Impact of Visible Residual Disease, Other Risk Factors on Advanced Ovarian Cancer Progression and Death: Real-World Evidence

2020 Year in Review - Ovarian Cancer

This real-world study based primarily on community-based practice data showed that a key predictor of time to next treatment and mortality in patients with advanced ovarian cancer was visible residual disease.

Up to 85% of women with ovarian cancer experience disease progression within 3 years, despite most patients responding to first-line treatment. It is critical to identify prognostic variables that impact survival, and important to detect patients whose overall health outcomes may improve from new therapeutic choices such as maintenance therapies.

At the European Society of Gynaecological Oncology 2020 Virtual Conference, Dana Chase and colleagues evaluated in patients with advanced ovarian cancer in a real-world setting the association between visible residual disease (VRD) following interval or primary debulking surgery, as well as other clinical factors, and the risk for disease progression or death.

Patients diagnosed with invasive ovarian cancer between January 1, 2011, and February 29, 2020, from the Flatiron Health electronic health record database were included in this retrospective cohort study.

This study included patients aged ≥18 years who had stage III/IV disease, had received any first-line treatment, and had ≥12 weeks of follow-up after completing first-line treatment. Patients were excluded from the study if they had missing date of interval debulking surgery or primary debulking surgery or had interval debulking surgery or primary debulking surgery and unknown VRD status.

Time to next treatment (TTNT; a proxy for disease progression), defined as the time from last date of first-line therapy to start date of second-line treatment, last confirmed structured activity, or death, will be assessed. Time from last date of first-line therapy to death or last confirmed structured activity was the definition of overall survival.

Included in the study were a total of 1920 patients with advanced ovarian cancer with a median age of 67.0 years. Seventy-four percent of patients were white and 88% originated from a community oncology practice.

Approximately two-thirds (67%) of patients had evidence of a BRCA biomarker test, yet only 5% had evidence of a homologous recombination deficient test.

Median TTNT and median overall survival were 6.4 months and 28.6 months, respectively, in the cohort of patients with VRD, and 11.9 months and 54.5 months, respectively, in the cohort of patients without VRD. 

A key predictor of TTNT and mortality in patients with advanced ovarian cancer was VRD. BRCA status was a key predictor of ovarian cancer outcomes among biomarkers; due to a lack of data, homologous recombination deficiency could not be evaluated. Whereas most retrospective studies present outcomes from a higher proportion of academic practices, the outcomes from community practices constitute the primary source of data in this study, serving as a significant strength.

Source: Chase D, et al. Int J Gynecol Cancer. 2020;30(4_suppl). Abstract 374.

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