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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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Colombo N, Dubot C, Lorusso D, Caceres MV, Hasegawa K, Shapira-Frommer R, Tewari KS, Salman P, Hoyos Usta E, Yañez E, Gümüş M, Olivera Hurtado de Mendoza M, Samouëlian V, Castonguay V, Arkhipov A, Toker S, Li K, Keefe SM, Monk BJ. Pembrolizumab for Persistent, Recurrent, or Metastatic Cervical Cancer. N Engl J Med 2021; 385:1856-1867. [PMID: 34534429 DOI: 10.1056/nejmoa2112435] [Citation(s) in RCA: 372] [Impact Index Per Article: 124.0] [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: 11/19/2022]
Abstract
BACKGROUND Pembrolizumab has efficacy in programmed death ligand 1 (PD-L1)-positive metastatic or unresectable cervical cancer that has progressed during chemotherapy. We assessed the relative benefit of adding pembrolizumab to chemotherapy with or without bevacizumab. METHODS In a double-blind, phase 3 trial, we randomly assigned patients with persistent, recurrent, or metastatic cervical cancer in a 1:1 ratio to receive pembrolizumab (200 mg) or placebo every 3 weeks for up to 35 cycles plus platinum-based chemotherapy and, per investigator discretion, bevacizumab. The dual primary end points were progression-free survival and overall survival, each tested sequentially in patients with a PD-L1 combined positive score of 1 or more, in the intention-to-treat population, and in patients with a PD-L1 combined positive score of 10 or more. The combined positive score is defined as the number of PD-L1-staining cells divided by the total number of viable tumor cells, multiplied by 100. All results are from the protocol-specified first interim analysis. RESULTS In 548 patients with a PD-L1 combined positive score of 1 or more, median progression-free survival was 10.4 months in the pembrolizumab group and 8.2 months in the placebo group (hazard ratio for disease progression or death, 0.62; 95% confidence interval [CI], 0.50 to 0.77; P<0.001). In 617 patients in the intention-to-treat population, progression-free survival was 10.4 months and 8.2 months, respectively (hazard ratio, 0.65; 95% CI, 0.53 to 0.79; P<0.001). In 317 patients with a PD-L1 combined positive score of 10 or more, progression-free survival was 10.4 months and 8.1 months, respectively (hazard ratio, 0.58; 95% CI, 0.44 to 0.77; P<0.001). Overall survival at 24 months was 53.0% in the pembrolizumab group and 41.7% in the placebo group (hazard ratio for death, 0.64; 95% CI, 0.50 to 0.81; P<0.001), 50.4% and 40.4% (hazard ratio, 0.67; 95% CI, 0.54 to 0.84; P<0.001), and 54.4% and 44.6% (hazard ratio, 0.61; 95% CI, 0.44 to 0.84; P = 0.001), respectively. The most common grade 3 to 5 adverse events were anemia (30.3% in the pembrolizumab group and 26.9% in the placebo group) and neutropenia (12.4% and 9.7%, respectively). CONCLUSIONS Progression-free and overall survival were significantly longer with pembrolizumab than with placebo among patients with persistent, recurrent, or metastatic cervical cancer who were also receiving chemotherapy with or without bevacizumab. (Funded by Merck Sharp and Dohme; KEYNOTE-826 ClinicalTrials.gov number, NCT03635567.).
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Affiliation(s)
- Nicoletta Colombo
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Coraline Dubot
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Domenica Lorusso
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - M Valeria Caceres
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Kosei Hasegawa
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Ronnie Shapira-Frommer
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Krishnansu S Tewari
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Pamela Salman
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Edwin Hoyos Usta
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Eduardo Yañez
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Mahmut Gümüş
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Mivael Olivera Hurtado de Mendoza
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Vanessa Samouëlian
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Vincent Castonguay
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Alexander Arkhipov
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Sarper Toker
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Kan Li
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Stephen M Keefe
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Bradley J Monk
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
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