Impact of neoadjuvant chemotherapy and postoperative adjuvant chemotherapy cycles in patients with advanced ovarian cancer

Impact of neoadjuvant chemotherapy and postoperative adjuvant chemotherapy cycles in patients with advanced ovarian cancer

Abstracts / Gynecologic Oncology 145 (2017) 2–220 Objective: Sarcopenia, or loss of muscle mass, has been associated with both poor surgical and surv...

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Abstracts / Gynecologic Oncology 145 (2017) 2–220

Objective: Sarcopenia, or loss of muscle mass, has been associated with both poor surgical and survival outcomes in solid tumors. Data on pancreas cancer suggest that patients with sarcopenia/cachexia have higher levels of interleukin-6 (IL-6), which may contribute to differential response to antiangiogenic therapies. This study evaluated the potential association of sarcopenia with survival following treatment with or without bevacizumab (bev) on GOG protocol 218. Method: Pretreatment computed tomography (CT) scans for 1,538/ 1,873 (82%) of participants of GOG 218 were available for this analysis. A total of 292 patients were eliminated leaving 1,247/1,873 (66%) patients included in this analysis. Sarcopenia was measured via the total psoas area (TPA) by investigators in a radiology core. Proportional hazards models were used to assess the association between TPA and overall survival (OS) in all 1,247 patients. Analysis of the predictive value of TPA on bev response was assessed only in the 830 patients randomized to chemotherapy (CT) + placebo (P)–NP and CT + bev–Nbev. Results: Demographic and tumor characteristic distribution for patients included in this analysis did not differ from the entire cohort as published in the primary manuscript. Distribution of TPA did not differ between arms of GOG 218 (P = 0.990). There was no statistically significant association (P = 0.432) between the hazard of death and TPA after adjusting for stage, treatment, and performance status. There is a modest trend in the log of the treatment hazard ratio, which compares patients treated with CT +bev–Nbev versus CT+P– NP, on the basis of OS, to decrease with increasing decile of TPA. A test of a treatment by TPA interaction is statistically significant (P = 0.031). Among patients with a high TPA, those treated with bev tended to live longer (median duration of survival is 50 vs 39 months) versus patients with low TPA, with no difference in OS between treatment groups (45 vs 43 months). (See Fig. 1.) Conclusion: Predictive biomarkers for bev have been an elusive target. This retrospective analysis suggests that TPA, as a marker of sarcopenia, may predict patients most likely to achieve a survival benefit from addition of bev to upfront therapy. Validation of these data and further study of the microenvironment surrounding presence or absence of sarcopenia in ovarian cancer is warranted.

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Objective: The goal of this study was to compare overall survival (OS) and progression-free survival (PFS) of intravenous (IV) chemotherapy versus intraperitoneal (IP) chemotherapy among women with epithelial ovarian, fallopian, or primary peritoneal cancer who received neoadjuvant chemotherapy followed by optimal interval debulking. Method: A retrospective chart review was conducted of women diagnosed with epithelial ovarian, fallopian tube, or primary peritoneal cancer between January 1, 2004, and December 31, 2015, at a single institution. Patient demographics and clinical data were extracted from the medical records and were summarized and compared by chemotherapy administration route (IV vs IP). The association between chemotherapy administration route and OS and PFS was analyzed using Kaplan-Meier survival curves and compared using log rank tests. Multivariate models were conducted to adjust for stage and residual disease status using Cox proportional hazards regression. Results: A total of 67 eligible patients were identified; 37 received IV and 30 received IP chemotherapy following interval optimal debulking (b1 cm). The majority of patients had high-grade serous cancer (76.1%). There was no significant difference between the 2 groups in the proportion of microscopic residual disease after interval debulking. Median PFS was 15.8 months (95% CI 13.7– 23.1) in the IV group and 18.8 months (95% CI 13.0–23.0) in the IP group (P = 0.82). Median OS was 38.8 months (95% CI 29.0–42.3) in the IV group and 56 months (95% CI 31.1–58.6) in the IP group (P = 0.46). IP chemotherapy was not statistically significantly predictive of PFS or OS (adjusted HR = 0.88, 95% CI 0.44–1.76, P = 0.71 and HR = 0.67, 95% CI 0.28–1.59, P = 0.36, respectively). (See Fig. 1.) Conclusion: We showed there is a potential advantage for OS with IP chemotherapy use following neoadjuvant chemotherapy and interval debulking; however, given the small sample size, this was not significant. These data suggest a prospective study is warranted.

Fig. 1. Survival probability. Fig. 1. Overall survival by treatment (IP vs IV). P = 0.46.

doi:10.1016/j.ygyno.2017.03.237 doi:10.1016/j.ygyno.2017.03.238 210 - Poster Session 211 - Poster Session Is there a survival benefit associated with intraperitoneal chemotherapy after neoadjuvant chemotherapy for optimally debulked epithelial ovarian cancer patients? M. Song, R. Isaksson Vogel, C. Rivard. University of Minnesota, Minneapolis, MN, USA

Impact of neoadjuvant chemotherapy and postoperative adjuvant chemotherapy cycles in patients with advanced ovarian cancer Y.S. Chung, K.J. Eoh, I. Lee, J.Y. Lee, E.J. Nam, S. Kim, S.W. Kim, Y.T. Kim. Yonsei University College of Medicine, Seoul, South Korea

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Abstracts / Gynecologic Oncology 145 (2017) 2–220

