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Loverix L, Vergote I, Busschaert P, Vanderstichele A, Venken T, Boeckx B, Harter P, Brems H, Van Nieuwenhuysen E, Pignata S, Baert T, Gonzalez-Martin A, Han S, Marth C, Neven P, Colombo N, Berteloot P, Mäenpää J, Olbrecht S, Laga T, Sablon E, Ray-Coquard I, Pujade-Lauraine E, Lambrechts D, Van Gorp T. PARP inhibitor predictive value of the Leuven HRD test compared with Myriad MyChoice CDx PLUS HRD on 468 ovarian cancer patients from the PAOLA-1/ENGOT-ov25 trial. Eur J Cancer 2023; 188:131-139. [PMID: 37245441 DOI: 10.1016/j.ejca.2023.04.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND The PAOLA-1/ENGOT-ov25 trial showed improved progression-free (PFS) and overall survival (OS) in homologous recombination deficient (HRD) positive patients treated with olaparib, but not when HRD negative (HRD tested with MyChoice CDx PLUS [Myriad test]). PATIENTS AND METHODS The academic Leuven HRD test consists of capture-based targeted sequencing of genome-wide single-nucleotide polymorphisms and coding exons of eight HR genes including BRCA1, BRCA2, and TP53. We compared the predictive value of the Leuven HRD versus Myriad HRD test for PFS and OS in the randomised PAOLA-1 trial. RESULTS 468 patients had left-over DNA after Myriad testing for Leuven HRD testing. Positive/negative/overall percent agreement for the Leuven versus Myriad HRD status was 95%/86%/91%, respectively. Tumours were HRD+ in 55% and 52%, respectively. In Leuven HRD+ patients, 5years PFS (5yPFS) was 48.6% versus 20.3% (HR 0.431; 95% confidence intervals (CI) 0.312-0.595) for olaparib versus placebo, respectively (Myriad test 0.409; 95% CI 0.292-0.572). In Leuven HRD+/BRCAwt patients 5yPFS was 41.3% versus 12.6% (HR 0.497; 95% CI 0.316-0.783), and 43.6% versus 13.3% (HR 0.435; 95% CI 0.261-0.727) for the Myriad test. 5yOS was prolonged in the HRD+ subgroup with both tests 67.2% versus 54.4% (HR 0.663; 95% CI 0.442-0.995) for the Leuven test, and 68.0% versus 51.8% (HR 0.596 95% CI 0.393-0.904) for the Myriad test. HRD status was undetermined in 10.7% and 9.4% of the samples, respectively. CONCLUSIONS A robust correlation between the Leuven HRD and Myriad test was observed. For HRD+ tumours, the academic Leuven HRD showed a similar difference in PFS and OS as the Myriad test.
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Affiliation(s)
- Liselore Loverix
- University Hospitals Leuven, Leuven Cancer Institute (LKI), KU Leuven, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG), Leuven, Belgium; KU Leuven VIB Center for Cancer Biology, Lab of Translational Genetics, Leuven, Belgium
| | - Ignace Vergote
- University Hospitals Leuven, Leuven Cancer Institute (LKI), KU Leuven, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG), Leuven, Belgium
| | - Pieter Busschaert
- University Hospitals Leuven, Leuven Cancer Institute (LKI), KU Leuven, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG), Leuven, Belgium
| | - Adriaan Vanderstichele
- University Hospitals Leuven, Leuven Cancer Institute (LKI), KU Leuven, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG), Leuven, Belgium
| | - Tom Venken
- KU Leuven VIB Center for Cancer Biology, Lab of Translational Genetics, Leuven, Belgium
| | - Bram Boeckx
- KU Leuven VIB Center for Cancer Biology, Lab of Translational Genetics, Leuven, Belgium
| | - Philipp Harter
- Department of Gynaecology & Gynaecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, and Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), Germany
| | - Hilde Brems
- University Hospitals Leuven, KU Leuven, Department of Human Genetics, Leuven, Belgium
| | - Els Van Nieuwenhuysen
- University Hospitals Leuven, Leuven Cancer Institute (LKI), KU Leuven, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG), Leuven, Belgium
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples, Italy
| | - Thaïs Baert
- University Hospitals Leuven, Leuven Cancer Institute (LKI), KU Leuven, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG), Leuven, Belgium
| | - Antonio Gonzalez-Martin
- Department of Medical Oncology, Clínica Universidad de Navarra, Program in Solid Tumors (CIMA), Pamplona, and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Spain
