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Herzog TJ, Pignata S, Ghamande SA, Rubio MJ, Fujiwara K, Vulsteke C, Armstrong DK, Sehouli J, Coleman RL, Gabra H, Scambia G, Monk BJ, Arranz JA, Ushijima K, Hanna R, Zamagni C, Wenham RM, González-Martín A, Slomovitz B, Jia Y, Ramsay L, Tewari KS, Weil SC, Vergote IB. Randomized phase II trial of farletuzumab plus chemotherapy versus placebo plus chemotherapy in low CA-125 platinum-sensitive ovarian cancer. Gynecol Oncol 2023; 170:300-308. [PMID: 36758420 DOI: 10.1016/j.ygyno.2023.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/19/2022] [Accepted: 01/04/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The primary purpose of this study was to determine if farletuzumab, an antifolate receptor-α monoclonal antibody, improved progression-free survival (PFS) versus placebo when added to standard chemotherapy regimens in patients with platinum-sensitive recurrent ovarian cancer (OC) in first relapse (platinum-free interval: 6-36 months) with low cancer antigen 125 (CA-125) levels. METHODS Eligibility included CA-125 ≤ 3 x upper limit of normal (ULN, 105 U/mL), high-grade serous, platinum-sensitive recurrent OC, previous treatment with debulking surgery, and first-line platinum-based chemotherapy with 1st recurrence between 6 and 36 months since frontline platinum-based treatment. Patients received investigator's choice of either carboplatin (CARBO)/paclitaxel (PTX) every 3 weeks or CARBO/pegylated liposomal doxorubicin (PLD) every 4 weeks x6 cycles in combination with either farletuzumab [5 mg/kg weekly] or placebo randomized in a 2:1 ratio. Maintenance treatment with farletuzumab (5 mg/kg weekly) or placebo was given until disease progression or intolerance. RESULTS 214 patients were randomly assigned to farletuzumab+chemotherapy (142 patients) versus placebo+chemotherapy (72 patients). The primary efficacy endpoint, PFS, was not significantly different between treatment groups (1-sided α = 0.10; p-value = 0.25; hazard ratio [HR] = 0.89, 80% confidence interval [CI]: 0.71, 1.11), a median of 11.7 months (95% CI: 10.2, 13.6) versus 10.8 months (95% CI: 9.5, 13.2) for farletuzumab+chemotherapy and placebo+chemotherapy, respectively. No new safety concerns were identified with the combination of farletuzumab+chemotherapy. CONCLUSIONS Adding farletuzumab to standard chemotherapy does not improve PFS in patients with OC who were platinum-sensitive in first relapse with low CA-125 levels. Folate receptor-α expression was not measured in this study. (Clinical Trial Registry NCT02289950).
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Affiliation(s)
- Thomas J Herzog
- University of Cincinnati Cancer Center, Cincinnati, OH, USA.
| | - Sandro Pignata
- Instituto Nazionale Tumori di Napoli IRCCS, Fondazione Pascale (MITO), Napoli, Italy
| | | | - Maria-Jesús Rubio
- Hospital Universitario Reina Sofia, Grupo Español de Investigación en Cáncer de Ovario (GEICO) Group, Cordoba, Spain
| | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, Hidaka-City, Saitama, Japan
| | - Christof Vulsteke
- Center for Oncological Research (CORE), Antwerp University and Integrated Cancer Center, Ghent, Belgium
| | | | - Jalid Sehouli
- Charité-Universitätsmedizin Berlin and North-Eastern German Society for Gynecological Oncology (NOGGO), NOGGO, Germany
| | | | | | - Giovanni Scambia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Rome, Italy
| | - Bradley J Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ, USA
| | | | | | | | | | | | - Antionio González-Martín
- GEICO, Medical Oncology Department, Clínica Universidad de Navarra, Madrid, Spain; Program in Solid Tumors, Center for Applied Medical Research (CIMA), Pamplona, Spain
| | - Brian Slomovitz
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | | | | | | | | | - Ignace B Vergote
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG) and University Hospitals Leuven, Leuven, Belgium
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