Monk BJ. Progression-free survival and safety at 3.5 years of follow-up: results from the randomized phase 3 PRIMA/ENGOT-OV26/GOG-3012 trial of niraparib maintenance treatment in patients with newly diagnosed ovarian cancer - a plain language summary. Future Oncol 2024. [PMID: 38501262 DOI: 10.2217/fon-2023-0782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? This PLSP provides a short summary of an original scientific article that presented results from the PRIMA study after 3.5 years of follow-up time. The original article was published in the European Journal of Cancer in 2023. The PRIMA study included adult patients with newly diagnosed advanced high-risk ovarian cancer whose tumors shrunk or became undetectable after treatment with chemotherapy with or without surgery. The PRIMA study evaluated how well the drug niraparib, also known as Zejula, worked at delaying or preventing ovarian cancer from coming back (recurring) or getting worse (progressing) compared with placebo (a substance with no effects that a doctor gives to a patient instead of a drug). The first results from the PRIMA study were published in 2019, when patients had participated in the PRIMA study for about 1.2 years. The article this PLSP is based on reports longer-term data from the PRIMA study, when patients had participated in the PRIMA study for about 3.5 years. Patients were monitored (or followed) for a longer time to understand how well niraparib continued to work and to evaluate whether the safety of niraparib changed with additional time being monitored. WHAT WERE THE RESULTS? Patients who took niraparib had more time before their cancer came back or got worse than patients who took placebo. In terms of safety, no new types of side effects with niraparib treatment were observed with additional time being monitored as part of the PRIMA study. WHAT DO THE RESULTS MEAN? These results support that niraparib remains an important treatment option to help delay the cancer from coming back or getting worse in patients with newly diagnosed advanced ovarian cancer that responded to initial treatment. Clinical Trial Registration: NCT02655016 (PRIMA study) (ClinicalTrials.gov).
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Affiliation(s)
- Antonio González-Martín
- Medical Oncology Department, Cancer Center Clínica Universidad de Navarra, Madrid, Program in Solid Tumours, CIMA, Pamplona, & Grupo Español de Investigación en Cáncer de Ovario (GEICO), Madrid, Spain
| | - Bhavana Pothuri
- Gynecologic Oncology Group (GOG Foundation), NYU Langone Health, Department of Obstetrics & Gynecology, Perlmutter Cancer Center, New York, NY, USA
| | - Ignace Vergote
- Belgium & Luxembourg Gynaecological Oncology Group (BGOG), Department of Gynaecology & Obstetrics, Division of Gynaecological Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium, European Union
| | - Whitney Graybill
- GOG, Gynecologic Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Domenica Lorusso
- Multicentre Italian Trials in Ovarian Cancer & Gynecologic Malignancies (MITO), Fondazione Policlinico Gemelli IRCCS & Catholic University of Sacred Heart, Rome, Italy, when the study was conducted; present affiliation Humanitas San Pio X, Milan, Humanitas University, Rozzano, Italy
| | | | - Gilles Freyer
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), HCL Cancer Institute, Department of Medical Oncology, Lyon University, Lyon, France
| | - Floor Backes
- Division of Gynecologic Oncology, Ohio State University, Columbus, OH, USA
| | - Florian Heitz
- AGO Study Group & the Department for Gynaecology & Gynaecologic Oncology, Kliniken Essen-Mitte, Essen, & Charité - Universitätsmedizin Berlin, Humboldt- Universität zu Berlin, Berlin Institute of Health, Department of Gynaecology, Berlin, Germany
| | - Andrés Redondo
- GEICO, Department of Medical Oncology, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Richard G Moore
- Division of Gynecologic Oncology, Wilmot Cancer Institute, Department of Obstetrics & Gynecology, University of Rochester, Rochester, NY, USA
| | - Christof Vulsteke
- BGOG, Department of Medical Oncology & Hematology, AZ Maria Middelares, Gent, & Department of Molecular Imaging, Pathology, Radiotherapy & Oncology, Center for Oncological Research, Antwerp University, Antwerp, Belgium
| | - Roisin E O'Cearbhaill
- GOG, Gynecologic Medical Oncology, Memorial Sloan Kettering Cancer Center, & Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | | | | | - Mansoor R Mirza
- Department of Oncology, Rigshospitalet-Copenhagen University Hospital & Nordic Society of Gynaecological Oncology, Copenhagen, Denmark
| | - Bradley J Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Phoenix Creighton University, Phoenix, AZ, USA, when the study was conducted; present affiliation GOG Foundation; Florida Cancer Specialists & Research Institute, West Palm Beach, FL, USA
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Arcieri M, Tius V, Andreetta C, Restaino S, Biasioli A, Poletto E, Damante G, Ercoli A, Driul L, Fagotti A, Lorusso D, Scambia G, Vizzielli G. How BRCA and homologous recombination deficiency change therapeutic strategies in ovarian cancer: a review of literature. Front Oncol 2024; 14:1335196. [PMID: 38525421 PMCID: PMC10957789 DOI: 10.3389/fonc.2024.1335196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/09/2024] [Indexed: 03/26/2024] Open
Abstract
About 50% of High Grade Serous Ovarian Cancer exhibit a high degree of genomic instability due to mutation of genes involved in Homologous Recombination (HRD) and such defect accounts for synthetic lethality mechanism of PARP inhibitors (PARP-i). Several clinical trials have shown how BRCA and HRD mutational status profoundly affect first line chemotherapy as well as response to maintenance therapy with PARP-i, hence Progression Free Survival and Overall Survival. Consequently, there is urgent need for the development of increasingly reliable HRD tests, overcoming present limitations, as they play a key role in the diagnostic and therapeutic process as well as have a prognostic and predictive value. In this review we offer an overview of the state of the art regarding the actual knowledge about BRCA and HRD mutational status, the rationale of PARPi use and HRD testing (current and in development assays) and their implications in clinical practice and in the treatment decision process, in order to optimize and choose the best tailored therapy in patients with ovarian cancer.
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Affiliation(s)
- Martina Arcieri
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, Messina, Italy
| | - Veronica Tius
- Medical Area Department (DAME), in Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Claudia Andreetta
- Department of Medical Oncology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Stefano Restaino
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Anna Biasioli
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Elena Poletto
- Department of Medical Oncology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Giuseppe Damante
- Medical Area Department (DAME), in Department of Medicine (DMED), University of Udine, Udine, Italy
- Medical Genetics Institute, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Alfredo Ercoli
- Department of Human Pathology in Adult and Childhood “G. Barresi”, Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Medical Area Department (DAME), in Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Anna Fagotti
- Dipartimento per le Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, in Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenica Lorusso
- Dipartimento per le Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, in Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Dipartimento per le Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, in Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Medical Area Department (DAME), in Department of Medicine (DMED), University of Udine, Udine, Italy
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12
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Ledermann JA, Matias-Guiu X, Amant F, Concin N, Davidson B, Fotopoulou C, González-Martin A, Gourley C, Leary A, Lorusso D, Banerjee S, Chiva L, Cibula D, Colombo N, Croce S, Eriksson AG, Falandry C, Fischerova D, Harter P, Joly F, Lazaro C, Lok C, Mahner S, Marmé F, Marth C, McCluggage WG, McNeish IA, Morice P, Nicum S, Oaknin A, Pérez-Fidalgo JA, Pignata S, Ramirez PT, Ray-Coquard I, Romero I, Scambia G, Sehouli J, Shapira-Frommer R, Sundar S, Tan DSP, Taskiran C, van Driel WJ, Vergote I, Planchamp F, Sessa C, Fagotti A. ESGO-ESMO-ESP consensus conference recommendations on ovarian cancer: pathology and molecular biology and early, advanced and recurrent disease. Ann Oncol 2024; 35:248-266. [PMID: 38307807 DOI: 10.1016/j.annonc.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/17/2023] [Accepted: 11/28/2023] [Indexed: 02/04/2024] Open
Abstract
The European Society of Gynaecological Oncology, the European Society for Medical Oncology (ESMO) and the European Society of Pathology held a consensus conference (CC) on ovarian cancer on 15-16 June 2022 in Valencia, Spain. The CC panel included 44 experts in the management of ovarian cancer and pathology, an ESMO scientific advisor and a methodologist. The aim was to discuss new or contentious topics and develop recommendations to improve and harmonise the management of patients with ovarian cancer. Eighteen questions were identified for discussion under four main topics: (i) pathology and molecular biology, (ii) early-stage disease and pelvic mass in pregnancy, (iii) advanced stage (including older/frail patients) and (iv) recurrent disease. The panel was divided into four working groups (WGs) to each address questions relating to one of the four topics outlined above, based on their expertise. Relevant scientific literature was reviewed in advance. Recommendations were developed by the WGs and then presented to the entire panel for further discussion and amendment before voting. This manuscript focuses on the recommendation statements that reached a consensus, their voting results and a summary of evidence supporting each recommendation.
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Affiliation(s)
- J A Ledermann
- Department of Oncology, UCL Cancer Institute, University College London, London, UK.
| | - X Matias-Guiu
- CIBERONC, Madrid; Department of Pathology, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, University of Lleida, Lleida; Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain.
| | - F Amant
- Department of Gynaecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium; Department of Gynecology, Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N Concin
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Innsbruck, Austria; Department of Gynaecology and Gynaecologic Oncology, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - B Davidson
- Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - C Fotopoulou
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - A González-Martin
- Department of Medical Oncology and Program in Solid Tumours-Cima, Cancer Center Clínica Universidad de Navarra, Madrid, Spain
| | - C Gourley
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - A Leary
- Department of Medicine, Institut Gustave Roussy, Villejuif, France
| | - D Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Woman, Child and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - S Banerjee
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - L Chiva
- Department of Gynaecology and Obstetrics, Cancer Center Clínica Universidad de Navarra, Navarra, Spain
| | - D Cibula
- Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - N Colombo
- Department of Gynecologic Oncology, Istituto Europeo di Oncologia IRCCS, Milan; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - S Croce
- Department of Biopathology, Bergonié Institut, Bordeaux, France
| | - A G Eriksson
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Gynecologic Oncology, Division of Cancer Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - C Falandry
- Institute of Aging, Hospices Civils de Lyon, Lyon; CarMeN Laboratory, INSERM U1060/Université Lyon 1/INRAE U1397/Hospices Civils Lyon, Pierre-Bénite, France
| | - D Fischerova
- Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - P Harter
- Department of Gynaecology and Gynaecologic Oncology, Evang. Kliniken Essen-Mitte, Essen, Germany; Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Study Group, Germany
| | - F Joly
- GINECO Group, Department of Medical Oncology, Centre François-Baclesse, University of Caen Normandy, Caen, France
| | - C Lazaro
- Hereditary Cancer Program, Catalan Institute of Oncology (ICO-IDIBELL-CIBERONC), L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Lok
- Department of Gynecology, Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Mahner
- Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Study Group, Germany; Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich
| | - F Marmé
- Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Study Group, Germany; Department of Obstetrics and Gynecology, University Hospital Mannheim, Mannheim; Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Marth
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Innsbruck, Austria
| | - W G McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - I A McNeish
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - P Morice
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - S Nicum
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - A Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona
| | - J A Pérez-Fidalgo
- Department of Medical Oncology, Hospital Clínico Universitario - INCLIVA, CIBERONC, Valencia, Spain
| | - S Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori di Napoli, IRCCS Fondazione Pascale, Napoli, Italy
| | - P T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, USA
| | - I Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, University Claude Bernard, Lyon, France
| | - I Romero
- Department of Medical Oncology, Instituto Valenciano Oncologia, Valencia, Spain
| | - G Scambia
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Woman, Child and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - J Sehouli
- North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin; Department of Gynecology with Center for Oncological Surgery, Charité Berlin University of Medicine, Berlin, Germany
| | | | - S Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham; Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - D S P Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University of Singapore (NUS) Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cancer Science Institute, National University of Singapore, Singapore; Department of Haematology-Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore, Singapore
| | - C Taskiran
- Department of Gynecologic Oncology, School of Medicine, Koç University, Istanbul, Turkey
| | - W J van Driel
- Department of Gynecology, Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - I Vergote
- Department of Gynaecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | | | - C Sessa
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - A Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Woman, Child and Public Health, Catholic University of Sacred Heart, Rome, Italy.
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Salutari V, Giudice E, Lorusso D. Maintenance therapy for newly and recurrent epithelial ovarian cancer: current therapies and future perspectives. Curr Opin Obstet Gynecol 2024; 36:9-17. [PMID: 38170548 DOI: 10.1097/gco.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Epithelial ovarian cancer (EOC) is the fifth cause of cancer death among women, and 70-80% of patients relapse within 2 years from the last cycle of first-line chemotherapy despite a complete response to chemotherapy and optimal debulking surgery. In this context, the goal of the maintenance treatment strategy is to prolong the time to recurrence. The recent development of targeted molecular therapies resulted in a broader spectrum of maintenance therapeutic options with consequent higher clinical benefit but less toxicity. This review summarizes the currently available maintenance strategies for newly and recurrent EOC, focusing on the decision-making process to personalize treatment and future perspectives. RECENT FINDINGS Over the past 10 years, several studies have demonstrated the clear benefit in terms of survival with the addition of a maintenance treatment strategy over the 'watchful waiting' approach both in the first line and recurrent setting. Since December 2016, the United States Food and Drug Administration and European Medicines Agency have approved four drugs for ovarian cancer maintenance based on the results of several clinical trials demonstrating efficacy and tolerability. These include the antiangiogenic drug Bevacizumab and three polyadenosine diphosphate-ribose polymerase (PARP) inhibitors: olaparib, niraparib, and rucaparib. SUMMARY These data led American and European Treatment guidelines to include bevacizumab, olaparib, niraparib, rucaparib, and combination bevacizumab-olaparib as maintenance treatment options in first-line and recurrent ovarian cancer therapy. However, with the availability of different maintenance options, identifying the best treatment choice for each patient can be challenging, and several clinical and molecular aspects have to be taken into account in the decision-making process.
