What proportion of patients with stage 3 ovarian cancer are potentially cured following intraperitoneal chemotherapy? Analysis of the long term (≥10 years) survivors in NRG/GOG randomized clinical trials of intraperitoneal and intravenous chemotherapy in stage III ovarian cancer

• Published in: Gynecologic oncology 2022-09, Vol.166 (3), p.410-416
• Main Authors: Pitiyarachchi, Omali, Friedlander, Michael, Java, James J., Chan, John K., Armstrong, Deborah K., Markman, Maurie, Herzog, Thomas J., Monk, Bradley J., Backes, Floor, Secord, Angeles Alvarez, Bonebrake, Albert, Rose, Peter G., Tewari, Krishnansu S., Lentz, Samuel S., Geller, Melissa A., Copeland, Larry J., Mannel, Robert S.
• Format: Article
• Language: English
• Subjects: 10-year survival; Advanced ovarian cancer; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer Survivors; Carcinoma, Ovarian Epithelial - drug therapy; Carcinoma, Ovarian Epithelial - pathology; Chemotherapy; Disease-Free Survival; Female; Humans; Middle Aged; Neoplasm Staging; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - pathology; Randomized Controlled Trials as Topic
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2022.07.004

Patients with advanced epithelial ovarian cancer (EOC) alive without progression at a landmark time-point of 10 years from diagnosis are likely cured. We report the proportion of patients with Stage III EOC who were long-term disease-free survivors (LTDFS≥10 years) following either intraperitoneal (IP) or intravenous (IV) chemotherapy as well as the predictors of LTDFS. Data from 3 mature NRG/GOG trials (104, 114, 172) were analyzed and included demographics, clinicopathologic details, route of administration, and survival outcomes of patients living ≥10 years assessed according to the Kaplan-Meier method. Cox regression survival analysis was performed to evaluate independent prognostic predictors of LTDFS. Of 1174 patients randomized, 10-year overall survival (OS) was 26% (95% CI, 23–28%) and LTDFS ≥10 years was 18% (95% CI, 16–20%). Patients with LTDFS ≥10 years had a median age of 54.6 years (p < 0.001). Younger age (p < 0.001) was the only independent prognostic factor for LTDFS≥10 years on multivariate Cox analysis. Approximately 18% of patients were LTDFS ≥10 years. They form the tail end of the survival curve and are likely cured. Our results provide a comparative benchmark to evaluate the impact of PARP inhibitors in 1st line maintenance trials on survival outcomes. •Long term survivors with advanced ovarian cancer are uncommon and include patients alive with or without disease recurrence•Clinical trials don't report the patients who are long term disease free survivors (LTDFS ≥10 years) and likely cured•Almost 20% of patients were LTDFS ≥10 years in GOG trials of intravenous vs intraperitoneal chemotherapy•Apart from younger patient age at diagnosis there were no other factors associated with LTDFS ≥10 years