The post-progression survival of patients with recurrent or persistent ovarian clear cell carcinoma: results from a randomized phase III study in JGOG3017/GCIG

Abstract

Objective In this study we sought to investigate the clinical factors that affect post-progression survival (PPS) in patients with recurrent or persistent clear cell carcinoma (CCC). We utilized the JGOG3017/Gynecological Cancer InterGroup data to compare paclitaxel plus carboplatin (TC) and irinotecan plus cisplatin (CPT-P) in the treatment of stages I to IV CCC. Methods We enrolled 166 patients with recurrent or persistent CCC and assessed the impact of variables, including platinum sensitivity, treatment arm, crossover chemotherapy, primary stage, residual tumor at primary surgery, performance status, ethnicity, and tumor reduction surgery at recurrence on the median of PPS in patients with recurrent or persistent CCC. Results A total of 77 patients received TC, and 89 patients received CPT-P. The median PPS for patients with platinum-resistant disease was 10.9 months, compared with 18.8 months for patients with platinum-sensitive disease (hazard ratio [HR]=1.88; 95% confidence interval [CI]=1.30–2.72; log-rank p<0.001). In the multivariate analysis, the platinum sensitivity (resistant vs. sensitivity; HR=1.60; p=0.027) and primary stage (p=0.009) were identified as independent predictors of prognosis factors for PPS in recurrent or persistent CCC. Conclusions Our findings revealed that platinum sensitivity and primary stage are clinical factors that significantly affect PPS in patients with recurrent or persistent CCC as well as other histologic subtypes of ovarian cancer. PPS in patients with recurrent CCC should establish the basis for future clinical trials in this population.

Incidence and predictive factors for recurrent clear cell ovarian carcinoma: results from a single center in Thailand

“…Post-recurrence survival in this study was 13.96 months. Previous studies reported median post-recurrence survivals of 14.0–16.5 months [ 11 , 19 , 23 ]. Platinum sensitivity and primary stage were reported as independent prognostic factors for recurrent or persistent CCC, whereas chemotherapy regimens (paclitaxel plus carboplatin versus irinotecan plus cisplatin) did not demonstrate a significant difference [ 23 ].…”

“…Previous studies reported median post-recurrence survivals of 14.0–16.5 months [ 11 , 19 , 23 ]. Platinum sensitivity and primary stage were reported as independent prognostic factors for recurrent or persistent CCC, whereas chemotherapy regimens (paclitaxel plus carboplatin versus irinotecan plus cisplatin) did not demonstrate a significant difference [ 23 ]. Our investigations revealed that single-site and nodal site recurrences indicated a favorable prognosis for post-recurrence survival.…”

“…It has been reported that surgical resection combined with systemic chemotherapy might improve the oncological outcome in patients with single-site recurrent CCC [ 9 , 20 ]. Kondo et al [ 23 ] reported survival rates of tumor reduction surgery during recurrence. The median post-progression survival in the tumor reduction surgery group was significantly longer than in the non-tumor reduction surgery group (26.5 NA vs. 12.9 months) (HR, 0.23; 95% CI, 0.09–0.63; P =0.002) [ 23 ].…”

“…Kondo et al [ 23 ] reported survival rates of tumor reduction surgery during recurrence. The median post-progression survival in the tumor reduction surgery group was significantly longer than in the non-tumor reduction surgery group (26.5 NA vs. 12.9 months) (HR, 0.23; 95% CI, 0.09–0.63; P =0.002) [ 23 ]. In agreement with this study, a patient who underwent debulking surgery followed by systemic chemotherapy had significantly longer post-recurrence survival than patients who received only systemic chemotherapy.…”

Predicting Long-Term Prognoses and Grading Platinum Sensitivity Using a Novel Progression-Free Interval Criterion in Ovarian Clear Cell Carcinoma: A Multi-Institutional Cohort Study

“…For relapsed EOC, grading platinum sensitivity by the distribution of 6- and 12-month progression-free intervals (PFI) has been adopted in clinical guidelines, and is relevant to the selection of second-line regimens [ 20 , 21 , 22 ]. Owing to the chemo-resistant features of OCCC, individualized PFI criteria (i.e., PFI extended to 12 and 18 months) have been proposed [ 21 ].…”