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Affiliation(s)
- Vanda Salutari
- Gynaecology Oncology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS
| | - Elena Giudice
- Gynaecology Oncology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS
| | - Domenica Lorusso
- Gynaecology Oncology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS
- Catholic University of Sacred Heart, Rome, Italy
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Tewari KS, Colombo N, Monk BJ, Dubot C, Cáceres MV, Hasegawa K, Shapira-Frommer R, Salman P, Yañez E, Gümüş M, Olivera Hurtado de Mendoza M, Samouëlian V, Castonguay V, Arkhipov A, Tekin C, Li K, Toker S, Keefe SM, Lorusso D. Pembrolizumab or Placebo Plus Chemotherapy With or Without Bevacizumab for Persistent, Recurrent, or Metastatic Cervical Cancer: Subgroup Analyses From the KEYNOTE-826 Randomized Clinical Trial. JAMA Oncol 2024; 10:185-192. [PMID: 38095881 PMCID: PMC10722390 DOI: 10.1001/jamaoncol.2023.5410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/22/2023] [Indexed: 12/17/2023]
Abstract
Importance The KEYNOTE-826 randomized clinical trial showed statistically significant and clinically meaningful survival benefits with the addition of pembrolizumab to chemotherapy with or without bevacizumab in patients with persistent, recurrent, or metastatic cervical cancer. Treatment effects in patient subgroups of the study population are unknown. Objective To assess efficacy outcomes in patient subgroups of KEYNOTE-826. Design, Setting, and Participants Exploratory subgroup analyses were conducted in a global, phase 3, randomized, double-blind, placebo-controlled clinical trial. Participants included women with persistent, recurrent, or metastatic adenocarcinoma, adenosquamous carcinoma, or squamous cell carcinoma of the cervix that had not been treated with systemic chemotherapy and was not amenable to curative treatment. This subanalysis was conducted from November 20, 2018, to May 3, 2021. Interventions Pembrolizumab, 200 mg, every 3 weeks or placebo for up to 35 cycles plus chemotherapy (paclitaxel, 175 mg/m2, plus cisplatin, 50 mg/m2, or carboplatin AUC 5 [area under the free carboplatin plasma concentration vs time curve]) with or without bevacizumab, 15 mg/kg. Main Outcomes and Measures Overall survival (OS) and progression-free survival (PFS) by investigator assessment per Response Evaluation Criteria in Solid Tumors version 1.1 in subgroups defined by use of bevacizumab (yes or no), choice of platinum (carboplatin or cisplatin), prior chemoradiotherapy (CRT) exposure only (yes or no), and histologic type (squamous or nonsquamous) in patients with programmed cell death ligand 1-positive tumors (defined as a combined positive score [CPS] ≥1) and in the intention-to-treat population. Results A total of 617 patients (median age, 51 years; range, 22-82 years) were enrolled in the trial. In the CPS greater than or equal to 1 population, hazard ratios (HRs) for OS favored the pembrolizumab group in all subgroups: with bevacizumab (HR, 0.62; 95% CI, 0.45-0.87) and without bevacizumab (HR, 0.67; 95% CI, 0.47-0.96), use of carboplatin (HR, 0.65; 95% CI, 0.50-0.85) and cisplatin (HR, 0.53; 95% CI, 0.27-1.04), with prior CRT only (HR, 0.56; 95% CI, 0.39-0.81) and without prior CRT only (HR, 0.72; 95% CI, 0.52-1.00), and squamous (HR, 0.60; 95% CI, 0.46-0.79) and nonsquamous (HR, 0.70; 95% CI, 0.41-1.20) histologic type. In the intention-to-treat population, HRs for OS also favored the pembrolizumab group in all subgroups: with bevacizumab (HR, 0.63; 95% CI, 0.47-0.87) and without bevacizumab (HR, 0.74; 95% CI, 0.53-1.04), use of carboplatin (HR, 0.69; 95% CI, 0.54-0.89) or cisplatin (HR, 0.59; 95% CI, 0.32-1.09), with prior CRT only (HR, 0.64; 95% CI, 0.45-0.91) and without prior CRT only (HR, 0.71; 95% CI, 0.53-0.97), and squamous (HR, 0.61; 95% CI, 0.47-0.80) and nonsquamous (HR, 0.76; 95% CI, 0.47-1.23) histologic type. Similar to OS, the addition of pembrolizumab prolonged PFS across all subgroups in the CPS greater than or equal to 1 and intention-to-treat populations. Conclusions and Relevance The findings of this trial suggest that adding pembrolizumab to chemotherapy with or without bevacizumab improved OS across subgroups of patients with persistent, recurrent, or metastatic cervical cancer. Trial Registration ClinicalTrials.gov Identifier: NCT03635567.
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Affiliation(s)
| | - Nicoletta Colombo
- Gynecologic Oncology, European Institute of Oncology IRCCS and Università degli Studi di Milano Bicocca, Milan, Italy
| | - Bradley J. Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix
| | - Coraline Dubot
- Oncologie Médicale, Institut Curie Saint Cloud, and GINECO, Paris, France
| | - M. Valeria Cáceres
- Medical Oncology, Instituto de Oncologia Angel H. Roffo, Buenos Aires, Argentina
| | - Kosei Hasegawa
- Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | | | - Pamela Salman
- Medical Oncology, Oncovida Cancer Center, Providencia, Santiago, Chile
| | - Eduardo Yañez
- Medical Oncology, Universidad de la Frontera, Temuco, Chile
| | - Mahmut Gümüş
- Medical Oncology, Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | | | - Vanessa Samouëlian
- Gynecologic Oncology, Centre Hospitalier de l’Université de Montréal, Centre de Recherche de l’Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Vincent Castonguay
- Medical Oncology, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Alexander Arkhipov
- Oncology and Chemical Therapy, Medical Rehabilitation Center Under the Ministry of Health of Russian Federation, Moscow, Russian Federation
| | | | - Kan Li
- Oncology, Merck & Co, Inc, Rahway, New Jersey
| | | | | | - Domenica Lorusso
- Gynaecology Oncology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
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Musacchio L, Palluzzi E, Di Napoli M, Lauria R, Ferrandina G, Angioli R, Bergamini A, Corrado G, Perniola G, Cassani C, Savarese A, Gori S, Greco F, De Angelis C, Zafarana E, Giannarelli D, Cinieri S, Mosconi AM, Raspagliesi F, Pignata S, Scambia G, Lorusso D. Real world data of niraparib in platinum sensitive relapsed ovarian cancer: A multicenter experience of the MITO group. Gynecol Oncol 2024; 184:24-30. [PMID: 38277918 DOI: 10.1016/j.ygyno.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/13/2023] [Accepted: 01/12/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE PARP (poly adenosine diphosphate [ADP]-ribose polymerase) inhibitors are approved as maintenance therapy in platinum sensitive ovarian cancer (OC), in first line and in the recurrent setting, regardless of BRCA mutational status. Real-world data after the introduction of these agents are needed to evaluate whether the benefit observed in phase III randomized clinical trials can be translated into clinical practice. The aim of our study was to provide real-life data on efficacy and safety of niraparib administered as maintenance in platinum sensitive relapsed OC patients (PSROC). METHODS This retrospective/prospective observational study included relapsed OC patients that received niraparib as maintenance, at the time of platinum sensitive recurrence within the Italian expanded-access program. Clinical data at the time of diagnosis and at the time of recurrence were collected and analyzed. Median progression free survival (PFS) and overall survival (OS) were calculated as the time from start of niraparib treatment to subsequent radiologically confirmed relapse and death or last contact, respectively. RESULTS Among 304 eligible patients, 260 (85%) had BRCA wild-type tumor and 36. (11.9%) were BRCA mutated. Median PFS was 9.1 months (95% CI: 6.9-11.2) and 10.3 months (95% CI: 7.0-13.5) in the BRCAwt and BRCAmut cohorts, respectively. Furthermore, median OS was 41.7 months (95% CI: 31.6-41.9) and 34.6 months (95% CI: N.E.) in the BRCAwt and BRCAmut cohorts, respectively. CONCLUSION Data from this large real-life dataset suggested that maintenance with niraparib in the real-life setting of platinum sensitive OC recurrence is effective and well tolerated.
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Affiliation(s)
- Lucia Musacchio
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Palluzzi
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marilena Di Napoli
- Dipartimento di Uro-Ginecologia, Istituto Nazionale per lo Studio e la Cura dei Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Rossella Lauria
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Ferrandina
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynaecology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Giacomo Corrado
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgia Perniola
- Department of Obstetrics and Gynecology, Sapienza University, Rome, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonella Savarese
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stefania Gori
- Medical Oncology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella (Verona), Italy
| | - Filippo Greco
- Department of Oncology; "Mater Salutis" Hospital, ULSS9, Verona, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elena Zafarana
- Dipartimento Oncologico, SOC Oncologia Medica-Prato, Nuovo Ospedale di Prato Santo Stefano, Azienda USL Toscana Centro, Prato, Italy
| | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Saverio Cinieri
- Department of Medical Oncology, Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Anna Maria Mosconi
- Medical Oncology Division, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Sandro Pignata
- Dipartimento di Uro-Ginecologia, Istituto Nazionale per lo Studio e la Cura dei Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Giovanni Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome, Italy.
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Arezzo F, Giannone G, Castaldo D, Scotto G, Tuninetti V, Turinetto M, Bartoletti M, Mammoliti S, Artioli G, Mangili G, Salutari V, Lorusso D, Cormio G, Loizzi V, Zamagni C, Savarese A, Di Maio M, Ronzino G, Pisano C, Pignata S, Valabrega G. Corrigendum: Management of metastatic endometrial cancer: physicians' choices beyond the first line after approval of checkpoint inhibitors. Front Oncol 2024; 13:1357793. [PMID: 38318323 PMCID: PMC10840838 DOI: 10.3389/fonc.2023.1357793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 02/07/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fonc.2023.1247291.].
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Affiliation(s)
- Francesca Arezzo
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- Department of Precision and Regenerative Medicine – Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Gaia Giannone
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Daniele Castaldo
- Segreteria Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO) Group, Naples, Italy
| | - Giulia Scotto
- Department of Oncology, University of Turin, Turin, Italy
| | - Valentina Tuninetti
- Department of Oncology, Mauriziano Hospital, University of Turin, Turin, Italy
| | | | - Michele Bartoletti
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Serafina Mammoliti
- Ospedale Policlinico San Martino - Department of Medical Oncology, IRCCS, Genoa, Italy
| | - Grazia Artioli
- Oncologia Medica, Unità locale socio sanitaria n2 (ULSS2) Marca Trevigiana, Treviso, Italy
| | - Giorgia Mangili
- Obstet-Gynecol Department, San Raffaele Scientific Institute, IRCCS, Milan, Italy
| | - Vanda Salutari
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Domenica Lorusso
- Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, and Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Vera Loizzi
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Claudio Zamagni
- Azienda Ospedaliero-universitaria di Bologna, IRCCS, Bologna, Italy
| | - Antonella Savarese
- Department of Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Massimo Di Maio
- Department of Oncology, Mauriziano Hospital, University of Turin, Turin, Italy
| | | | - Carmela Pisano
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Naples, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Naples, Italy
| | - Giorgio Valabrega
- Department of Oncology, Mauriziano Hospital, University of Turin, Turin, Italy
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Oaknin A, Gladieff L, Martínez-García J, Villacampa G, Takekuma M, De Giorgi U, Lindemann K, Woelber L, Colombo N, Duska L, Leary A, Godoy-Ortiz A, Nishio S, Angelergues A, Rubio MJ, Fariñas-Madrid L, Yamaguchi S, Lorusso D, Ray-Coquard I, Manso L, Joly F, Alarcón J, Follana P, Romero I, Lebreton C, Pérez-Fidalgo JA, Yunokawa M, Dahlstrand H, D'Hondt V, Randall LM. Atezolizumab plus bevacizumab and chemotherapy for metastatic, persistent, or recurrent cervical cancer (BEATcc): a randomised, open-label, phase 3 trial. Lancet 2024; 403:31-43. [PMID: 38048793 DOI: 10.1016/s0140-6736(23)02405-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND The GOG240 trial established bevacizumab with chemotherapy as standard first-line therapy for metastatic or recurrent cervical cancer. In the BEATcc trial (ENGOT-Cx10-GEICO 68-C-JGOG1084-GOG-3030), we aimed to evaluate the addition of an immune checkpoint inhibitor to this standard backbone. METHODS In this investigator-initiated, randomised, open-label, phase 3 trial, patients from 92 sites in Europe, Japan, and the USA with metastatic (stage IVB), persistent, or recurrent cervical cancer that was measurable, previously untreated, and not amenable to curative surgery or radiation were randomly assigned 1:1 to receive standard therapy (cisplatin 50 mg/m2 or carboplatin area under the curve of 5, paclitaxel 175 mg/m2, and bevacizumab 15 mg/kg, all on day 1 of every 3-week cycle) with or without atezolizumab 1200 mg. Treatment was continued until disease progression, unacceptable toxicity, patient withdrawal, or death. Stratification factors were previous concomitant chemoradiation (yes vs no), histology (squamous cell carcinoma vs adenocarcinoma including adenosquamous carcinoma), and platinum backbone (cisplatin vs carboplatin). Dual primary endpoints were investigator-assessed progression-free survival according to Response Evaluation Criteria in Solid Tumours version 1.1 and overall survival analysed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03556839, and is ongoing. FINDINGS Between Oct 8, 2018, and Aug 20, 2021, 410 of 519 patients assessed for eligibility were enrolled. Median progression-free survival was 13·7 months (95% CI 12·3-16·6) with atezolizumab and 10·4 months (9·7-11·7) with standard therapy (hazard ratio [HR]=0·62 [95% CI 0·49-0·78]; p<0·0001); at the interim overall survival analysis, median overall survival was 32·1 months (95% CI 25·3-36·8) versus 22·8 months (20·3-28·0), respectively (HR 0·68 [95% CI 0·52-0·88]; p=0·0046). Grade 3 or worse adverse events occurred in 79% of patients in the experimental group and in 75% of patients in the standard group. Grade 1-2 diarrhoea, arthralgia, pyrexia, and rash were increased with atezolizumab. INTERPRETATION Adding atezolizumab to a standard bevacizumab plus platinum regimen for metastatic, persistent, or recurrent cervical cancer significantly improves progression-free and overall survival and should be considered as a new first-line therapy option. FUNDING F Hoffmann-La Roche.
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Affiliation(s)
- Ana Oaknin
- Medical Oncology Service, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | | | | | - Guillermo Villacampa
- SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebron Institute of Oncology, Barcelona, Spain; The Institute of Cancer Research, London, UK
| | | | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Kristina Lindemann
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Oslo University Hospital, Oslo, Norway
| | - Linn Woelber
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicoletta Colombo
- Gynecologic Oncology Department, European Institute of Oncology IRCCS Milan, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Linda Duska
- University of Virginia Cancer Center, Charlottesville, VA, USA
| | | | | | | | | | | | - Lorena Fariñas-Madrid
- Medical Oncology Service, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Domenica Lorusso
- Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Catholic University of Sacred Heart, Rome, Italy
| | | | - Luis Manso
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Ignacio Romero
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - J Alejandro Pérez-Fidalgo
- University Hospital of Valencia, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain; CIBERONC, Valencia, Spain
| | | | - Hanna Dahlstrand
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden
| | | | - Leslie M Randall
- Massey Comprehensive Cancer Center, VCUHealth, Richmond, VA, USA
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Colombo N, Lorusso D, Monk BJ, Slomovitz B, Hasegawa K, Nogueira-Rodrigues A, Zale M, Okpara CE, Barresi G, McKenzie J, Makker V. Characterization and Management of Adverse Reactions in Patients With Advanced Endometrial Cancer Receiving Lenvatinib Plus Pembrolizumab. Oncologist 2024; 29:25-35. [PMID: 37523661 PMCID: PMC10769802 DOI: 10.1093/oncolo/oyad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/19/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Lenvatinib plus pembrolizumab significantly improved efficacy compared with chemotherapy in patients with advanced endometrial cancer (aEC) regardless of microsatellite instability status or histologic subtype, who had disease progression following prior platinum-based therapy, in Study-309/KEYNOTE-775. The safety profile of the combination was generally consistent with that of each monotherapy drug and of the combination in patients with endometrial cancer and other solid tumors. Given the medical complexity of patients with aEC, this paper aims to characterize key adverse reactions (ARs) of the combination treatment and review management strategies, providing a guide for AR management to maximize anticancer benefits and minimize treatment discontinuation. MATERIALS AND METHODS In Study-309/KEYNOTE-775, patients received lenvatinib (20 mg orally once daily) plus pembrolizumab (200 mg intravenously every 3 weeks) or chemotherapy (doxorubicin or paclitaxel). The incidence and median time to the first onset of ARs, dose modifications, and concomitant medications are described. Key ARs characterized include hypothyroidism, hypertension, fatigue, diarrhea, musculoskeletal disorders, nausea, decreased appetite, vomiting, stomatitis, weight decreased, proteinuria, and palmar-plantar erythrodysesthesia syndrome. RESULTS As expected, the most common any-grade key ARs included: hypothyroidism, hypertension, fatigue, diarrhea, and musculoskeletal disorders. Grades 3-4 key ARs with incidence ≥10% included: hypertension, fatigue, and weight decreased. Key ARs first occurred within approximately 3 months of treatment initiation. AR management strategies consistent with the prescribing information and the study protocol are discussed. CONCLUSION Successful AR management strategies for lenvatinib plus pembrolizumab include education of the patient and entire treatment team, preventative measures and close monitoring, and judicious use of dose modifications and concomitant medications. CLINICALTRIALS.GOV ID NCT03517449.
