Carboplatin re-treatment in platinum-resistant epithelial ovarian cancer patients
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ORIGINAL ARTICLE
Carboplatin re‑treatment in platinum‑resistant epithelial ovarian cancer patients Mads Kingo Guldberg Hansen1 · Maja Patricia Smerdel2 · Marianne Waldstrøm3 · Rikke Fredslund Andersen4 · Parvin Adimi1 · Anders Jakobsen1 · Karina Dahl Steffensen1 Received: 17 June 2020 / Accepted: 30 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Treatment of multi-resistant epithelial ovarian cancer represents a clinical challenge with limited choices. Antiangiogenic therapy has shown great potential in combination with frontline-therapy. Studies investigating heavily pre-treated patients are few. This study investigated the effect of re-treating patients with carboplatin combined with bevacizumab and cell-free DNA (cfDNA) as a potential predictor of outcome. Methods This single-center study enrolled 73 multi-resistant ovarian cancer patients from 2008 to 2015. Patients were treated with a combination of bevacizumab (10 mg/kg) and carboplatin (AUC5) every 3 weeks. Baseline plasma samples were analyzed for cfDNA levels. Treatment response was evaluated based on the Response Evaluation Criteria in Solid Tumors (RECIST) criteria and CA125 blood values. Results The response rate according to RECIST and/or CA125 was 57%. Median number of cycles was 6. The median progression-free survival and overall survival was 5.0 and 11.2 months, respectively. Eighteen patients developed allergic reactions to carboplatin. Patients were grouped into two cfDNA-groups according to median value. The cfDNA value was correlated to progression-free survival (PFS, p = 0.015), but not to overall survival (OS, p = 0.067) in the univariate analysis. In the multivariate analysis both PFS and OS were highly correlated to the levels of cfDNA (PFS, hazard ratio = 1.87, p = 0.012; OS, hazard ratio = 1.67, p = 0.037) with patients with high levels of cfDNA having poorest outcome. Conclusion Our results might provide guidance in cases with heavily pre-treated patients, where alternatives are limited. Carboplatin and bevacizumab treatment should be weighed against best supportive care, current non-platinum therapies and experimental treatment. cfDNA seems to offer prognostic insight. Keywords Ovarian cancer · Carboplatin · Bevacizumab · cfDNA · Re-treatment Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00280-020-04162-5) contains supplementary material, which is available to authorized users. * Mads Kingo Guldberg Hansen [email protected] 1
Department of Oncology, Lillebaelt Hospital – University Hospital of Southern Denmark,, Beriderbakken 4, 7100 Vejle, Denmark
2
Department of Clinical Genetics, Lillebaelt Hospital – University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
3
Department of Pathology, Lillebaelt Hospital – University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
4
Department of Clinical Biochemistry, Lillebaelt Hospital – University Hospital of Southern Denma
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