Scientific publications
How long is long enough? An international survey exploring practice variations on the recommended duration of maintenance therapy with PARP inhibitors in patients with platinum sensitive recurrent ovarian cancer and long-term outcomes. Scientific Publications
Lucy Haggstrom 1 2 , Yeh Chen Lee 1 2 , Clare Scott 3 4 , Philipp Harter 5 6 , Linn Woelber 6 7 , Jonathan Ledermann 8 9 , Charlie Gourley 10 , Iain A McNeish 11 , Frédéric Amant 12 13 , Isabelle Ray-Coquard 14 15 , Alexandra Leary 16 , Amit M Oza 17 , Anna Tinker 18 , Antonio González Martin 19 20 , Sabrina Chiara Cecere 21 22 , Sandro Pignata 21 22 , Nicoletta Colombo 23 24 , Hiroyuki Yoshida 25 26 , Christian Marth 27 , Ora Rosengarten 28 , Kathleen Nadine Moore 29 , Eva María Gómez-García 30 , David Tan 31 , Michael L Friedlander 32 2
Objective: There are no data, and thus no consensus, on the optimal duration of poly(ADP-ribose) polymerase (PARP) inhibitor maintenance therapy for exceptional responders (here defined as progression-free for 5 years or longer) with platinum sensitive recurrent ovarian cancer. The current licence is to continue PARP inhibitors until progression or toxicity; however, international practice varies considerably. The risks of late progression and late-onset myeloid malignancies, defined as occurring beyond 5 years of PARP inhibition, are unknown. This study aims to examine the practice patterns and opinions regarding the management and surveillance protocols of exceptional responders with platinum sensitive recurrent ovarian cancer.
Methods: An online international survey of experts from June 2023 to June 2024 was carried out, disseminated at Gynaecologic Cancer Intergroup meetings and by Chairs of Cooperative Groups.
Results: 210 responses were received from 26 countries including Australia (27 respondents), Germany (24), the UK (21), the Netherlands (16), France (13), Spain (12), Canada (12), Italy (11), Japan (11), and other countries (63). Most respondents did not have institutional or trials group guidelines regarding duration of PARP inhibitors (154, 73.3%). For the minority with guidelines, recommendations varied: 1 year (2), 2 years (13), 3 years (4), and indefinite treatment (22). Individual practice varied considerably for those without guidelines: most (116, 76.3%) recommended ≥5 years of PARP inhibition, of which 73 (48.0%) recommended indefinite PARP inhibition. Sixty-six respondents (31.4%) reported having patients with late progression and 46 (22.0%) had cases with late-onset myeloid malignancies. Surveillance practices varied widely across all respondents.
Conclusions: This international survey highlights the diverse practice variations and disparate views on the optimal duration of maintenance therapy with PARP inhibitors in platinum sensitive recurrent ovarian cancer. The responses suggest a notable risk of late progression and myelodysplastic syndrome/acute myeloid leukemia among exceptional responders which needs confirmation. Detailed individual patient data is required to draw more reliable conclusions; another study is underway addressing this.
CITATION Int J Gynecol Cancer. 2024 Oct 22:ijgc-2024-005976. doi: 10.1136/ijgc-2024-005976
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