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Affiliation(s)
- Nicoletta Colombo
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Italy
| | - Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
| | - Bradley J Monk
- HonorHealth Research Institute, University of Arizona, Creighton University, Phoenix, AZ, USA
| | - Brian Slomovitz
- Division of Gynecologic Oncology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Angélica Nogueira-Rodrigues
- Universidade Federal de Minas Gerais (UFMG), Brazilian Group of Gynecologic Oncology (EVA), Grupo Oncoclínicas, DOM Oncologia, Brazil
| | - Melissa Zale
- Clinical Safety & Risk Management Late-Stage Oncology – Gynecologic Cancers, Merck & Co., Inc., Rahway, NJ, USA
| | | | | | - Jodi McKenzie
- Oncology Business Group, Eisai Inc., Nutley, NJ, USA
| | - Vicky Makker
- Department of Medicine, Memorial Sloan Kettering Cancer Center; Weill Cornell Medical Center, New York, NY, USA
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Bruchim I, Capasso I, Polonsky A, Meisel S, Salutari V, Werner H, Lorusso D, Scambia G, Fanfani F. New therapeutic targets for endometrial cancer: a glimpse into the preclinical sphere. Expert Opin Ther Targets 2024; 28:29-43. [PMID: 38327111 DOI: 10.1080/14728222.2024.2316739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/06/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Endometrial cancer (EC) is the only gynecologic malignancy showing increasing trends in incidence and mortality. While standard treatment has been effective primarily for early-stage EC, precision medicine with tailored therapy has revolutionized the management of this disease. Genome sequencing analyses have identified four sub-types of EC. Treatments for primary and metastatic disease can now be tailored more accurately to achieve better oncologic results. AREAS COVERED This review provides an overview of the most relevant and updated evidence in the literature regarding EC molecular analysis and its role in risk classification, prognostication, and guidance for tailored and target therapies in early and advanced/metastatic stages. In addition, it provides updated information on optimal surgical management based on molecular classification and highlights key advances and future strategies. EXPERT OPINION EC molecular analysis yields the potential of tailoring adjuvant treatment by escalating or deescalating therapy, as shown for POLE-mutated and p53-mutated tumors. Moreover, the expression of specific molecular signatures offers the possibility to employ novel target therapies, such as immune-checkpoint inhibitors that have demonstrated a significant benefit on prognosis. New treatment guidelines are still being established, and ongoing studies are exploring the potential prognostic role of further sub-stratifications of the four molecular classes and treatment options.
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Affiliation(s)
- Ilan Bruchim
- Gynecology and Gynecologic Oncology Department, Hillel Yaffe Medical Center, Hadera, Israel
- Gynecology Laboratory, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
- The Technion, Institute of Technology, Haifa, Israel
| | - Ilaria Capasso
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ariel Polonsky
- Gynecology and Gynecologic Oncology Department, Hillel Yaffe Medical Center, Hadera, Israel
- Gynecology Laboratory, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Shilhav Meisel
- Gynecology Laboratory, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
- The Technion, Institute of Technology, Haifa, Israel
| | - Vanda Salutari
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Haim Werner
- The Technion, Institute of Technology, Haifa, Israel
- Department of Human Molecular Genetics and Biochemistry, School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Domenica Lorusso
- Università Cattolica del Sacro Cuore, Rome, Italy
- Scientific Directorate, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Abstract
Immune checkpoint blockers (ICB) act by reverting the immunosuppressive phenotype of cancer cells, thus allowing host immune system to generate an immune response to the tumor. One of the key mechanisms targeted by ICB is the PD-1/PD-L1 axis, which lies onto the interaction between the programmed-cell death protein 1 and its ligand, overexpressed in several tumor types. This interaction leads to the inhibition of T-cell proliferation and their apoptosis and exhaustion. Anti-PD-1/PD-L1 monoclonal antibodies are now the mainstay of treatment for several advanced stage tumors. Dostarlimab is a novel IgG4 anti-PD-1 antibody which has yielded remarkable results in mismatch-repair deficient endometrial cancer and locally advanced rectal cancer. This product review will illustrate the preclinical development of dostarlimab and its pharmacological characteristics, the clinical trials published so far and the ongoing clinical investigations.
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Affiliation(s)
- Carlo Maria Cicala
- Department of Medical and Surgical Science, Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Sarcoma Translational Research Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Lucia Musacchio
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome, Italy
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Vergote I, Van Nieuwenhuysen E, O'Cearbhaill RE, Westermann A, Lorusso D, Ghamande S, Collins DC, Banerjee S, Mathews CA, Gennigens C, Cibula D, Tewari KS, Madsen K, Köse F, Jackson AL, Boere IA, Scambia G, Randall LM, Sadozye A, Baurain JF, Gort E, Zikán M, Denys HG, Ottevanger N, Forget F, Mondrup Andreassen C, Eaton L, Chisamore MJ, Viana Nicacio L, Soumaoro I, Monk BJ. Tisotumab Vedotin in Combination With Carboplatin, Pembrolizumab, or Bevacizumab in Recurrent or Metastatic Cervical Cancer: Results From the innovaTV 205/GOG-3024/ENGOT-cx8 Study. J Clin Oncol 2023; 41:5536-5549. [PMID: 37651655 PMCID: PMC10730069 DOI: 10.1200/jco.23.00720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/22/2023] [Accepted: 07/12/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE Tissue factor is highly expressed in cervical carcinoma and can be targeted by tisotumab vedotin (TV), an antibody-drug conjugate. This phase Ib/II study evaluated TV in combination with bevacizumab, pembrolizumab, or carboplatin for recurrent or metastatic cervical cancer (r/mCC). METHODS This open-label, multicenter study (ClinicalTrials.gov identifier: NCT03786081) included dose-escalation arms that assessed dose-limiting toxicities (DLTs) and identified the recommended phase II dose (RP2D) of TV in combination with bevacizumab (arm A), pembrolizumab (arm B), or carboplatin (arm C). The dose-expansion arms evaluated TV antitumor activity and safety at RP2D in combination with carboplatin as first-line (1L) treatment (arm D) or with pembrolizumab as 1L (arm E) or second-/third-line (2L/3L) treatment (arm F). The primary end point of dose expansion was objective response rate (ORR). RESULTS A total of 142 patients were enrolled. In dose escalation (n = 41), no DLTs were observed; the RP2D was TV 2 mg/kg plus bevacizumab 15 mg/kg on day 1 once every 3 weeks, pembrolizumab 200 mg on day 1 once every 3 weeks, or carboplatin AUC 5 on day 1 once every 3 weeks. In dose expansion (n = 101), the ORR was 54.5% (n/N, 18/33; 95% CI, 36.4 to 71.9) with 1L TV + carboplatin (arm D), 40.6% (n/N, 13/32; 95% CI, 23.7 to 59.4) with 1L TV + pembrolizumab (arm E), and 35.3% (12/34; 19.7 to 53.5) with 2L/3L TV + pembrolizumab (arm F). The median duration of response was 8.6 months, not reached, and 14.1 months, in arms D, E, and F, respectively. Grade ≥3 adverse events (≥15%) were anemia, diarrhea, nausea, and thrombocytopenia in arm D and anemia in arm F (none ≥15%, arm E). CONCLUSION TV in combination with bevacizumab, carboplatin, or pembrolizumab demonstrated manageable safety and encouraging antitumor activity in treatment-naive and previously treated r/mCC.
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Affiliation(s)
- Ignace Vergote
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven Cancer Institute, Leuven, Belgium
| | - Els Van Nieuwenhuysen
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven Cancer Institute, Leuven, Belgium
| | | | - Anneke Westermann
- Dutch Gynaecological Oncology Group, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Domenica Lorusso
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Sharad Ghamande
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA
| | - Dearbhaile C. Collins
- Department of Medical Oncology, Cancer Trials Ireland, Cork University Hospital, Cork, Ireland
| | - Susana Banerjee
- Royal Marsden National Health Service Foundation Trust, Institute of Cancer Research, London, United Kingdom
| | - Cara A. Mathews
- Program in Women's Oncology, Women & Infants Hospital, Legorreta Cancer Center at Alpert Medical School of Brown University, Providence, RI
| | | | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | - Kristine Madsen
- Centre for Cancer and Organ Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | - Amanda L. Jackson
- Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati, OH
| | | | - Giovanni Scambia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Azmat Sadozye
- Beatson West of Scotland Cancer Centre, Gartnavel General Hospital, Glasgow, United Kingdom
| | - Jean-François Baurain
- Cliniques Universitaires Saint-Luc and Université Catholique de Louvain and BGOG, Brussels, Belgium
| | - Eelke Gort
- University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michal Zikán
- First Faculty of Medicine, Bulovka University Hospital, Charles University, Prague, Czech Republic
| | | | | | - Frédéric Forget
- BGOG, Centre Hospitalier de l’Ardenne—Site de Libramont, Libramont-Chevigny, Belgium
| | | | | | | | | | | | - Bradley J. Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ
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22
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Monk BJ, Colombo N, Tewari KS, Dubot C, Caceres MV, Hasegawa K, Shapira-Frommer R, Salman P, Yañez E, Gümüş M, Olivera Hurtado de Mendoza M, Samouëlian V, Castonguay V, Arkhipov A, Tekin C, Li K, Keefe SM, Lorusso D. First-Line Pembrolizumab + Chemotherapy Versus Placebo + Chemotherapy for Persistent, Recurrent, or Metastatic Cervical Cancer: Final Overall Survival Results of KEYNOTE-826. J Clin Oncol 2023; 41:5505-5511. [PMID: 37910822 DOI: 10.1200/jco.23.00914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/29/2023] [Accepted: 09/02/2023] [Indexed: 11/03/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The phase III, double-blind KEYNOTE-826 trial of pembrolizumab 200 mg or placebo once every 3 weeks for up to 35 cycles plus platinum-based chemotherapy, with or without bevacizumab, showed statistically significant survival benefits with the addition of pembrolizumab for patients with persistent, recurrent, or metastatic cervical cancer (primary data cutoff: May 3, 2021). This article reports the protocol-specified final overall survival (OS) results tested in the PD-L1 combined positive score (CPS) ≥1, all-comer, and CPS ≥10 populations. At the final data cutoff (October 3, 2022), the median study follow-up duration was 39.1 months (range, 32.1-46.5 months). In the PD-L1 CPS ≥1 (N = 548), all-comer (N = 617), and CPS ≥10 (N = 317) populations, median OS with pembrolizumab-chemotherapy versus placebo-chemotherapy was 28.6 months versus 16.5 months (hazard ratio [HR] for death, 0.60 [95% CI, 0.49 to 0.74]), 26.4 months versus 16.8 months (HR, 0.63 [95% CI, 0.52 to 0.77]), and 29.6 months versus 17.4 months (HR, 0.58 [95% CI, 0.44 to 0.78]), respectively. The incidence of grade ≥3 adverse events was 82.4% with pembrolizumab-chemotherapy and 75.4% with placebo-chemotherapy. These results show that pembrolizumab plus chemotherapy, with or without bevacizumab, continued to provide clinically meaningful improvements in OS for patients with persistent, recurrent, or metastatic cervical cancer.
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Affiliation(s)
- Bradley J Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ
| | - Nicoletta Colombo
- Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
- Università degli Studi di Milano Bicocca, Milan, Italy
| | | | - Coraline Dubot
- Oncologie Médicale, Institut Curie Saint Cloud, and GINECO, Paris, France
| | - M Valeria Caceres
- Medical Oncology, Instituto de Oncologia Angel H. Roffo, Buenos Aires, Argentina
| | - Kosei Hasegawa
- Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | | | - Pamela Salman
- Medical Oncology, Oncovida Cancer Center, Providencia, Santiago, Chile
| | - Eduardo Yañez
- Medical Oncology, Universidad de la Frontera, Temuco, Chile
| | - Mahmut Gümüş
- Medical Oncology, Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | | | - Vanessa Samouëlian
- Gynecologic Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche de l'Université de Montréal (CRCHUM), Université de Montréal, Montreal, QC, Canada
| | - Vincent Castonguay
- Medical Oncology, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC, Canada
| | - Alexander Arkhipov
- Oncology and Chemical Therapy, Medical Rehabilitation Center under the Ministry of Health of Russian Federation, Moscow, Russian Federation
| | | | - Kan Li
- Oncology, Merck & Co, Inc, Rahway, NJ
| | | | - Domenica Lorusso
- Gynaecology Oncology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
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Moore KN, Angelergues A, Konecny GE, García Y, Banerjee S, Lorusso D, Lee JY, Moroney JW, Colombo N, Roszak A, Tromp J, Myers T, Lee JW, Beiner M, Cosgrove CM, Cibula D, Martin LP, Sabatier R, Buscema J, Estévez-García P, Coffman L, Nicum S, Duska LR, Pignata S, Gálvez F, Wang Y, Method M, Berkenblit A, Bello Roufai D, Van Gorp T. Mirvetuximab Soravtansine in FRα-Positive, Platinum-Resistant Ovarian Cancer. N Engl J Med 2023; 389:2162-2174. [PMID: 38055253 DOI: 10.1056/nejmoa2309169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Mirvetuximab soravtansine-gynx (MIRV), a first-in-class antibody-drug conjugate targeting folate receptor α (FRα), is approved for the treatment of platinum-resistant ovarian cancer in the United States. METHODS We conducted a phase 3, global, confirmatory, open-label, randomized, controlled trial to compare the efficacy and safety of MIRV with the investigator's choice of chemotherapy in the treatment of platinum-resistant, high-grade serous ovarian cancer. Participants who had previously received one to three lines of therapy and had high FRα tumor expression (≥75% of cells with ≥2+ staining intensity) were randomly assigned in a 1:1 ratio to receive MIRV (6 mg per kilogram of adjusted ideal body weight every 3 weeks) or chemotherapy (paclitaxel, pegylated liposomal doxorubicin, or topotecan). The primary end point was investigator-assessed progression-free survival; key secondary analytic end points included objective response, overall survival, and participant-reported outcomes. RESULTS A total of 453 participants underwent randomization; 227 were assigned to the MIRV group and 226 to the chemotherapy group. The median progression-free survival was 5.62 months (95% confidence interval [CI], 4.34 to 5.95) with MIRV and 3.98 months (95% CI, 2.86 to 4.47) with chemotherapy (P<0.001). An objective response occurred in 42.3% of the participants in the MIRV group and in 15.9% of those in the chemotherapy group (odds ratio, 3.81; 95% CI, 2.44 to 5.94; P<0.001). Overall survival was significantly longer with MIRV than with chemotherapy (median, 16.46 months vs. 12.75 months; hazard ratio for death, 0.67; 95% CI, 0.50 to 0.89; P = 0.005). During the treatment period, fewer adverse events of grade 3 or higher occurred with MIRV than with chemotherapy (41.7% vs. 54.1%), as did serious adverse events of any grade (23.9% vs. 32.9%) and events leading to discontinuation (9.2% vs. 15.9%). CONCLUSIONS Among participants with platinum-resistant, FRα-positive ovarian cancer, treatment with MIRV showed a significant benefit over chemotherapy with respect to progression-free and overall survival and objective response. (Funded by ImmunoGen; MIRASOL ClinicalTrials.gov number, NCT04209855.).
