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Cancer Research and Treatment > Epub ahead of print
doi: https://doi.org/10.4143/crt.2021.1010    [Epub ahead of print]
Identification of Patients with Recurrent Epithelial Ovarian Cancer Who Will Benefit from More Than Three Lines of Chemotherapy
Aeran Seol1 , Ga Won Yim2 , Joo Yeon Chung1, Se Ik Kim3, Maria Lee1,3 , Hee Seung Kim1,3, Hyun Hoon Chung1,3, Jae-Weon Kim1,3, Noh Hyun Park1,3, Yong Sang Song1,3
1Department of Obstetrics and Gynecology, Seoul National University Hospital, Korea
2Department of Obstetrics and Gynecology, Dongguk University College of Medicine, Goyang, Korea
3Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
Correspondence  Maria Lee ,Tel: 82-2-2072-2842, Fax: 82-2-762-3599, Email: marialeemd@gmail.com
Received: September 9, 2021;  Accepted: November 15, 2021.  Published online: November 17, 2021.
*Aeran Seol and Ga Won Yim contributed equally to this work.
ABSTRACT
Purpose
This study aimed to identify patients who would benefit from third and subsequent lines of chemotherapy in recurrent epithelial ovarian cancer (EOC).
Materials and Methods
Recurrent EOC patients who received third, fourth, or fifth-line palliative chemotherapy were retrospectively analyzed. Patients’ survival outcomes were assessed according to chemotherapy lines. Based on the best objective response, patients were divided into good-response (stable disease or better) and poor response (progressive disease or those who died before response assessment) groups. Survival outcomes were compared between the two groups, and factors associated with chemotherapy responses were investigated.
Results
A total of 189 patients were evaluated. Ninety-four and 95 patients were identified as good and poor response group respectively, during the study period of 2008 to 2021. The poor response group showed significantly worse progression-free survival (median, 2.1 months vs. 9.7 months; p < 0.001) and overall survival (median, 5.0 months vs. 22.9 months; p < 0.001) compared with the good response group. In multivariate analysis adjusting for clinicopathologic factors, short treatment-free interval (TFI) (hazard ratio [HR], 5.557; 95% confidence interval [CI], 2.403 to 12.850), platinum-resistant EOC (HR, 2.367; 95% CI, 1.017 to 5.510), and non-serous/endometrioid histologic type (HR, 5.045; 95% CI, 1.152 to 22.088) were identified as independent risk factors for poor response. There was no difference in serious adverse events between good and poor response groups (p=0.167).
Conclusion
Third and subsequent lines of chemotherapy could be carefully considered for palliative purposes in recurrent EOC patients with serous or endometrioid histology, initial platinum sensitivity, and long TFIs from the previous chemotherapy regimen.
Key words: Epithelial ovarian carcinoma, Drug therapy, Recurrence, Survival, Treatment response, Prognosis
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