Women with stage II-IV low-grade serous carcinoma of the ovary or peritoneum who received hormonal maintenance therapy after primary treatment had longer progression-free survival (PFS) compared with women who underwent routine observation after primary treatment.
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Low-grade serous carcinoma of the ovary or peritoneum is a rare histologic subtype that is not as responsive to chemotherapy as high-grade serous carcinoma. However, prior research has shown that low-grade disease is not entirely resistant to platinum-based chemotherapy, thus the justification for recommended platinum plus taxane chemotherapy for women with newly diagnosed stage II-IV disease after primary cytoreductive surgery. Some clinicians have abandoned postoperative chemotherapy for hormonal therapy, despite a lack of data from prospective clinical trials.
Researchers from the University of Texas MD Anderson Cancer Center led by David M Gershenson, MD, conducted a prospective trial to examine outcomes associated with hormonal maintenance therapy compared with routine observation after primary cytoreductive surgery and platinum-based chemotherapy in women with stage II-IV low-grade serous carcinoma. A total of 203 individual patient data were analyzed between 1981 and 2013 – 133 of whom underwent routine observation and 70 of whom received hormonal maintenance therapy. The two groups were compared for PFS and overall survival (OS) and subset analyses were performed for patients who were disease-free or had persistent disease. Results of the study were published in the Journal of Clinical Oncology (published online February 21, 2017; doi:10.1200/JCO.2016.71.0632).
Median PFS favored the patients who received maintenance therapy rather than routine observation (64.9 months vs 26.4 months, respectively). For subgroups of patients who were disease-free or had persistent disease, median PFS was similarly superior for those who received maintenance therapy (81.1 v 30.0 months; P < .001 and 38.1 v 15.2 months; P < .001, respectively). Survival outcomes between the two groups were not significant in the overall study population (P = .42), but after adjusting for disease status, median OS for the maintenance group was longer than that for the observation group (P = .014).
Researchers are in the process of furthering investigation into the benefits of hormonal maintenance therapy in this population. “We're in the process of trying to develop a randomized clinical trial to confirm our findings,” said Dr Gershenson in an interview with Cure (March 16, 2017). – Zachary Bessette