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Affiliation(s)
- Kathleen N Moore
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Antoine Angelergues
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Gottfried E Konecny
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Yolanda García
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Susana Banerjee
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Domenica Lorusso
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Jung-Yun Lee
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - John W Moroney
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Nicoletta Colombo
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Andrzej Roszak
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Jacqueline Tromp
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Tashanna Myers
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Jeong-Won Lee
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Mario Beiner
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Casey M Cosgrove
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - David Cibula
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Lainie P Martin
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Renaud Sabatier
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Joseph Buscema
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Purificación Estévez-García
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Lan Coffman
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Shibani Nicum
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Linda R Duska
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Sandro Pignata
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Fernando Gálvez
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Yuemei Wang
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Michael Method
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Anna Berkenblit
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Diana Bello Roufai
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
| | - Toon Van Gorp
- From the Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris (A.A.), Aix-Marseille Université, INSERM, National Center for Scientific Research, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille (R.S.), and Institut Curie, Saint-Cloud (D.B.R.) - all in France; the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles (G.E.K.); Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Y.G.), Hospital Universitario Virgen del Rocío and Instituto de Biomedicina de Sevilla, Seville (P.E.-G.), and Hospital Universitario de Jaén, Jaen (F.G.) - all in Spain; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research (S.B.) and University College London Cancer Institute (S.N.) - both in London; Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.), the Gynecologic Oncology Program, European Institute of Oncology IRCCS, and the Department of Medicine and Surgery, University Milan-Bicocca, Milan (N.C.), and Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G. Pascale, Naples (S.P.) - all in Italy; Yonsei University College of Medicine (J.-Y.L.) and the Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine (J.-W.L.) - both in Seoul, South Korea; the University of Chicago, Chicago (J.W.M.); Wielkopolskie Centrum Onkologii and Poznań University of Medical Sciences, Poznań, Poland (A.R.); Amsterdam University Medical Centers, Amsterdam (J.T.); Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield (T.M.), and ImmunoGen, Waltham (Y.W., M.M., A.B.) - both in Massachusetts; Meir Medical Center, Kfar Saba, Israel (M.B.); Ohio State University, Columbus (C.M.C.); the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); the Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.P.M.), and Hillman Cancer Center, University of Pittsburgh, Pittsburgh (L.C.) - both in Pennsylvania; Arizona Oncology Associates, PC-HOPE, Tucson (J.B.); the University of Virginia School of Medicine, Charlottesville (L.R.D.); and University Hospital of Leuven, Leuven Cancer Institute, Leuven, Belgium (T.V.G.)
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24
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Paracchini L, Mannarino L, Romualdi C, Zadro R, Beltrame L, Fuso Nerini I, Zola P, Laudani ME, Pagano E, Giordano L, Fruscio R, Landoni F, Franceschi S, Dalessandro ML, Canzonieri V, Bocciolone L, Lorusso D, Bosetti C, Raspagliesi F, Garassino IMG, D'Incalci M, Marchini S. Genomic instability analysis in DNA from Papanicolaou test provides proof-of-principle early diagnosis of high-grade serous ovarian cancer. Sci Transl Med 2023; 15:eadi2556. [PMID: 38055801 DOI: 10.1126/scitranslmed.adi2556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/08/2023] [Indexed: 12/08/2023]
Abstract
Late diagnosis and the lack of screening methods for early detection define high-grade serous ovarian cancer (HGSOC) as the gynecological malignancy with the highest mortality rate. In the work presented here, we investigated a retrospective and multicentric cohort of 250 archival Papanicolaou (Pap) test smears collected during routine gynecological screening. Samples were taken at different time points (from 1 month to 13.5 years before diagnosis) from 113 presymptomatic women who were subsequently diagnosed with HGSOC (pre-HGSOC) and from 77 healthy women. Genome instability was detected through low-pass whole-genome sequencing of DNA derived from Pap test samples in terms of copy number profile abnormality (CPA). CPA values of DNA extracted from Pap test samples from pre-HGSOC women were substantially higher than those in samples from healthy women. Consistently with the longitudinal analysis of clonal pathogenic TP53 mutations, this assay could detect HGSOC presence up to 9 years before diagnosis. This finding confirms the continual shedding of tumor cells from fimbriae toward the endocervical canal, suggesting a new path for the early diagnosis of HGSOC. We integrated the CPA score into the EVA (early ovarian cancer) test, the sensitivity of which was 75% (95% CI, 64.97 to 85.79), the specificity 96% (95% CI, 88.35 to 100.00), and the accuracy 81%. This proof-of-principle study indicates that the early diagnosis of HGSOC is feasible through the analysis of genomic alterations in DNA from endocervical smears.
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Affiliation(s)
- Lara Paracchini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan 20072, Italy
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Laura Mannarino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan 20072, Italy
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Chiara Romualdi
- Department of Biology, University of Padua, Padua 35121, Italy
| | - Riccardo Zadro
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Luca Beltrame
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Ilaria Fuso Nerini
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Paolo Zola
- Department of Surgical Science, University of Turin, Turin 10126, Italy
| | - Maria E Laudani
- Department of Surgical Science, University of Turin, Turin 10126, Italy
| | - Eva Pagano
- Unit of Clinical Epidemiology, Città della Salute e della Scienza Hospital, University of Turin and CPO Piemonte, Turin 10126, Italy
| | - Livia Giordano
- Unit of Clinical Epidemiology, Città della Salute e della Scienza Hospital, University of Turin and CPO Piemonte, Turin 10126, Italy
| | - Robert Fruscio
- Department of Obstetrics and Gynaecology, Università degli Studi Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy
| | - Fabio Landoni
- Department of Obstetrics and Gynaecology, Università degli Studi Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy
| | - Silvia Franceschi
- Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Pordenone 33081, Italy
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan 20132, Italy
| | - Maria L Dalessandro
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Vincenzo Canzonieri
- Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Pordenone 33081, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste 34149, Italy
| | - Luca Bocciolone
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan 20132, Italy
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Cristina Bosetti
- Unit of Cancer Epidemiology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan 20156, Italy
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan 20133, Italy
| | - Isabella M G Garassino
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Maurizio D'Incalci
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan 20072, Italy
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Sergio Marchini
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
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25
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Ray-Coquard I, Monk BJ, Lorusso D, Mahdi H, Upadhyay V, Graul R, Husain A, Mirza MR, Slomovitz B. The promise of combining CDK4/6 inhibition with hormonal therapy in the first-line treatment setting for metastatic or recurrent endometrial adenocarcinoma. Int J Gynecol Cancer 2023; 33:1943-1949. [PMID: 37907262 PMCID: PMC10804003 DOI: 10.1136/ijgc-2023-004739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/29/2023] [Indexed: 11/02/2023] Open
Abstract
Metastatic or recurrent endometrioid adenocarcinoma of the uterine corpus is often incurable with limited treatment options. First-line treatment often includes cytotoxic chemotherapy, which incurs significant toxicities for many patients. Endometrial cancer, specifically endometrioid cancer, is a hormone-sensitive disease and, while single-agent hormonal therapies have demonstrated clinical benefit, resistance to these agents often leads to the use of chemotherapy. There is a lack of approved endocrine treatment options in the metastatic setting for most recurrent endometrial cancers, representing an unmet clinical need. Emerging evidence suggests that hormonal therapy in combination with other targeted treatments, such as cyclin dependent kinase (CDK)4/6 inhibitors, is well tolerated and effective in select patient populations. We discuss the clinical evidence suggesting that the combination of CDK4/6 inhibitors and hormonal therapy has the potential to represent an important addition to the first-line treatment options for patients with low-grade advanced or recurrent endometrial cancer.
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Affiliation(s)
- Isabelle Ray-Coquard
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire (GINECO), Centre Leon Bèrard, Lyon, France
| | - Bradley J Monk
- Honor Health Research Institute, University of Arizona, Creighton University, Phoenix, Arizona, USA
| | - Domenica Lorusso
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Haider Mahdi
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Brian Slomovitz
- Gynecologic Oncology, Mount Sinai Medical Center, Miami, Florida, USA
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26
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Mahdi H, Ray-Coquard I, Lorusso D, Mirza MR, Monk BJ, Slomovitz B. Evolving treatment paradigms in metastatic or recurrent low-grade endometrial cancer: When is hormonal-based therapy the preferred option? Int J Gynecol Cancer 2023; 33:1675-1681. [PMID: 37640446 PMCID: PMC10646884 DOI: 10.1136/ijgc-2023-004454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023] Open
Abstract
Endometrial cancer is the most common gynecologic malignancy in developed countries, with increasing incidence and mortality rates worldwide. While most cases are successfully treated with surgery, first-line treatment options for metastatic or recurrent endometrial cancer involve significant toxicities. Imprecise classification of heterogeneous subgroups further complicates treatment decisions and interpretation of clinical trial results. Recent advances in molecular classification are guiding treatment decisions for metastatic or recurrent endometrial cancers. Integrating molecular characteristics with traditional clinicopathology can both reduce overtreatment or undertreatment and help guide the appropriate choice of therapies and effective design of future studies. Here we discuss the treatment of metastatic or recurrent low-grade endometrioid adenocarcinoma of the uterine corpus, which is distinct from high-grade tumors histologically, molecularly, and in treatment response.
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Affiliation(s)
- Haider Mahdi
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Isabelle Ray-Coquard
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire (GINECO), Centre Leon Berard, Lyon, Rhône-Alpes, France
| | - Domenica Lorusso
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | | | - Bradley J Monk
- HonorHealth Research Institute, University of Arizona, Creighton University, Phoenix, Arizona, USA
| | - Brian Slomovitz
- Division of Gynecologic Oncology, Mount Sinai Medical Center, Miami Beach, Florida, USA
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27
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Giudice E, Mirza MR, Lorusso D. Advances in the Management of Recurrent Cervical Cancer: State of the Art and Future Perspectives. Curr Oncol Rep 2023; 25:1307-1326. [PMID: 37870697 PMCID: PMC10640496 DOI: 10.1007/s11912-023-01463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE OF REVIEW This review aims to give an insight into the currently available options for recurrent/metastatic (R/M) cervical cancer (CC), along with the main future, potentially practice-changing perspectives in this field. RECENT FINDINGS Improvements in terms of tumor responses were observed with the use of immune checkpoints inhibitors (ICIs) in the previously treated CC population, followed by emerging striking data in terms of both antitumor activity and survival rates with the addition of the ICIs to platinum-based chemotherapy with or without bevacizumab in the first-line setting. Furthermore, the CC treatment landscape took another step forward in 2021 with the introduction of antibody-drug conjugates (ADCs) in the second-line setting, a highly targeted therapeutic strategy, which demonstrated to be a valid alternative option in the recurrent setting. R/M CC is a hard-to-treat disease. However, after several years of limited systemic therapeutic options for the recurrent setting, the year 2018 marked a turning point for R/M CC patients, with the introduction of immunotherapy in the treatment paradigm, which completely reshaped the therapeutic armamentarium of the disease. Besides, another valuable treatment option represented by ADCs demonstrated its efficacy in the recurrent setting, thus further widening the treatment landscape for those patients. Yet, the introduction of immunotherapy in the upfront setting brought along new issues to be addressed such as the emerging ICIs resistance and the following need for alternative options in the post-ICIs setting. Several innovative therapeutic strategies are under investigation in ongoing clinical trials, with the aim of overcoming ICIs resistance with the addition of immunomodulatory agents or bypassing the ICIs resistance with novel alternative drugs.
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Affiliation(s)
- Elena Giudice
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mansoor Raza Mirza
- Department of Cancer Treatment, Copenhagen University Hospital, Copenhagen, Denmark
| | - Domenica Lorusso
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy.
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
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28
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Colombo N, Van Gorp T, Matulonis UA, Oaknin A, Grisham RN, Fleming GF, Olawaiye AB, Nguyen DD, Greenstein AE, Custodio JM, Pashova HI, Tudor IC, Lorusso D. Relacorilant + Nab-Paclitaxel in Patients With Recurrent, Platinum-Resistant Ovarian Cancer: A Three-Arm, Randomized, Controlled, Open-Label Phase II Study. J Clin Oncol 2023; 41:4779-4789. [PMID: 37364223 PMCID: PMC10602497 DOI: 10.1200/jco.22.02624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/21/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE Despite therapeutic advances, outcomes for patients with platinum-resistant/refractory ovarian cancer remain poor. Selective glucocorticoid receptor modulation with relacorilant may restore chemosensitivity and enhance chemotherapy efficacy. METHODS This three-arm, randomized, controlled, open-label phase II study (ClinicalTrials.gov identifier: NCT03776812) enrolled women with recurrent, platinum-resistant/refractory, high-grade serous or endometrioid epithelial ovarian, primary peritoneal, or fallopian tube cancer, or ovarian carcinosarcoma treated with ≤4 prior chemotherapeutic regimens. Patients were randomly assigned 1:1:1 to (1) nab-paclitaxel (80 mg/m2) + intermittent relacorilant (150 mg the day before, of, and after nab-paclitaxel); (2) nab-paclitaxel (80 mg/m2) + continuous relacorilant (100 mg once daily); or (3) nab-paclitaxel monotherapy (100 mg/m2). Nab-paclitaxel was administered on days 1, 8, and 15 of each 28-day cycle. The primary end point was progression-free survival (PFS) by investigator assessment; objective response rate (ORR), duration of response (DOR), overall survival (OS), and safety were secondary end points. RESULTS A total of 178 women were randomly assigned. Intermittent relacorilant + nab-paclitaxel improved PFS (hazard ratio [HR], 0.66; log-rank test P = .038; median follow-up, 11.1 months) and DOR (HR, 0.36; P = .006) versus nab-paclitaxel monotherapy, while ORR was similar across arms. At the preplanned OS analysis (median follow-up, 22.5 months), the OS HR was 0.67 (P = .066) for the intermittent arm versus nab-paclitaxel monotherapy. Continuous relacorilant + nab-paclitaxel showed numerically improved median PFS but did not result in significant improvement over nab-paclitaxel monotherapy. Adverse events were comparable across study arms, with neutropenia, anemia, peripheral neuropathy, and fatigue/asthenia being the most common grade ≥3 adverse events. CONCLUSION Intermittent relacorilant + nab-paclitaxel improved PFS, DOR, and OS compared with nab-paclitaxel monotherapy. On the basis of protocol-prespecified Hochberg step-up multiplicity adjustment, the primary end point did not reach statistical significance (P < .025). A phase III evaluation of this regimen is underway (ClinicalTrials.gov identifier: NCT05257408).