| | - Sileny Han
- University Hospitals Leuven, Leuven Cancer Institute (LKI), KU Leuven, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG), Leuven, Belgium
| | - Christian Marth
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, and AGO Austria, Austria
| | - Patrick Neven
- University Hospitals Leuven, Leuven Cancer Institute (LKI), KU Leuven, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG), Leuven, Belgium
| | - Nicoletta Colombo
- University of Milan-Bicocca and European Institute of Oncology IRCCS, and Mario Negri Gynecologic Oncology Group (MANGO), Milan, Italy
| | - Patrick Berteloot
- University Hospitals Leuven, Leuven Cancer Institute (LKI), KU Leuven, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG), Leuven, Belgium
| | - Johanna Mäenpää
- Department of Obstetrics and Gynecology and Cancer Center, Tampere University and University Hospital, Tampere, and Nordic Society of Gynecologic Oncology NSGO, Finland
| | - Siel Olbrecht
- University Hospitals Leuven, Leuven Cancer Institute (LKI), KU Leuven, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG), Leuven, Belgium
| | - Tina Laga
- University Hospitals Leuven, Leuven Cancer Institute (LKI), KU Leuven, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG), Leuven, Belgium
| | - Erwin Sablon
- KU Leuven VIB Center for Cancer Biology, Lab of Translational Genetics, Leuven, Belgium
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard University Claude Bernard, Lyon, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), France
| | | | - Diether Lambrechts
- KU Leuven VIB Center for Cancer Biology, Lab of Translational Genetics, Leuven, Belgium
| | - Toon Van Gorp
- University Hospitals Leuven, Leuven Cancer Institute (LKI), KU Leuven, and Belgium and Luxembourg Gynecologic Oncology Group (BGOG), Leuven, Belgium.
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Loverix L, Vergote I, Busschaert P, Vanderstichele A, Boeckx B, Venken T, Harter P, Brems H, Nieuwenhuysen EV, Pignata S, Baert T, Gonzalez-Martin A, Han S, Marth C, Neven P, Colombo N, Berteloot P, Mäenpää J, Olbrecht S, Laga T, Sablon E, Ray-Coquard I, Pujade-Lauraine E, Lambrechts D, Gorp TV. Predictive value of the Leuven HRD test compared with Myriad myChoice PLUS on 468 ovarian cancer samples from the PAOLA-1/ENGOT-ov25 trial (LBA 6). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01299-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
PURPOSE OF REVIEW Ovarian cancer (OC) is a heterogeneous disease and a mounting body of evidence shows that a 'one-size-fits-all' approach is obsolete. Differences in epidemiology, tumor biology, genetic profiles and treatment responses of these different types necessitate a tumor and patient-specific approach. Ninety percentage consists of epithelial OC with 70% being high-grade serous OC. The other rarer subtypes are low-grade serous (5%), clear cell (12%), endometrioid (11%) and mucinous carcinoma (3%). The remaining 10% are nonepithelial rare OCs: germ cell (3%) and sex-cord stromal tumors (7%). RECENT FINDINGS Over the past few decades, the 5-year survival rates have only improved modestly, therefore novel therapies are urgently needed. Recently, immunotherapy has been introduced into clinical practice in a number of solid tumors. Although preclinical data confirm the presence of an immunogenic microenvironment in a number of ovarian tumor types, no single-agent immune checkpoint inhibitor has been approved hitherto. Identifying suitable treatment combinations, adequate patient selection and thus correct implementation of immunotherapy remain major challenges. SUMMARY In this review, we focus on the rationale of incorporating immune therapy in rare OC, we summarize the recent developments with preclinical data and results of clinical trials, with particular focus on rare ovarian histological subtypes.
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Affiliation(s)
- Tina Laga
- Division of Gynecological Oncology, Department of Gynecology and Obstetrics and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
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