Objective: In CHORUS trial, neoadjuvant chemotherapy (NAC) arm suggests 3 cycles of NAC, interval debulking surgery (IDS), and 3 cycles of postoperative adjuvant chemotherapy (POAC). However, treatment patterns vary, in particular, the number of cycles of NAC and POAC given in clinical practice. The aim of this study was to evaluate the impact of number of NAC and POAC cycles on survival in patients who undergo NAC/IDS/POAC. Method: Data from epithelial ovarian cancer patients (stage IIIC-IV), operated on between 2006 and 2014 were consecutively recorded. All patients underwent taxane plus carboplatin chemotherapy for NAC and POAC and were analyzed according to the number of NAC (1–3 vs ≥4 cycles), POAC (1–3 vs ≥4 cycles) and total chemotherapy (NAC + POAC, 2–6 vs 6 vs ≥6 cycles). Results: A total of 126 patients with stage IIIC-IV underwent NAC followed by IDS (median age 56.5 years; stage IV, 54.8%). Patients who received fewer than 6 cycles of total chemotherapy (NAC + POAC) had poorer outcomes than other groups (6 and ≥6 cycles). The Kaplan-Meier curve and the log rank test showed no difference in either progression-free survival or overall survival according to number of NAC cycles. Furthermore, the addition of more than 3 cycles of POAC did not improve the progression-free survival or overall survival. In a multivariate Cox model, completion of chemotherapy of at least 6 cycles (NAC + POAC) had no effect on either recurrence (HR = 0.03, 95% CI 0.01–0.13) or overall survival (HR = 0.04, 95% CI 0.01–0.13). Conclusion: The completion of total chemotherapy of at least 6 cycles is an independent prognostic factor to patients who undergo NAC/IDS/POAC. However, the addition of more than 3 cycles of NAC or POACdid not affect survival in this disease subset.

grade 3 regardless of any preoperative grade. Appropriate statistical tests were used. Results: A total of 1,280 met inclusion criteria: 1,155 low-grade, 88 high-grade, and 37 discordant. Median follow-up time for the entire cohort was 58 months (range, 0.4–198 months). Median age and BMI were statistically different among the 3 cohorts. The depth of myoinvasion (DOI), presence of LVSI, and use of adjuvant therapy also significantly differed. The 5-year PFS was 95.2% (SE 0.7%) for low-grade, 82% (SE 4.6%) for high-grade, and 85.6% (SE 6%) for discordant (P b 0.001). After adjusting for age, BMI, DOI, and use of adjuvant therapy, discordant cases were not independently associated with PFS (HR = 1.799, 95% CI 0.7–4.61). The 5-year OS was 94.4% (SE 0.8%) for low-grade, 88.3% (SE 4%) for high-grade, and 90.9% (SE 5%) for discordant (P = 0.02). After adjusting for age, BMI, DOI, and use of adjuvant therapy, discordant cases retained an independent association with a worse OS (HR = 2.392, 95% CI 1.14– 5.03). (See Fig. 1.) Conclusion: The clinical behavior of stage I endometrioid endometrial carcinoma diagnosed as high-grade on preoperative biopsy and low-grade on subsequent hysterectomy seems to differ from lowgrade cases diagnosed on both preoperative and final pathology. Consideration should be given to treating these “discordant” tumors as high-grade.

doi:10.1016/j.ygyno.2017.03.239

212 - Poster Session Withdrawn

doi:10.1016/j.ygyno.2017.03.240

213 - Poster Session Clinical behavior of FIGO stage I endometrioid endometrial adenocarcinoma diagnosed as high-grade on preoperative biopsy and low-grade on hysterectomy specimen B. Schlappe, M.B. Schiavone, D. DeLair, J.A. Ducie, A.G.Z. Eriksson, O. Zivanovic, V. Makker, R.A. Soslow, N.R. Abu-Rustum, M.M. Leitao. Memorial Sloan Kettering Cancer Center, New York, NY, USA Objective: Preoperative endometrial assessment may be discordant with final pathology. It is uncertain how best to classify cases with preoperative biopsy noted to be grade 3 and final hysterectomy specimen noted to be lower grade (i.e., discordant). The objective of this study was to determine the outcome of discordant cases. Method: All patients who had primary surgical treatment of endometrioid endometrial carcinoma from 2000 to 2012 were identified from an institutional database. Relevant patient, clinical, and pathologic characteristics were collected, including preoperative biopsy grade, adjuvant therapy, and follow-up information. For this analysis, discordant was defined as above; low-grade was defined as cases with final pathology grade 1 or 2 and with similar preoperative grade; and high-grade was defined as cases with final pathology

Fig. 1. Progression-free survival by tumor grade.

doi:10.1016/j.ygyno.2017.03.241

214 - Poster Session Should ovarian carcinoma metastatic to the inguinal nodes be assigned stage IVB? D. Nasioudis, E. Chapman-Davis, M. Frey, T.A. Caputo, S.S. Witkin, M.M. Holcomb. Weill Cornell Medicine, New York, NY, USA Objective: According to the recently revised Fédération Internationale de Gynécologie et d' Obstétrique (FIGO) staging classification, women with ovarian carcinoma and inguinal lymph nodes (LN) metastases, formerly stage III, are now considered stage IVB. The prognostic significance of this classification has yet to be evaluated. In this retrospective study we compare the survival of these patients to that of women with stage III (with aortic and/or pelvic LN metastases) and stage IV (due to distant metastasis) disease.