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Affiliation(s)
- Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University Milan-Bicocca, Milan, Italy
| | - Toon Van Gorp
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Ana Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rachel N. Grisham
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | | | - Alexander B. Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | | | | | | | | | - Domenica Lorusso
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
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29
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Matulonis UA, Lorusso D, Oaknin A, Pignata S, Dean A, Denys H, Colombo N, Van Gorp T, Konner JA, Marin MR, Harter P, Murphy CG, Wang J, Noble E, Esteves B, Method M, Coleman RL. Reply to Z.R. McCaw et al. J Clin Oncol 2023; 41:4705-4706. [PMID: 37535884 DOI: 10.1200/jco.23.00752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Ursula A Matulonis
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Domenica Lorusso
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Ana Oaknin
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Sandro Pignata
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Andrew Dean
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Hannelore Denys
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Nicoletta Colombo
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Toon Van Gorp
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Jason A Konner
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Margarita Romeo Marin
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Philipp Harter
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Conleth G Murphy
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Jiuzhou Wang
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Elizabeth Noble
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Brooke Esteves
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Michael Method
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
| | - Robert L Coleman
- Ursula A. Matulonis, MD, Dana-Farber Cancer Institute, Boston, MA; Domenica Lorusso, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Catholic University of Sacred Heart, Rome, Italy; Ana Oaknin, MD, PhD, Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Sandro Pignata, MD, Istituto Nazionale Tumori di Napoli Fondazione G Pascale IRCCS, Naples, Italy; Andrew Dean, MD, WA Medical Oncology St John of God Subiaco Hospital, Subiaco, WA, Australia; Hannelore Denys, MD, PhD, Ghent University Hospital, Ghent, Belgium; Nicoletta Colombo, MD, European Institute of Oncology IRCCS, Milan, Italy and University of Milan-Bicocca, Milan, Italy; Toon Van Gorp, MD, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium; Jason A. Konner, MD, Memorial Sloan Kettering Cancer Center, New York, NY; Margarita Romeo Marin, MD, Institut Català d'Oncologia, Badalona, Spain; Philipp Harter, MD, Ev. Kliniken Essen-Mitte, Essen, Germany; Conleth G. Murphy, MD, Bon Secours Hospital and Cancer Trials, Cork, Ireland; Jiuzhou Wang, PhD; Elizabeth Noble, BS; Brooke Esteves, BS; and Michael Method, MD, ImmunoGen Inc, Waltham, MA; and Robert L. Coleman, MD, US Oncology Research, Texas Oncology, The Woodlands, TX
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Bogani G, Ray-Coquard I, Mutch D, Vergote I, Ramirez PT, Prat J, Concin N, Ngoi NYL, Coleman RL, Enomoto T, Takehara K, Denys H, Lorusso D, Takano M, Sagae S, Wimberger P, Segev Y, Kim SI, Kim JW, Herrera F, Mariani A, Brooks RA, Tan D, Paolini B, Chiappa V, Longo M, Raspagliesi F, Benedetti Panici P, Di Donato V, Caruso G, Colombo N, Pignata S, Zannoni G, Scambia G, Monk BJ. Gestational choriocarcinoma. Int J Gynecol Cancer 2023; 33:1504-1514. [PMID: 37758451 DOI: 10.1136/ijgc-2023-004704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Gestational choriocarcinoma accounts for 5% of gestational trophoblastic neoplasms. Approximately 50%, 25%, and 25% of gestational choriocarcinoma occur after molar pregnancies, term pregnancies, and other gestational events, respectively. The FIGO scoring system categorizes patients into low (score 0 to 6) and high risk (score 7 or more) choriocarcinoma. Single-agent and multi-agent chemotherapy are used in low- and high-risk patients, respectively. Chemotherapy for localized disease has a goal of eradication of disease without surgery and is associated with favorable prognosis and fertility preservation. Most patients with gestational choriocarcinoma are cured with chemotherapy; however, some (<5.0%) will die as a result of multi-drug resistance, underscoring the need for novel approaches in this group of patients. Although there are limited data due to its rarity, the treatment response with immunotherapy is high, ranging between 50-70%. Novel combinations of immune checkpoint inhibitors with targeted therapies (including VEGFR-2 inhibitors) are under evaluation. PD-L1 inhibitors are considered a potential important opportunity for chemo-resistant patients, and to replace or de-escalate chemotherapy to avoid or minimize chemotherapy toxicity. In this review, the Rare Tumor Working Group and the European Organization for Research and Treatment of Cancer evaluated the current landscape and further perspective in the management of patients diagnosed with gestational choriocarcinoma.
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Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Isabelle Ray-Coquard
- Centre Leon Berard, LYON CEDEX 08, France
- Hesper lab, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - David Mutch
- Washington University in Saint Louis, St Louis, Missouri, USA
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - Pedro T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
| | - Jaime Prat
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Nicole Concin
- Department of Gynecology and Obstetrics; Innsbruck Medical Univeristy, Innsbruck, Austria
| | | | | | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Belgium
| | - Kazuhiro Takehara
- Department of Gynecologic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | | | | | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Japan
| | - Satoru Sagae
- Gynecologic Oncology, Tokeidai Kinen Byoin, Sapporo, Japan
| | - Pauline Wimberger
- Gyncology and Obstetrics, Technische Universitat Dresden Medizinische Fakultat Carl Gustav Carus, Dresden, Germany
| | - Yakir Segev
- Obstetrics and Gynecology, Carmel Hospital, Haifa, Israel
| | - Se Ik Kim
- Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Jae-Weon Kim
- Obstetrics and gynecology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Fernanda Herrera
- Centre Hospitalier Universitaire Vaudois Departement doncologie CHUV-UNIL, Lausanne, Switzerland
| | - Andrea Mariani
- Gynecologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Rebecca A Brooks
- Section of Gynecologic Oncology, University of Chicago Medicine, Chicago, Illinois, USA
| | - David Tan
- National University Cancer Institute, Singapore
| | - Biagio Paolini
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy
| | - Valentina Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | | | | | | | | | | | - Nicoletta Colombo
- Medical Gynecologic Oncology Unit; University of Milan Bicocca; Milan; Italy, European Institute of Oncology, Milano, Italy
| | - Sandro Pignata
- Gynaecological Oncology, National Cancer Institute Napels, Naples, Italy
| | - Gianfranco Zannoni
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Bradley J Monk
- Virginia G Piper Cancer Center - Biltmore Cancer Center, Phoenix, Arizona, USA
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31
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Milani A, Tuninetti V, Pignata S, Lorusso D, Castaldo D, De Giorgi U, Savarese A, Biglia N, Scandurra G, Mangili G, Di Maio M, Turinetto M, Bellero M, Mammoliti S, Testa S, Scotto G, Purro A, Artioli G, Valabrega G. Prescribing pattern of anticoagulants in patients with cancer associated thrombosis: Results of a survey among MITO group and AIOM society. Tumori 2023; 109:490-495. [PMID: 36609207 DOI: 10.1177/03008916221146820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Low molecular weight heparin (LMWH) has been the backbone of the treatment of cancer associated thrombosis (CAT). Direct-acting oral anticoagulants (DOACs) have shown efficacy and safety not inferior to LMWH and guidelines included DOACs as an option for CAT treatment. Nevertheless, DOACs are still poorly prescribed in patients with cancer. The aim of this survey was to better understand prescription patterns of anticoagulants, in particular of DOACs, especially in gynecological cancers (GCs). METHODS Our survey was made up of 21 questions, the last four questions addressed to medical doctors (MDs) involved in GCs. An invitation to complete the survey was sent by e-mail to 691 MITO (Multicentre Italian Trials in Ovarian cancer and gynaecologic malignancies) and 2093 AIOM (Associazione Italiana di Oncologia Medica) members. RESULTS Overall, 113 MDs completed the questionnaire, 69 involved in GCs. Most respondents (46, 41%) were aged 30-40 years old, worked in public hospitals (59, 52.2%), were medical oncologists (86, 76.1%). LMWH was the preferred choice for the treatment of CAT (104, 92%). However, 89 respondents (78.8%) prescribed or asked to prescribe a DOAC for CAT. The major concern about DOACs was the difficulty in verifying the therapeutic effect and the absence of antidotes in case of bleeding (37.9%). In patients with GCs, DOACs were used with niraparib, olaparib, rucaparib and immune checkpoint inhibitors (ICIs) in less than 10 patients by 23%, 20%, 9% and 10.2% of respondents, respectively. CONCLUSION The responders are aware of the Direct-acting oral anticoagulants option and would like to use them.
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Affiliation(s)
- Andrea Milani
- Pronto Soccorso, Ospedale San Lorenzo, ASL TO5, Turin, Italy
| | - Valentina Tuninetti
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - Sandro Pignata
- Department of Urogynecology, National Cancer Institute, Pascale Foundation (Scientific Institute for Research and Healthcare), Naples, Italy
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Daniele Castaldo
- Segreteria Multicenter Italian Trials in Ovarian Cancer and Gynaecologic Malignancies (MITO) Group, Naples, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | | | - Nicoletta Biglia
- Obstetrics and Gynaecology Unit, Umberto I Hospital, Department of Surgical Sciences, School of Medicine, University of Turin, Turin, Italy
| | | | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - Margherita Turinetto
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - Marco Bellero
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | | | - Silvia Testa
- Anestesia e Rianimazione, Struttura Complessa di Anestesia e Rianimazione, Ospedale San Lorenzo, ASL TO5, Turin, Italy
| | - Giulia Scotto
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - Andrea Purro
- Pronto Soccorso, Ospedale San Lorenzo, ASL TO5, Turin, Italy
| | | | - Giorgio Valabrega
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
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González-Martín A, Harter P, Leary A, Lorusso D, Miller RE, Pothuri B, Ray-Coquard I, Tan DSP, Bellet E, Oaknin A, Ledermann JA. Newly diagnosed and relapsed epithelial ovarian cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2023; 34:833-848. [PMID: 37597580 DOI: 10.1016/j.annonc.2023.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/21/2023] Open
Affiliation(s)
- A González-Martín
- Department of Medical Oncology and Program in Solid Tumors Cima-Universidad de Navarra, Cancer Center Clínica Universidad de Navarra, Madrid and Pamplona, Spain
| | - P Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - A Leary
- Department of Medical Oncology, Gustave Roussy Cancer Center, INSERM U981, Université Paris-Saclay, Paris, France
| | - D Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome; Department of Woman, Child and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - R E Miller
- Department of Medical Oncology, University College Hospital, London; Department of Medical Oncology, St Bartholomew's Hospital, London, UK
| | - B Pothuri
- Department of Obstetrics and Gynecology, Perlmutter Cancer Center, NYU Langone Health, New York University School of Medicine, New York, USA
| | - I Ray-Coquard
- Department of Medical Oncology, Centre Leon Bernard and Université Claude Bernard Lyon I, Lyon, France
| | - D S P Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University of Singapore (NUS) Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Cancer Science Institute, National University of Singapore, Singapore, Singapore; Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - E Bellet
- ACTO-Alleanza contro il Tumore Ovarico, Milan, Italy
| | - A Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - J A Ledermann
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
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Agostinelli V, Musacchio L, Camarda F, Salutari V, Carbone MV, Ghizzoni V, Nero C, Ricci C, Perri MT, Giudice E, Lardino S, Berardi R, Scambia G, Lorusso D. Therapeutic Potential of Tisotumab Vedotin in the Treatment of Recurrent or Metastatic Cervical Cancer: A Short Report on the Emerging Data. Cancer Manag Res 2023; 15:1063-1072. [PMID: 37790898 PMCID: PMC10543937 DOI: 10.2147/cmar.s294080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Cervical cancer is the fourth most common type of cancer in women worldwide. It is associated with a high death rate, despite the fact that it is a nearly 100% preventable disease because of very effective primary and secondary preventive strategies. Advanced and recurrent disease is uncurable with a high relapse risk and the second-line therapies are limited with modest response rates and short durability. Investigating alternative mechanisms of action is crucial because of the high request for effective new therapies. Tisotumab vedotin (TV) is the first antibody-drug conjugated to target a cell surface-expressed tissue factor, and preliminary data in patients with metastatic and recurrent cervical cancer have been promising. In addition, the trials showed a favorable tolerability profile, with limited incidence of grade 3 or worse adverse events. According to the data of ENGOT-cx6/GOG-3023/innovaTV 204, the US Food and Drug Administration granted expedited approval of TV on September 20, 2021, for women with recurrent or metastatic cervical cancer. Actually, two other trials testing TV alone or in combination with other agents are ongoing. ENGOT-cx8/GOG-3024/innovaTV 205 is a Phase Ib/II trial of TV in combination with platinum or bevacizumab or pembrolizumab, in patients with recurrent or metastatic cervical cancer who have not received prior systemic therapy or who have progressed after no more than two prior systemic therapies. ENGOT-cx12/GOG-3057/InnovaTV 301 is a Phase 3 trial of TV vs investigator's choice chemotherapy in patients with advanced or recurrent cervical cancer who had received no more than 2 prior chemotherapy lines. The outcomes of these two trials will potentially confirm and reinforce the use of TV as a new standard of care in advanced or recurrent cervical cancer.
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Affiliation(s)
| | - Lucia Musacchio
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Floriana Camarda
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Vanda Salutari
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Maria Vittoria Carbone
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Viola Ghizzoni
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Camilla Nero
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Caterina Ricci
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Maria Teresa Perri
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Elena Giudice
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara Lardino
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rossana Berardi
- Oncologic Clinic, Università Politecnica delle Marche, Ancona, Italy
| | - Giovanni Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenica Lorusso
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
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Arezzo F, Giannone G, Castaldo D, Scotto G, Tuninetti V, Turinetto M, Bartoletti M, Mammoliti S, Artioli G, Mangili G, Salutari V, Lorusso D, Cormio G, Loizzi V, Zamagni C, Savarese A, Di Maio M, Ronzino G, Pisano C, Pignata S, Valabrega G. Management of metastatic endometrial cancer: physicians' choices beyond the first line after approval of checkpoint inhibitors. Front Oncol 2023; 13:1247291. [PMID: 37781174 PMCID: PMC10538538 DOI: 10.3389/fonc.2023.1247291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Endometrial cancer (EC) represents 3.4% of all newly diagnosed cancer cases and is responsible for 2.1% of all cancer-related deaths. Approximately 10%-15% of women with EC are diagnosed with advanced-stage disease, resulting in a reported 5-year survival rate of only 17% for those with distant metastases. A better understanding of its molecular features has ushered in a new era of immunotherapy for the treatment of EC, allowing for alternative therapeutic approaches, even in cases of advanced disease. Methods We administered a multi-choice online survey for Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) members. The questionnaire was available for 2 months, starting in October 2022. Our objective was to evaluate the current attitude of incorporating molecular characterization of EC into routine clinical practice, appraise the implementation of newly available therapies, and compare the outcomes with the previous survey conducted in April-May 2021 to ascertain the actual changes that have transpired during this recent time period. Results The availability of molecular classification in Italian centers has changed in 1 year. Seventy-five percent of centers performed the molecular classification compared with 55.6% of the previous survey. Although this percentage has increased, only 18% performed all the tests. Significant changes have occurred in the administration of new treatments in EC patients in MITO centers. In 2022, 82.1% of the centers administrated dostarlimab in recurrent or advanced MMR-deficient (dMMR) EC experiencing disease progression after platinum-based chemotherapy regimens, compared to only 24.4% in 2021. In 2022, 85.7% of the centers already administrated the pembrolizumab plus lenvatinib combination as a second-line therapy for MMR-proficient (pMMR) patients with advanced or recurrent EC who had progressed from first-line platinum-based therapy. Conclusion Both the therapeutic and diagnostic scenarios have changed over the last couple of years in MITO centers, with an increased prescription of immune checkpoint inhibitors and use of the molecular classification.
