Is First-Line Maintenance Underused in Advanced Ovarian Cancer?

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A real-world study suggests that many patients with advanced ovarian cancer do not receive first-line maintenance therapy, and treatment patterns vary by country. 

Researchers also found that treatment patterns varied over time, with the use of PARP inhibitor monotherapy increasing and the use of anti-angiogenic therapy decreasing. 

These findings were presented at the SGO 2022 Annual Meeting on Women’s Cancer by Kathleen Moore, MD, of the University of Oklahoma in Norman.


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Dr Moore noted that the treatment landscape for first-line maintenance has evolved in recent years, with PARP inhibitors being approved as monotherapy or in combination. However, there has been a lack of real-world data evaluating the impact of novel agents on the ovarian cancer treatment paradigm in the United States and Europe.

With this in mind, Dr Moore and colleagues conducted a retrospective study of electronic medical records for patients diagnosed with ovarian cancer from June 1, 2017, to May 31, 2020.

The review included a total of 7072 patients from Italy (1200 cases), France (1200 cases), Germany (1207 cases), Spain (1200 cases), the United Kingdom (1065 cases), and the US (1200 cases). 

Of the 7072 patients, 5386 had stage III/IV disease and were included in the final analysis. The researchers stratified patients by country and date of diagnosis (split into 3 time periods) to capture treatment patterns at different time points. 

Of the 5386 patients ultimately included, 5047 (94%) completed primary treatment. This was followed by first-line maintenance for 3016 patients (56%) and active surveillance for 2031. 

The proportion of patients who received any first-line maintenance increased over time. It rose from 53% for patients diagnosed in the first time period analyzed (June 1, 2017 – May 31, 2018) to 60% for those diagnosed in the second time period (June 1, 2018 – May 31, 2019) and 66% in the last time period (June 1, 2019 – May 31, 2020).

This increase in first-line maintenance use was seen in all countries except Germany, where use decreased from 71% for patients diagnosed in the first time period to 65% in the second time period and 64% in the third time period.

The use of first-line maintenance was highest in France (72%) and lowest in the UK (48%). Italy had the largest increase in first-line maintenance use over time, from 44% to 56% and 68% across the 3 time periods. 

The use of first-line PARP inhibitor maintenance was highest in the US (40%) and lowest in France (12%). The use of anti-angiogenic monotherapy maintenance was highest in France (85%) and lowest in the US (42%).

“When you look at all the patients included in this, about 55% had received some sort of frontline maintenance, which leads us to the question of what happened to the other 45%, and are there missed opportunities for access and education so that everyone can get the biomarker-directed therapy that they deserve in the frontline,” Dr Moore said.

Disclosures: This research was funded by GlaxoSmithKline. Dr Moore disclosed relationships with AstraZeneca, Genentech/Roche, Immunogen, Clovis, GSK/Tesaro, Pfizer, Aravive, VBL Therapeutics, OncoMed, Lilly, Eisai, Vavotar, Abbvie, Tarveda, Myriad, Rubius, and Elevar.

Reference

Moore K, Mirza M, Gourley C, et al. Evolution of the ovarian cancer treatment paradigm, including maintenance treatment, in the US and Europe: A real-world chart review analysis (2017–2020). Presented at SGO 2022; March 18-21, 2022. Abstract 28.



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