Survival impact of extended cycles of second-line chemotherapy in platinum-sensitive relapsed ovarian cancer patients wi
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RESEARCH ARTICLE
Open Access
Survival impact of extended cycles of second-line chemotherapy in platinumsensitive relapsed ovarian cancer patients with residual tumor after six cycles Se Ik Kim1†, Woo Yeon Hwang2†, Maria Lee1, Hee Seung Kim1, Kidong Kim2, Hyun Hoon Chung1, Jae Hong No2, Jae-Weon Kim1, Yong Beom Kim2, Noh Hyun Park1, Yong-Sang Song1 and Dong Hoon Suh2*
Abstract Background: To determine if extended chemotherapy improves survival outcomes in patients with platinumsensitive relapsed epithelial ovarian cancer (EOC) who have residual disease after six cycles of second-line chemotherapy. Methods: In this study, 135 EOC patients who experienced platinum-sensitive recurrence after primary treatment between 2008 and 2018, and had a residual tumor ≥0.5 cm (detected on CT scans) after completing six cycles of second-line, platinum-based chemotherapy, were retrospectively reviewed. Based on the number of main therapy cycles (second-line chemotherapy), we divided patients into an extended group (>6 cycles, n = 52) or a standard group (6 cycles, n = 83) and compared patient characteristics and survival outcomes between these groups. Results: The extended group had a shorter platinum-free interval after primary treatment than the standard group (median, 11.0 vs. 13.1 months; P = 0.018). Secondary debulking surgery was less frequently performed in the standard group (1.9% vs. 19.3%; P = 0.003). After six chemotherapy cycles, the extended and standard groups showed similar serum CA-125 levels (P = 0.122) and residual tumor sizes (P = 0.232). There was no difference in overall survival (OS) between the groups (P = 0.382), although the extended group had significantly worse progression-free survival (PFS) than the standard group (median, 13.9 vs. 15.1 months; P = 0.012). Multivariate analyses revealed that platinum-free interval was an independent prognostic factor for PFS and OS, but extended chemotherapy was not (PFS: HR, 1.25; 95% CI, 0.84–1.85; P = 0.279; and OS: HR, 1.36; 95% CI, 0.72–2.56; P = 0.342). We observed consistent results in the subset of patients who did not undergo secondary debulking surgery. Conclusions: More than six cycles of platinum-based chemotherapy might not improve survival outcomes in patients with platinum-sensitive recurrent EOC who had a residual tumor ≥0.5 cm after six cycles of second-line chemotherapy. Keywords: Ovarian cancer, Chemotherapy, Extended, Survival outcome, Recurrence * Correspondence: [email protected] † Se Ik Kim and Woo Yeon Hwang authors contributed equally as first authors. 2 Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit
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