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Affiliation(s)
- Francesca Arezzo
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- Department of Precision and Regenerative Medicine – Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Gaia Giannone
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Daniele Castaldo
- Segreteria Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO) Group, Naples, Italy
| | - Giulia Scotto
- Department of Oncology, University of Turin, Turin, Italy
| | - Valentina Tuninetti
- Department of Oncology, Mauriziano Hospital, University of Turin, Turin, Italy
| | | | - Michele Bartoletti
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Serafina Mammoliti
- Ospedale Policlinico San Martino - Department of Medical Oncology, IRCCS, Genoa, Italy
| | - Grazia Artioli
- Oncologia Medica, Unità locale socio sanitaria n2 (ULSS2) Marca Trevigiana, Treviso, Italy
| | - Giorgia Mangili
- Obstet-Gynecol Department, San Raffaele Scientific Institute, IRCCS, Milan, Italy
| | - Vanda Salutari
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Domenica Lorusso
- Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, and Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Vera Loizzi
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Claudio Zamagni
- Azienda Ospedaliero-universitaria di Bologna, IRCCS, Bologna, Italy
| | - Antonella Savarese
- Department of Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Massimo Di Maio
- Department of Oncology, Mauriziano Hospital, University of Turin, Turin, Italy
| | | | - Carmela Pisano
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Naples, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Naples, Italy
| | - Giorgio Valabrega
- Department of Oncology, Mauriziano Hospital, University of Turin, Turin, Italy
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Polano M, Bedon L, Dal Bo M, Sorio R, Bartoletti M, De Mattia E, Cecchin E, Pisano C, Lorusso D, Lissoni AA, De Censi A, Cecere SC, Scollo P, Marchini S, Arenare L, De Giorgi U, Califano D, Biagioli E, Chiodini P, Perrone F, Pignata S, Toffoli G. Machine Learning Application Identifies Germline Markers of Hypertension in Patients With Ovarian Cancer Treated With Carboplatin, Taxane, and Bevacizumab. Clin Pharmacol Ther 2023; 114:652-663. [PMID: 37243926 DOI: 10.1002/cpt.2960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
Pharmacogenomics studies how genes influence a person's response to treatment. When complex phenotypes are influenced by multiple genetic variations with little effect, a single piece of genetic information is often insufficient to explain this variability. The application of machine learning (ML) in pharmacogenomics holds great potential - namely, it can be used to unravel complicated genetic relationships that could explain response to therapy. In this study, ML techniques were used to investigate the relationship between genetic variations affecting more than 60 candidate genes and carboplatin-induced, taxane-induced, and bevacizumab-induced toxicities in 171 patients with ovarian cancer enrolled in the MITO-16A/MaNGO-OV2A trial. Single-nucleotide variation (SNV, formerly SNP) profiles were examined using ML to find and prioritize those associated with drug-induced toxicities, specifically hypertension, hematological toxicity, nonhematological toxicity, and proteinuria. The Boruta algorithm was used in cross-validation to determine the significance of SNVs in predicting toxicities. Important SNVs were then used to train eXtreme gradient boosting models. During cross-validation, the models achieved reliable performance with a Matthews correlation coefficient ranging from 0.375 to 0.410. A total of 43 SNVs critical for predicting toxicity were identified. For each toxicity, key SNVs were used to create a polygenic toxicity risk score that effectively divided individuals into high-risk and low-risk categories. In particular, compared with low-risk individuals, high-risk patients were 28-fold more likely to develop hypertension. The proposed method provided insightful data to improve precision medicine for patients with ovarian cancer, which may be useful for reducing toxicities and improving toxicity management.
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Affiliation(s)
- Maurizio Polano
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Luca Bedon
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Michele Dal Bo
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Roberto Sorio
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Michele Bartoletti
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Elena De Mattia
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Erika Cecchin
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Carmela Pisano
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Fondazione G. Pascale, Naples, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome, Italy
| | - Andrea Alberto Lissoni
- Clinica Ostetrica e Ginecologica, Istituto di Ricovero e Cura a Carattere Scientifico S. Gerardo Monza, Università di Milano Bicocca, Milano, Italy
| | | | - Sabrina Chiara Cecere
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Fondazione G. Pascale, Naples, Italy
| | - Paolo Scollo
- Unità Operativa Ostetricia e Ginecologia, Dipartimento Materno-Infantile, Ospedale Cannizzaro, Catania, Italy
| | - Sergio Marchini
- Molecular Pharmacology laboratory, Group of Cancer Pharmacology Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Italy
| | - Laura Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione G. Pascale, Naples, Italy
| | - Ugo De Giorgi
- Istituto di Ricovero e Cura a Carattere Scientifico Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Daniela Califano
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Elena Biagioli
- Department Of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milano, Milano, Italy
| | - Paolo Chiodini
- Department of Mental Health and Public Medicine, Section of Statistics, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione G. Pascale, Naples, Italy
| | - Sandro Pignata
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Fondazione G. Pascale, Naples, Italy
| | - Giuseppe Toffoli
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
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Lorusso D, Danesi R, Locati LD, Masi G, De Giorgi U, Gadducci A, Pignata S, Sabbatini R, Savarese A, Valabrega G, Zamagni C, Colombo N. Corrigendum: Optimizing the use of lenvatinib in combination with pembrolizumab in patients with advanced endometrial carcinoma. Front Oncol 2023; 13:1232476. [PMID: 37609387 PMCID: PMC10441771 DOI: 10.3389/fonc.2023.1232476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/05/2023] [Indexed: 08/24/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fonc.2022.979519.].
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Affiliation(s)
- Domenica Lorusso
- Department of Clinical Research Planning, Fondazione Policlinico Universitario A Gemelli Istituto di Ricerca e Cura a carattere scientifico (IRCCS), Rome, Italy
- Department of Life Science and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Romano Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Laura Deborah Locati
- Translational Oncology Unit, Istituto di Ricerca e Cura a carattere scientifico (IRCCS) Istituti Clinici Scientifici (ICS) Maugeri, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto di Ricerca e Cura a carattere scientifico (IRCCS) Istituto Romagnolo per lo Studio dei Tumori (IRST), Dino Amadori, Meldola, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricerca e Cura a carattere scientifico (IRCCS) “Fondazione Giovanni Pascale”, Naples, Italy
| | - Roberto Sabbatini
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricerca e Cura a carattere scientifico (IRCCS) “Fondazione Giovanni Pascale”, Naples, Italy
| | - Antonella Savarese
- Division of Medical Oncology 1, Istituto di Ricerca e Cura a carattere scientifico (IRCCS) -Regina Elena National Cancer Institute, Rome, Italy
| | - Giorgio Valabrega
- University of Torino-Struttura Complessa a Direzione Universitaria (S.C.D.U.) Oncologia Azienda Ospedaliera (A.O) Ordine Mauriziano-Ospedale Umberto I, Torino, Italy
| | - Claudio Zamagni
- Addarii Medical Oncology, Istituto di Ricerca e Cura a carattere scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Nicoletta Colombo
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Department of Oncological Gynecology, European Institute of Oncology (IEO) Istituto di Ricerca e Cura a carattere scientifico (IRCCS), Milan, Italy
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37
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Colombo N, Gadducci A, Landoni F, Lorusso D, Sabbatini R, Artioli G, Berardi R, Ceccherini R, Cecere SC, Cormio G, De Angelis C, Legge F, Lissoni A, Mammoliti S, Mangili G, Naglieri E, Petrella MC, Ricciardi GRR, Ronzino G, Salutari V, Sambataro D, Savarese A, Scandurra G, Tasca G, Tomao F, Valabrega G, Zavallone L, Pignata S. Consensus statements and treatment algorithm to guide clinicians in the selection of maintenance therapy for patients with newly diagnosed, advanced ovarian carcinoma: Results of a Delphi study. Gynecol Oncol 2023; 175:182-189. [PMID: 37355448 DOI: 10.1016/j.ygyno.2023.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Standard treatment of newly diagnosed, advanced ovarian carcinoma (OC) consists of cytoreductive surgery followed by platinum-based chemotherapy with or without bevacizumab. Maintenance therapy with PARP inhibitors and olaparib-bevacizumab has recently shown to significantly improve progression-free survival in the first-line setting. Some practical aspects of maintenance therapy, however, are still poorly defined. AIM OF THE STUDY To provide guidance to clinicians in the selection of maintenance therapy for newly diagnosed, advanced ovarian carcinoma. METHODS A board of six gynecologic oncologists with expertise in the treatment of OC in Italy convened to address issues related to the new options for maintenance treatment. Based on scientific evidences, the board produced practice-oriented statements. Consensus was reached via a modified Delphi study that involved a panel of 22 experts from across Italy. RESULTS Twenty-seven evidence- and consensus-based statements are presented, covering the following areas of interest: use of biomarkers (BRCA mutations and presence of homologous recombination deficiency); timing and outcomes of surgery; selection of patients eligible for bevacizumab; definition of response to treatment; toxicity and contraindications; evidence of synergy of bevacizumab plus PARP inhibitor. Two treatment algorithms are also included, for selecting maintenance therapy based on timing and outcomes of surgery, response to platinum-based chemotherapy and biomarker status. A score for the assessment of response to chemotherapy is proposed, but its validation is ongoing. CONCLUSIONS We provide here consensus statements and treatment algorithms to guide clinicians in the selection of appropriate and personalized maintenance therapy in the first-line setting of advanced OC management.
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Affiliation(s)
- Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology, IRCSS, Milano, Italy; Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Fabio Landoni
- Department of Obstetrics and Gynecology, San Gerardo Hospital and University of Milano Bicocca, Milano, Italy
| | - Domenica Lorusso
- Fondazione Policlinico Gemelli IRCSS and Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Roberto Sabbatini
- Medical Oncology Division, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Rossana Berardi
- Department of Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Rita Ceccherini
- Department of Oncology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy
| | - Sabrina Chiara Cecere
- U.O.C. of Experimental Uro-Gynecological Clinical Oncology, Istituto Nazionale Tumori, IRCSS, Fondazione G. Pascale, Napoli, Italy
| | - Gennaro Cormio
- Ginecologic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Italy; Department of Interdisciplinary Medicine (DIM), University of Bari, 70121 Bari, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Francesco Legge
- Gynecologic Oncology Unit, General Regional Hospital "F. Miulli" of Acquaviva delle Fonti, Italy
| | - Andrea Lissoni
- Department of Medicine and Surgery, Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Monza, University of Milan Bicocca, Milan, Italy
| | | | - Giorgia Mangili
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Emanuele Naglieri
- Department of Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II", Bari 70124, Italy
| | | | | | | | - Vanda Salutari
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | | | - Antonella Savarese
- Division of Medical Oncology 1, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | | | - Giulia Tasca
- Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Giorgio Valabrega
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, 10128 Turin, Italy
| | - Laura Zavallone
- Department Medical Oncology, Infermi Hospital, Biella, Italy
| | - Sandro Pignata
- U.O.C. of Experimental Uro-Gynecological Clinical Oncology, Istituto Nazionale Tumori, IRCSS, Fondazione G. Pascale, Napoli, Italy
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González-Martín A, Pothuri B, Vergote I, Graybill W, Lorusso D, McCormick CC, Freyer G, Backes F, Heitz F, Redondo A, Moore RG, Vulsteke C, O'Cearbhaill RE, Malinowska IA, Shtessel L, Compton N, Mirza MR, Monk BJ. Progression-free survival and safety at 3.5years of follow-up: results from the randomised phase 3 PRIMA/ENGOT-OV26/GOG-3012 trial of niraparib maintenance treatment in patients with newly diagnosed ovarian cancer. Eur J Cancer 2023; 189:112908. [PMID: 37263896 DOI: 10.1016/j.ejca.2023.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE To report updated long-term efficacy and safety from the double-blind, placebo-controlled, phase 3 PRIMA/ENGOT-OV26/GOG-3012 study (NCT02655016). METHODS Patients with newly diagnosed advanced ovarian cancer with complete or partial response (CR or PR) to first-line platinum-based chemotherapy received niraparib or placebo once daily (2:1 ratio). Stratification factors were best response to first-line chemotherapy regimen (CR/PR), receipt of neoadjuvant chemotherapy (yes/no), and homologous recombination deficiency (HRD) status (deficient [HRd]/proficient [HRp] or not determined). Updated (ad hoc) progression-free survival (PFS) data (as of November 17, 2021) by investigator assessment (INV) are reported. RESULTS In 733 randomised patients (niraparib, 487; placebo, 246), median PFS follow-up was 3.5years. Median INV-PFS was 24.5 versus 11.2months (hazard ratio, 0.52; 95% confidence interval [CI], 0.40-0.68) in the HRd population and 13.8 versus 8.2months (hazard ratio, 0.66; 95% CI, 0.56-0.79) in the overall population for niraparib and placebo, respectively. In the HRp population, median INV-PFS was 8.4 versus 5.4months (hazard ratio, 0.65; 95% CI, 0.49-0.87), respectively. Results were concordant with the primary analysis. Niraparib-treated patients were more likely to be free of progression or death at 4years than placebo-treated patients (HRd, 38% versus 17%; overall, 24% versus 14%). The most common grade ≥ 3 treatment-emergent adverse events in niraparib patients were thrombocytopenia (39.7%), anaemia (31.6%), and neutropenia (21.3%). Myelodysplastic syndromes/acute myeloid leukaemia incidence rate (1.2%) was the same for niraparib- and placebo-treated patients. Overall survival remained immature. CONCLUSIONS Niraparib maintained clinically significant improvements in PFS with 3.5years of follow-up in patients with newly diagnosed advanced ovarian cancer at high risk of progression irrespective of HRD status. No new safety signals were identified.
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Affiliation(s)
- Antonio González-Martín
- Medical Oncology Department, Cancer Center Clínica Universidad de Navarra, Madrid, Program in Solid Tumours, CIMA, Pamplona, and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Madrid, Spain
| | - Bhavana Pothuri
- Gynecologic Oncology Group (GOG Foundation), NYU Langone, Health, Department of Obstetrics & Gynecology, Perlmutter Cancer Center, New York, NY, USA
| | - Ignace Vergote
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Department of Gynaecology and Obstetrics, Division of Gynaecological Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Whitney Graybill
- GOG, Gynecologic Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Domenica Lorusso
- Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
| | | | - Gilles Freyer
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), HCL Cancer Institute Department of Medical Oncology, Lyon University, Lyon, France
| | - Floor Backes
- Division of Gynecologic Oncology, Ohio State University, Columbus, OH, USA
| | - Florian Heitz
- AGO Study Group and the Department for Gynaecology and Gynaecologic Oncology, Kliniken Essen-Mitte, Essen, Germany; Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Gynaecology, Berlin, Germany
| | - Andrés Redondo
- GEICO, Department of Medical Oncology, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Richard G Moore
- Division of Gynecologic Oncology, Wilmot Cancer Institute, Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Christof Vulsteke
- BGOG, Department of Medical Oncology and Hematology, AZ Maria Middelares, Gent, Belgium; Department of Molecular Imaging, Pathology, Radiotherapy & Oncology, Center for Oncological Research, Antwerp University, Antwerp, Belgium
| | - Roisin E O'Cearbhaill
- GOG, Gynecologic Medical Oncology, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | | | | | - Mansoor R Mirza
- Department of Oncology, Rigshospitalet-Copenhagen University Hospital and Nordic Society of Gynaecological Oncology, Copenhagen, Denmark
| | - Bradley J Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Phoenix Creighton University, Phoenix, AZ, USA
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Cibula D, Rosaria Raspollini M, Planchamp F, Centeno C, Chargari C, Felix A, Fischerová D, Jahnn-Kuch D, Joly F, Kohler C, Lax S, Lorusso D, Mahantshetty U, Mathevet P, Raj Naik M, Nout RA, Oaknin A, Peccatori F, Persson J, Querleu D, Rubio Bernabé S, Schmid MP, Stepanyan A, Svintsitskyi V, Tamussino K, Zapardiel I, Lindegaard J. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - Update 2023. Radiother Oncol 2023; 184:109682. [PMID: 37336614 DOI: 10.1016/j.radonc.2023.109682] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer, the three sister societies jointly decided to update these evidence-based guidelines. The update includes new topics to provide comprehensive guidelines on all relevant issues of diagnosis and treatment in cervical cancer. To serve on the expert panel (27 experts across Europe) ESGO/ESTRO/ESP nominated practicing clinicians who are involved in managing patients with cervical cancer and have demonstrated leadership through their expertise in clinical care and research, national and international engagement, profile, and dedication to the topics addressed. To ensure the statements were evidence based, new data identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Before publication, the guidelines were reviewed by 155 independent international practitioners in cancer care delivery and patient representatives. These updated guidelines are comprehensive and cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined.
