Ovarian Cancer Trials: The Good News and the Bad News

Maurie Markman, MD


August 19, 2020

This transcript has been edited for clarity.

Hello. I'm Dr Maurie Markman from Cancer Treatment Centers of America in Philadelphia, Pennsylvania.

I want to comment on three interesting and important abstracts in gynecologic cancer that were presented at the American Society of Clinical Oncology (ASCO) meeting, which was held virtually this year.

The first is the overall survival results from the SOLO2 trial. SOLO2 was a randomized phase 3 trial that looked at the use of single-agent olaparib in patients with ovarian cancer as second-line therapy and beyond.

Previously published results showed a significant improvement in progression-free survival. But the report presented at this year's ASCO meeting reported overall survival, a secondary endpoint. The results were rather striking. SOLO2 demonstrated a 13-month median improvement in overall survival associated with the use of maintenance olaparib compared with placebo. At 5 years of follow-up, 42% of patients who received olaparib and 33% of patients who received placebo were alive.

Improvement in overall survival is clearly an important endpoint. I believe this must be considered a paradigm-changing trial.

The second study is the DESKTOP III trial. This was a randomized phase 3 trial of secondary cytoreductive surgery in patients with recurrent, potentially platinum-sensitive ovarian cancer, compared with chemotherapy without surgery. The results showed an improvement in overall survival in the patients who underwent surgery, specifically and exclusively in the patient population with complete macroscopic surgical resection in the second-line setting.

This is interesting because of the striking difference in the results of this study compared with the previously published data from the Gynecologic Oncology Group (GOG), which showed no improvement in overall survival in any subgroup who underwent secondary surgical cytoreduction, including those patients who had achieved a complete response, compared with chemotherapy alone.

It is difficult to conduct cross-trial comparisons to learn why these outcomes may have differed. But it is reasonable to speculate that one of the important differences is how patients were treated after the surgical intervention. When we're talking about overall survival, this could have been 1, 2, 3, or more years later. Clearly, if patients had received more active therapies in the trial conducted by the GOG — for example, denosumab or a PARP inhibitor — the results could have been different.

Again, cross-trial comparisons are difficult, but it's important to note that the DESKTOP III trial did show improvement in overall survival, in contrast to the previously published data from the GOG.

Finally, there is a discouraging note. An important study reported real-world data from ASCO's CancerLinQ, looking at 2600 patients with ovarian cancer or cancer types who should have been considered for BRCA testing. Only 22.6% of the patients had documentation within the electronic medical record (EMR) that they had undergone BRCA testing. This is distressing, in my opinion.

Today, with data demonstrating the value of PARP inhibitors in ovarian cancer therapy, the well-established reasons for obtaining such testing to inform family members of the potential risks for ovarian cancer and breast cancer and other tumor types, and evidence of the value of prophylactic surgical procedures, the fact that not even one quarter of patients had documentation of BRCA testing in the EMR is cause for great concern. We, as a community of practitioners, need to figure out what's going on and how we can improve that situation.

Although I hope we will be able to be together in Chicago next year, the virtual character of this meeting doesn't change the value of the information presented this year.

I encourage you to read the abstracts and discuss them with your colleagues. They provide important information to inform the management of gynecologic cancers and benefit our patients.

Thank you for your attention.

Maurie Markman, MD, is president of medicine and science at Cancer Treatment Centers of America in Philadelphia. He has more than 20 years of experience in cancer treatment and gynecologic oncology research.

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