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Affiliation(s)
- David Cibula
- Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic; General University Hospital in Prague, Prague, Czech Republic.
| | | | | | - Carlos Centeno
- Department of Palliative Medicine, University of Navarra, Pamplona, Spain
| | - Cyrus Chargari
- Service d'Oncologie Radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Ana Felix
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal; Universidade Nova de Lisboa, Lisboa, Portugal
| | - Daniela Fischerová
- Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic; General University Hospital in Prague, Prague, Czech Republic
| | - Daniela Jahnn-Kuch
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florence Joly
- François Baclesse Centre de Lutte Contre le Cancer, Caen, France
| | - Christhardt Kohler
- Asklepios Clinic Altona, Hamburg, Germany; Asklepios Comprehensive Tumor Center, Hamburg, Germany
| | - Sigurd Lax
- Hospital Graz II, Graz, Austria; Johannes Kepler Universitat Linz, Linz, Austria
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy; Catholic University of Sacred Heart, Rome, Italy
| | - Umesh Mahantshetty
- Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, Andhra Pradesh, India
| | | | - Mr Raj Naik
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Remi A Nout
- Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, the Netherlands; University Medical Center, Rotterdam, the Netherlands
| | - Ana Oaknin
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Jan Persson
- Department of Obstetrics and Gynecology, Lund University Hosptial, Lund, Sweden; Skåne University Hospital Lund, Lund, Sweden
| | - Denis Querleu
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy; University Hospitals Strasbourg, Strasbourg, France
| | | | - Maximilian P Schmid
- Department of Radiation Oncology, Medical University of Vienna, Wien, Austria
| | - Artem Stepanyan
- Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
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40
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Makker V, Colombo N, Herráez AC, Monk BJ, Mackay H, Santin AD, Miller DS, Moore RG, Baron-Hay S, Ray-Coquard I, Ushijima K, Yonemori K, Kim YM, Guerra Alia EM, Sanli UA, Bird S, Orlowski R, McKenzie J, Okpara C, Barresi G, Lorusso D. Lenvatinib Plus Pembrolizumab in Previously Treated Advanced Endometrial Cancer: Updated Efficacy and Safety From the Randomized Phase III Study 309/KEYNOTE-775. J Clin Oncol 2023; 41:2904-2910. [PMID: 37058687 PMCID: PMC10414727 DOI: 10.1200/jco.22.02152] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/15/2023] [Indexed: 04/16/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.We report the final prespecified analysis for overall survival (OS), along with updated progression-free survival (PFS) and objective response rate (ORR), and safety from the open-label, randomized, phase III Study 309/KEYNOTE-775. In total, 827 patients with advanced, recurrent, or metastatic endometrial cancer (EC) were randomly assigned to receive lenvatinib 20 mg orally once daily plus pembrolizumab 200 mg intravenously once every 3 weeks (n = 411) or chemotherapy of the treating physician's choice (doxorubicin 60 mg/m2 intravenously once every 3 weeks or paclitaxel 80 mg/m2 intravenously once weekly [3 weeks on; 1 week off] [n = 416]). Efficacy was reported for patients with mismatch repair proficient (pMMR) tumors and all-comers, and by subgroups (histology, prior therapy, MMR status). Updated safety was also reported.Lenvatinib plus pembrolizumab showed benefits in OS (pMMR HR, 0.70; 95% CI, 0.58 to 0.83; all-comer HR, 0.65; 95% CI, 0.55 to 0.77), PFS (pMMR HR, 0.60; 95% CI, 0.50 to 0.72; all-comer HR, 0.56; 95% CI, 0.48 to 0.66), and ORR (pMMR patients, 32.4% v 15.1%; all-comers, 33.8% v 14.7%) versus chemotherapy. OS, PFS, and ORR favored lenvatinib plus pembrolizumab in all subgroups of interest. No new safety signals were observed. Lenvatinib plus pembrolizumab continued to show improved efficacy versus chemotherapy and manageable safety in patients with previously treated advanced EC.
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Affiliation(s)
- Vicky Makker
- Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York City, NY
| | - Nicoletta Colombo
- Gynecologic Oncology Department, University of Milan-Bicocca, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Bradley J. Monk
- HonorHealth Research Institute, University of Arizona, Creighton University, Phoenix, AZ
| | - Helen Mackay
- Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alessandro D. Santin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - David S. Miller
- Division of Gynecologic Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Richard G. Moore
- Division of Gynecologic Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Sally Baron-Hay
- Medical Oncology Department, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Isabelle Ray-Coquard
- Medical Oncology Department, Centre Léon Bérard, University Claude Bernard, GINECO Group, Lyon, France
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Kan Yonemori
- Department of Medical Oncology, National Cancer Center Hospital, Chuo-ku, Japan
| | - Yong Man Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Eva M. Guerra Alia
- Department of Medical Oncology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Ulus A. Sanli
- Individualized Medicine Application and Research Center and Department of Medical Oncology, Ege University, Izmir, Turkey
| | | | | | | | | | | | - Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
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Lorusso D, Colombo N, Herraez AC, Santin AD, Colomba E, Miller DS, Fujiwara K, Pignata S, Baron-Hay SE, Ray-Coquard IL, Shapira-Frommer R, Kim YM, McCormack M, Massaad R, Nguyen AM, Zhao Q, McKenzie J, Prabhu VS, Makker V. Health-Related Quality of Life in Patients With Advanced Endometrial Cancer Treated With Lenvatinib Plus Pembrolizumab or Treatment of Physician's Choice. Eur J Cancer 2023; 186:172-184. [PMID: 37086595 PMCID: PMC11003310 DOI: 10.1016/j.ejca.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE Lenvatinib and pembrolizumab (LEN+PEMBRO) demonstrated clinically meaningful and statistically significant improvements in efficacy versus treatment of physician's choice (TPC) in patients with advanced endometrial cancer (aEC) in the phase 3 Study 309/KEYNOTE-775. Health-related quality-of-life (HRQoL) is reported. PATIENTS AND METHODS Patients were randomly assigned to receive LEN+PEMBRO (n = 411; LEN 20 mg/day; PEMBRO 200 mg Q3W) or TPC (n = 416; doxorubicin 60 mg/m2 Q3W or paclitaxel 80 mg/m2 [weekly, 3 weeks on/1 week off]). Impact of treatment on HRQoL assessed by the global health status/quality of life (GHS/QoL) score of the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30) was a secondary objective; other scales of the Quality-of-Life Questionnaire (QLQ-C30), EORTC QLQ-Endometrial, 24 questions (EORTC QLQ-EN24), and EuroQoL 5 dimensions, 5 levels (EQ-5D-5L) were exploratory objectives. HRQoL was assessed on day 1 of each cycle. Completion/compliance, change from baseline, time to first and definitive deterioration were assessed. No multiplicity adjustments were applied for HRQoL endpoints. RESULTS The latest timepoint at which the predefined rates of completion (≥60%) and compliance (≥80%) were met was week 12. HRQoL at week 12 between treatment groups was generally similar. Time to first deterioration symptom scales favoured LEN+PEMBRO for QLQ-C30 dyspnoea, and QLQ-EN24 for poor body image, tingling/numbness, and hair loss; and TPC was favoured for QLQ-C30 pain, appetite loss, and diarrhoea, and QLQ-EN24 muscular pain. While the QLQ-C30 physical functional scale favoured TPC, other functional scales were generally similar between arms. Time to definitive deterioration favoured LEN+PEMBRO on most scales. CONCLUSION HRQoL data from Study 309/KEYNOTE-775, with previously published efficacy and safety results, indicate that LEN+PEMBRO has an overall favourable benefit/risk profile versus TPC for the treatment of patients with aEC. CLINICALTRIALS GOV: NCT03517449.
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Affiliation(s)
- Domenica Lorusso
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, and Catholic University of Sacred Heart, Rome, Italy.
| | - Nicoletta Colombo
- University of Milan-Bicocca, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Emeline Colomba
- Gustave Roussy Cancerology Institute, Villejuif, GINECO Group, France
| | | | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Sandro Pignata
- Istituto Nazionale Tumori IRCCS-Fondazione G. Pascale, Naples, Italy
| | | | | | | | - Yong Man Kim
- Asan Medical Center, University of Ulsan, Seoul, Korea, Republic of South Korea
| | - Mary McCormack
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | - Vicky Makker
- Weill Cornell Medical Center, New York, NY, USA; Memorial Sloan Kettering Cancer Center, New York, NY, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Petrelli F, Rea CG, Solinas C, Ghidini A, Borgonovo K, Celotti A, Villa A, Luciani A, Lorusso D. Treatments for relapsed, BRCA-wild type, platinum-sensitive ovarian cancer: A systematic review and network meta-analysis. Cancer Treat Rev 2023; 118:102571. [PMID: 37201444 DOI: 10.1016/j.ctrv.2023.102571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/06/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Although platinum-based chemotherapy (CT) is considered the standard treatment for relapsed platinum-sensitive ovarian cancer, there is currently no standard treatment for these patients. We compared the effectiveness of modern and older therapies in relapsed platinum-sensitive, BRCA-wild type, and ovarian cancers using a network meta-analysis (NMA). METHODS A systematic search of PubMed, EMBASE, and Cochrane Library was performed up to October 31, 2022. Randomized controlled trials (RCT) that compared different second-line approaches were included. The primary endpoint was overall survival (OS) and the secondary endpoint was progression-free survival (PFS). RESULTS In total, 17 RCTs (n = 9405) comparing various strategies were included. The risk of death was significantly decreased with carboplatin + pegylated liposomal doxorubicin + bevacizumab compared to platinum-based doublet CT (hazard ratio [HR] = 0.59, 95%CI 0.35, 1). Various strategies, including secondary cytoreduction followed by platinum-based CT, carboplatin + pegylated liposomal doxorubicin + bevacizumab, and platinum-based CT with bevacizumab or cediranib, were better than platinum-based doublets alone for PFS. CONCLUSIONS This NMA showed that carboplatin + pegylated liposomal doxorubicin + bevacizumab seems to increase the efficacy of standard second-line CT. These strategies can be considered when treating patients with relapsed platinum-sensitive ovarian cancer without BRCA mutations. This study provides systematic comparative evidence for the efficacy of different second-line therapies for relapsed ovarian cancer.
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Affiliation(s)
| | | | - Cinzia Solinas
- Medical Oncology, AOU Cagliari, P.O. Duilio Casula, Monserrato (CA), Italy
| | | | | | | | | | - Andrea Luciani
- Oncology Unit, ASST Bergamo ovest, Treviglio (BG), Italy
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cibula D, Raspollini MR, Planchamp F, Centeno C, Chargari C, Felix A, Fischerová D, Jahnn-Kuch D, Joly F, Kohler C, Lax S, Lorusso D, Mahantshetty U, Mathevet P, Naik R, Nout RA, Oaknin A, Peccatori F, Persson J, Querleu D, Bernabé SR, Schmid MP, Stepanyan A, Svintsitskyi V, Tamussino K, Zapardiel I, Lindegaard J. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - Update 2023. Virchows Arch 2023:10.1007/s00428-023-03552-3. [PMID: 37145263 DOI: 10.1007/s00428-023-03552-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer, the three sister societies jointly decided to update these evidence-based guidelines. The update includes new topics to provide comprehensive guidelines on all relevant issues of diagnosis and treatment in cervical cancer.To serve on the expert panel (27 experts across Europe) ESGO/ESTRO/ESP nominated practicing clinicians who are involved in managing patients with cervical cancer and have demonstrated leadership through their expertise in clinical care and research, national and international engagement, profile, and dedication to the topics addressed. To ensure the statements were evidence based, new data identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Before publication, the guidelines were reviewed by 155 independent international practitioners in cancer care delivery and patient representatives.These updated guidelines are comprehensive and cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined.
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Affiliation(s)
- David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, 121 08, Czech Republic.
- General University Hospital in Prague, Prague, Czech Republic.
| | | | | | - Carlos Centeno
- Department of Palliative Medicine, University of Navarra, Pamplona, Spain
| | - Cyrus Chargari
- Service d'Oncologie Radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Ana Felix
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
- Universidade Nova de Lisboa, Lisboa, Portugal
| | - Daniela Fischerová
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, 121 08, Czech Republic
- General University Hospital in Prague, Prague, Czech Republic
| | - Daniela Jahnn-Kuch
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florence Joly
- François Baclesse Centre de Lutte Contre le Cancer, Caen, France
| | - Christhardt Kohler
- Asklepios Clinic Altona, Hamburg, Germany
- Asklepios Comprehensive Tumor Center, Hamburg, Germany
| | - Sigurd Lax
- Hospital Graz II, Graz, Austria
- Johannes Kepler Universitat Linz, Linz, Austria
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Umesh Mahantshetty
- Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, Andhra Pradesh, India
| | | | - Raj Naik
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Remi A Nout
- Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, The Netherlands
- University Medical Center, Rotterdam, The Netherlands
| | - Ana Oaknin
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Jan Persson
- Department of Obstetrics and Gynecology, Lund University Hosptial, Lund, Sweden
- Skåne University Hospital Lund, Lund, Sweden
| | - Denis Querleu
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
- University Hospitals Strasbourg, Strasbourg, France
| | | | - Maximilian P Schmid
- Department of Radiation Oncology, Medical University of Vienna, Wien, Austria
| | - Artem Stepanyan
- Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
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Cibula D, Raspollini MR, Planchamp F, Centeno C, Chargari C, Felix A, Fischerová D, Jahnn-Kuch D, Joly F, Kohler C, Lax S, Lorusso D, Mahantshetty U, Mathevet P, Naik R, Nout RA, Oaknin A, Peccatori F, Persson J, Querleu D, Bernabé SR, Schmid MP, Stepanyan A, Svintsitskyi V, Tamussino K, Zapardiel I, Lindegaard J. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - Update 2023. Int J Gynecol Cancer 2023; 33:649-666. [PMID: 37127326 PMCID: PMC10176411 DOI: 10.1136/ijgc-2023-004429] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer, the three sister societies jointly decided to update these evidence-based guidelines. The update includes new topics to provide comprehensive guidelines on all relevant issues of diagnosis and treatment in cervical cancer.To serve on the expert panel (27 experts across Europe) ESGO/ESTRO/ESP nominated practicing clinicians who are involved in managing patients with cervical cancer and have demonstrated leadership through their expertise in clinical care and research, national and international engagement, profile, and dedication to the topics addressed. To ensure the statements were evidence based, new data identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Before publication, the guidelines were reviewed by 155 independent international practitioners in cancer care delivery and patient representatives.These updated guidelines are comprehensive and cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined.
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Affiliation(s)
- David Cibula
- Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic
- General University Hospital in Prague, Prague, Czech Republic
| | | | | | - Carlos Centeno
- Department of Palliative Medicine, University of Navarra, Pamplona, Spain
| | - Cyrus Chargari
- Service d'Oncologie Radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Ana Felix
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
- Universidade Nova de Lisboa, Lisboa, Portugal
| | - Daniela Fischerová
- Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic
- General University Hospital in Prague, Prague, Czech Republic
| | - Daniela Jahnn-Kuch
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florence Joly
- François Baclesse Centre de Lutte Contre le Cancer, Caen, France
| | - Christhardt Kohler
- Asklepios Clinic Altona, Hamburg, Germany
- Asklepios Comprehensive Tumor Center, Hamburg, Germany
| | - Sigurd Lax
- Hospital Graz II, Graz, Austria
- Johannes Kepler Universitat Linz, Linz, Austria
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Umesh Mahantshetty
- Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, Andhra Pradesh, India
| | | | - Raj Naik
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Remi A Nout
- Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, The Netherlands
- University Medical Center, Rotterdam, The Netherlands
| | - Ana Oaknin
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Jan Persson
- Department of Obstetrics and Gynecology, Lund University Hosptial, Lund, Sweden
- Skåne University Hospital Lund, Lund, Sweden
| | - Denis Querleu
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
- University Hospitals Strasbourg, Strasbourg, France
| | | | - Maximilian P Schmid
- Department of Radiation Oncology, Medical University of Vienna, Wien, Austria
| | - Artem Stepanyan
- Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
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Gauduchon T, Kfoury M, Lorusso D, Floquet A, Ventriglia J, Salaun H, Moubarak M, Rivoirard R, Polastro L, Favier L, You B, Berton D, de la Motte Rouge T, Mansi L, Abdeddaim C, Prulhiere K, Lancry Lecomte L, Provansal M, Dalban C, Ray-Coquard I. PARP inhibitors (PARPi) prolongation after local therapy for oligo-metastatic progression in relapsed ovarian cancer patients. Gynecol Oncol 2023; 173:98-105. [PMID: 37105063 DOI: 10.1016/j.ygyno.2023.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND PARP inhibitors (PARPi) have revolutionized the management of high-grade epithelial ovarian cancer (HGOC) treatment. However, a significant number of patients relapse or progress under PARPi, leading to the introduction of a new line of systemic therapy such as chemotherapy. In patients with a limited number of metastatic sites at progression, -referred to as an oligometastatic progression- a potential indication for local therapy followed by re-introduction or continuation of PARPi treatment rather than initiating a new line of chemotherapy could be proposed. However, the impact of such strategies on progression free survival (PFS) in these patients remains unknown. METHODS This international multicenter retrospective study evaluated the efficacy of PARPi continuation or re-introduction in patients with HGOC after local treatment for oligometastatic progression. The main objective was to assess PFS under PARPi after local therapy (PFS post-LT). Secondary objectives included safety and overall survival (OS). RESULTS 74 patients were identified in 20 centers between April 2020 and November 2021. 65% of patients were BRCA mutated and 92% had received ≥2 lines of prior systemic chemotherapy before the initial introduction of PARPi. Main progression sites were lymph nodes (42%), peritoneum (27%), liver (16%), other visceral (16%) and abdominal wall (4%). Local therapies included radiotherapy (45%), surgery (43%), both (7%), percutaneous thermal ablation (4%) or chemoembolization (1%). Median PFS post-LT was 11.5 months [95% CI 7.4; 17.2]. After a median follow up of 14.8 months, 6 patients (8.1%) discontinued PARPi due to toxicity. The 1-year overall survival rate was 90.7% [95% CI 79.1; 96.0]. CONCLUSIONS With close to one year without progression or introduction of a new line of systemic therapy, this study reports the feasibility and potential benefit of this original strategy in patients with oligometastatic progression under PARPi.
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Affiliation(s)
| | - Maria Kfoury
- Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Domenica Lorusso
- Gynecologic Oncology, Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
| | - Anne Floquet
- Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Jole Ventriglia
- Medical Oncology, IRCCS National Cancer Institute "Fondazione G. Pascale", Naples, Italy
| | | | - Malak Moubarak
- Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Romain Rivoirard
- Medical Oncology, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Laura Polastro
- Medical Oncology, Institut Jules Bordet, Brussels, Belgium
| | - Laure Favier
- Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Benoit You
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Groupement Hospitalier Sud, GINECO, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, EA 3738 CICLY, Lyon, France
| | - Dominique Berton
- Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | - Laura Mansi
- Medical Oncology, Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz, Besançon, France
| | | | | | | | | | - Cécile Dalban
- Department of Biostatistics, Direction de Recherche Clinique et de l'innovation du Centre Léon Bérard, Lyon 69008, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est Inserm, Lyon 69008, France.
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Forlani L, De Cecco L, Simeon V, Paolini B, Bagnoli M, Cecere SC, Spina A, Citeroni E, Bignotti E, Lorusso D, Arenare L, Russo D, De Angelis C, Ardighieri L, Scognamiglio G, Del Sesto M, Tognon G, Califano D, Schettino C, Chiodini P, Perrone F, Mezzanzanica D, Pignata S, Tomassetti A. Biological and clinical impact of membrane EGFR expression in a subgroup of OC patients from the phase IV ovarian cancer MITO-16A/MANGO-OV2A trial. J Exp Clin Cancer Res 2023; 42:83. [PMID: 37041632 PMCID: PMC10088260 DOI: 10.1186/s13046-023-02651-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/21/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Validated prognostic biomarkers for anti-angiogenic therapy using the anti-VEGF antibody Bevacizumab in ovarian cancer (OC) patients are still an unmet clinical need. The EGFR can contribute to cancer-associated biological mechanisms in OC cells including angiogenesis, but its targeting gave disappointing results with less than 10% of OC patients treated with anti-EGFR compounds showing a positive response, likely due to a non adequate selection and stratification of EGFR-expressing OC patients. METHODS EGFR membrane expression was evaluated by immunohistochemistry in a cohort of 310 OC patients from the MITO-16A/MANGO-OV2A trial, designed to identify prognostic biomarkers of survival in patients treated with first line standard chemotherapy plus bevacizumab. Statistical analyses assessed the association between EGFR and clinical prognostic factors and survival outcomes. A single sample Gene Set Enrichment-like and Ingenuity Pathway Analyses were applied to the gene expression profile of 195 OC samples from the same cohort. In an OC in vitro model, biological experiments were performed to assess specific EGFR activation. RESULTS Based on EGFR-membrane expression, three OC subgroups of patients were identified being the subgroup with strong and homogeneous EGFR membrane localization, indicative of possible EGFR out/in signalling activation, an independent negative prognostic factor for overall survival of patients treated with an anti-angiogenic agent. This OC subgroup resulted statistically enriched of tumors of histotypes different than high grade serous lacking angiogenic molecular characteristics. At molecular level, among the EGFR-related molecular traits identified to be activated only in this patients' subgroup the crosstalk between EGFR with other RTKs also emerged. In vitro, we also showed a functional cross-talk between EGFR and AXL RTK; upon AXL silencing, the cells resulted more sensitive to EGFR targeting with erlotinib. CONCLUSIONS Strong and homogeneous cell membrane localization of EGFR, associated with specific transcriptional traits, can be considered a prognostic biomarker in OC patients and could be useful for a better OC patients' stratification and the identification of alternative therapeutic target/s in a personalized therapeutic approach.
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Affiliation(s)
- Luca Forlani
- Integrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Loris De Cecco
- Integrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Vittorio Simeon
- Department of Mental Health and Public Medicine, Section of Statistics, Università Degli Studi Della Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Biagio Paolini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Marina Bagnoli
- Integrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Sabrina Chiara Cecere
- Urogynaecological Medical Oncology, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Anna Spina
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Eleonora Citeroni
- Integrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Eliana Bignotti
- Division of Obstetrics and Gynecology, ASST Spedali Civili Di Brescia, Brescia, Italy
- Angelo Nocivelli Institute of Molecular Medicine, ASST Spedali Civili of Brescia- University of Brescia, Brescia, Italy
| | - Domenica Lorusso
- Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, and Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Laura Arenare
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Daniela Russo
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Laura Ardighieri
- Department of Pathology, Azienda Socio Sanitaria Territoriale Spedali Civili Di Brescia, Brescia, Italy
| | - Giosuè Scognamiglio
- Pathology Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Michele Del Sesto
- Pathology Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Germana Tognon
- Division of Obstetrics and Gynecology, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Daniela Califano
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Clorinda Schettino
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Paolo Chiodini
- Department of Mental Health and Public Medicine, Section of Statistics, Università Degli Studi Della Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Delia Mezzanzanica
- Integrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
| | - Sandro Pignata
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Antonella Tomassetti
- Integrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
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Musacchio L, Turinetto M, Arenare L, Bartoletti M, Califano D, Tuninetti V, Marchetti C, Cormio G, Loizzi V, Pisano C, Salutari V, Valabrega G, Priolo D, Cecere SC, Ventriglia J, Raspagliesi F, Perrone F, Fagotti A, Lorusso D, Scambia G, Pignata S. Effect of bevacizumab in advanced low grade serous ovarian cancer: Data from the MITO 22 trial. Gynecol Oncol 2023; 172:72-77. [PMID: 36965291 DOI: 10.1016/j.ygyno.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/26/2022] [Accepted: 03/15/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE The aim of the present analysis was to explore the efficacy of Bevacizumab (Bev) on survival outcome in advanced low grade serous ovarian cancer (LGSOC) both in first line and in recurrent setting. METHODS In retrospective observational multicenter study, we described the outcome of LGSOC patients enrolled in the MITO 22 study and treated with chemotherapy (CT) with or without Bev. Patients receiving Bev in first-line or in recurrence were considered and compared with patients receiving CT alone (stage III and IV in first line; platinum based-CT in second line). Descriptive and survival analyses were performed for each group. RESULTS Out of 128 patients included in MITO 22, 46 LGSOC patients receiving Bev in first line setting or at the time of first recurrence were identified. In first line, 30 patients received Bev + CT and 65 CT alone and the median PFS were 47.86 months (95% CI: 31.48 - NR) and 22.63 months (95% CI 15-39.24) (p-value 0.0392), respectively. In the recurrent setting, 16 patients who received Bev + CT were compared to 33 women treated with platinum-based CT alone. Median PFS were 37.1 months (95% CI: 13.42-40.56) and 11.22 months (95% CI: 8.26-15.63) (p-value 0.013), respectively. CONCLUSIONS Our study suggests that Bev might be effective in LGSOC both at diagnosis and at the time of relapse. These data warrants further studies.
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Affiliation(s)
- Lucia Musacchio
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Margherita Turinetto
- Department of Oncology, University of Torino at Ordine Mauriziano Hospital, Turin, Italy
| | - Laura Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS - Fondazione G.Pascale, Naples, Italy
| | - Michele Bartoletti
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Italy
| | - Daniela Califano
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori, IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Valentina Tuninetti
- Department of Oncology, University of Torino at Ordine Mauriziano Hospital, Turin, Italy
| | - Claudia Marchetti
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Istituto Tumori Giovanni Paolo II - IRCCS, Bari, Italy; Interdisciplinary Department of Medicine, University of Bari, Italy
| | - Vera Loizzi
- Gynecologic Oncology Istituto Tumori Giovanni Paolo II - IRCCS, Bari, Italy; Interdisciplinary Department of Medicine, University of Bari, Italy
| | - Carmela Pisano
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Italy
| | - Vanda Salutari
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgio Valabrega
- Department of Oncology, University of Torino at Ordine Mauriziano Hospital, Turin, Italy
| | - Domenico Priolo
- Medical Oncology Department, San Vincenzo Hospital, Taormina, Messina, Italy
| | - Sabrina Chiara Cecere
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Italy
| | - Jole Ventriglia
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Italy
| | | | - Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS - Fondazione G.Pascale, Naples, Italy
| | - Anna Fagotti
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Life Science and Public Health, Catholic University of Sacred Heart, Largo Agostino Gemelli, Rome, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Life Science and Public Health, Catholic University of Sacred Heart, Largo Agostino Gemelli, Rome, Italy
| | - Giovanni Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Life Science and Public Health, Catholic University of Sacred Heart, Largo Agostino Gemelli, Rome, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Italy.
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50
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Perrone E, Capasso I, De Felice F, Giannarelli D, Dinoi G, Petrecca A, Palmieri L, Foresta A, Nero C, Arciuolo D, Lorusso D, Zannoni GF, Scambia G, Fanfani F. Back to the future: The impact of oestrogen receptor profile in the era of molecular endometrial cancer classification. Eur J Cancer 2023; 186:98-112. [PMID: 37062213 DOI: 10.1016/j.ejca.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE The aim of this study is to evaluate the impact of the oestrogen receptor (ER) profile on oncologic outcomes in the new endometrial cancer (EC) risk classification. METHODS Immunohistochemistry (IHC) analyses were performed in a retrospectively reviewed large series of ECs to assess the presence/absence of oestrogen receptors (ER0\1+ or ER2+\3+) and other molecular factors (i.e. p53 mutation, p53mut; and mismatch repair mutational status, MMRd (mismatch repair deficient) versus MMRp (mismatch repair proficient)), histopathologic and clinical outcomes. ER status was correlated with molecular, histologic, clinical and prognostic data. RESULTS 891 EC patients were included in the study (211 ER0\1+ and 680 ER2+\3+). The ER0\1+ phenotype was associated with an unfavourable clinicopathological profile (i.e. grading, histotype, lymphovascular space invasion (LVSI), stages, etc.). Simple regression showed that risk class, p53mut, and ER0/1+ impacted on both disease-free survival (DFS) and overall survival (OS) (p < 0.05). In the ER0/1+ population, p53mut no longer influenced DFS and OS (p > 0.05). In multiple regression, age, high and advanced/metastatic risk classes influenced survival outcomes (p < 0.05), but lost significance in the ER0/1+ population (p > 0.05). ER-positivity retained a remarkable prognostic impact even after stratification of the population according to the European Society of Gynaecological Oncology, the European Society for Radiotherapy and Oncology, and the European Society of Pathology (ESGO/ESTRO/ESP) 2021 risk classes and molecular classification. ER0/1+ intermediate, high-intermediate, high and advanced risk versus ER2+/3+ intermediate, high-intermediate, high and advanced risk classes showed statistically different OS and DFS (p< 0.001). ER0/1+ status was associated with a worse prognosis when associated with MMRp, MMRd and p53mut compared to the same molecular classes associated with ER2+/3 (p < 0.001). CONCLUSIONS We demonstrated that ER status has a significant impact on oncologic outcomes, regardless of risk class and p53/MMR status. Based on our results, we recommend the inclusion of ER assessment in featured EC risk classification system.
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Affiliation(s)
- Emanuele Perrone
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Ilaria Capasso
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Giorgia Dinoi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Alessandro Petrecca
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Palmieri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Aniello Foresta
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Camilla Nero
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Damiano Arciuolo
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Gyneco-pathology and Breast Pathology Unit, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Gian Franco Zannoni
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Gyneco-pathology and Breast Pathology Unit, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Fanfani
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
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