Cytoreductive surgery for advanced epithelial ovarian cancer in the poly(ADP-ribose) polymerase inhibitors era—Is it time for a new paradigm shift? A systematic review and meta-analysis
In patients with newly diagnosed advanced high-grade serous and endometrioid epithelial ovarian cancer (EOC) first-line maintenance therapy with poly(ADP-ribose) polymerase inhibitors (PARPi) tremendously improved progression-free survival (PFS). Yet, data on the effect of PARPi in proportion to pos...
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| Veröffentlicht in: | European journal of cancer (1990) 2023-07, Vol.187, p.77-86 |
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| container_title | European journal of cancer (1990) |
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| creator | Peters, Inge T.A. Marchetti, Claudia De Palma, Antonella Giannarelli, Diana Carcagnì, Antonella Scambia, Giovanni Fagotti, Anna |
| description | In patients with newly diagnosed advanced high-grade serous and endometrioid epithelial ovarian cancer (EOC) first-line maintenance therapy with poly(ADP-ribose) polymerase inhibitors (PARPi) tremendously improved progression-free survival (PFS). Yet, data on the effect of PARPi in proportion to postoperative residual disease status were lacking.
A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items of Systematic reviews and Meta-Analysis (PRISMA) guidelines. We searched Medline/Pubmed, Embase and Cochrane databases as well as meeting abstracts until 18th March 2023. Hazard ratios (HRs) alongside their 95% confidence intervals (CIs) for PFS were extracted from the studies. A subgroup analysis was conducted to examine the effect of PARPi according to postoperative residual disease.
A total of six phase III randomised controlled trials were included and comprised SOLO 1, PAOLA 1, PRIMA, PRIME, ATHENA-MONO and VELIA. Patients who received PARPi following complete gross resection showed greatest PFS benefit. Compared with placebo, maintenance with PARPi significantly improved PFS in patients with macroscopic residual disease (pooled HR 0.55; 95% CI 0.44–0.68). This magnitude was comparable to that found in patients with complete gross resection (pooled HR 0.53; 95% CI 0.41–0.67).
Patients with macroscopic residual disease benefit from PARPi at the same extent as cases with complete gross resection. However, patients with complete gross resection who were treated with PARPi show the most favourable PFS rates. Hence, the pursuit of achieving complete cytoreduction remains valid in the PARPi era.
•The benefit from PARPi is the same in patients with and without residual disease.•Complete gross resection followed by PARPi results in the most favourable PFS rates.•In the PARPi era, achieving complete gross resection remains the leading principle. |
| doi_str_mv | 10.1016/j.ejca.2023.03.035 |
| format | Article |
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A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items of Systematic reviews and Meta-Analysis (PRISMA) guidelines. We searched Medline/Pubmed, Embase and Cochrane databases as well as meeting abstracts until 18th March 2023. Hazard ratios (HRs) alongside their 95% confidence intervals (CIs) for PFS were extracted from the studies. A subgroup analysis was conducted to examine the effect of PARPi according to postoperative residual disease.
A total of six phase III randomised controlled trials were included and comprised SOLO 1, PAOLA 1, PRIMA, PRIME, ATHENA-MONO and VELIA. Patients who received PARPi following complete gross resection showed greatest PFS benefit. Compared with placebo, maintenance with PARPi significantly improved PFS in patients with macroscopic residual disease (pooled HR 0.55; 95% CI 0.44–0.68). This magnitude was comparable to that found in patients with complete gross resection (pooled HR 0.53; 95% CI 0.41–0.67).
Patients with macroscopic residual disease benefit from PARPi at the same extent as cases with complete gross resection. However, patients with complete gross resection who were treated with PARPi show the most favourable PFS rates. Hence, the pursuit of achieving complete cytoreduction remains valid in the PARPi era.
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A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items of Systematic reviews and Meta-Analysis (PRISMA) guidelines. We searched Medline/Pubmed, Embase and Cochrane databases as well as meeting abstracts until 18th March 2023. Hazard ratios (HRs) alongside their 95% confidence intervals (CIs) for PFS were extracted from the studies. A subgroup analysis was conducted to examine the effect of PARPi according to postoperative residual disease.
A total of six phase III randomised controlled trials were included and comprised SOLO 1, PAOLA 1, PRIMA, PRIME, ATHENA-MONO and VELIA. Patients who received PARPi following complete gross resection showed greatest PFS benefit. Compared with placebo, maintenance with PARPi significantly improved PFS in patients with macroscopic residual disease (pooled HR 0.55; 95% CI 0.44–0.68). This magnitude was comparable to that found in patients with complete gross resection (pooled HR 0.53; 95% CI 0.41–0.67).
Patients with macroscopic residual disease benefit from PARPi at the same extent as cases with complete gross resection. However, patients with complete gross resection who were treated with PARPi show the most favourable PFS rates. Hence, the pursuit of achieving complete cytoreduction remains valid in the PARPi era.
•The benefit from PARPi is the same in patients with and without residual disease.•Complete gross resection followed by PARPi results in the most favourable PFS rates.•In the PARPi era, achieving complete gross resection remains the leading principle.</description><subject>Carcinoma, Ovarian Epithelial - drug therapy</subject><subject>Carcinoma, Ovarian Epithelial - surgery</subject><subject>Cytoreduction Surgical Procedures</subject><subject>Cytoreductive surgery</subject><subject>Epithelial ovarian cancer</subject><subject>Female</subject><subject>Humans</subject><subject>Ovarian Neoplasms - drug therapy</subject><subject>Ovarian Neoplasms - surgery</subject><subject>PARP inhibitors</subject><subject>Poly(ADP-ribose) Polymerase Inhibitors - therapeutic use</subject><subject>Postoperative residual disease</subject><subject>Progression-Free Survival</subject><issn>0959-8049</issn><issn>1879-0852</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc2KFDEQx4Mo7rj6Ah4kx_XQY9KddHdAkGH8WljQg55Ddbqyk6G_TNKz9M2H8G18G5_EtLN6FAoKqn71L6r-hDznbMsZL18dt3g0sM1ZXmzZGvIB2fC6UhmrZf6QbJiSKquZUBfkSQhHxlhVC_aYXBQVL5goiw35uV_i6LGdTXQnpGH2t-gXakdPoT3BYLClOLl4wM5BR8cTeAcDNWvHUzfQ1KHT2C1Xu7efM--aMeDLP4UePQRMyME1Lu0INBV-ff9xHaiLNLoez1vogHd0Ag-tu-1pODgb39AdDUuI2EN0hno8ucTA0NIeI2QwQLcEF56SRxa6gM_u8yX5-v7dl_3H7ObTh-v97iYzhSxjVoncAFaSy5KXyhor20LwCkqr0DCLAK2oK9koI0Vt2jJP37GWCd4Y1cjCFpfk6qw7-fHbjCHq3gWDXQcDjnPQec0UY0IokdD8jBo_huDR6sm7HvyiOdOrafqoV9P0appma8g09OJef256bP-N_HUpAa_PAKYr0y-8Dsbh6o3zaKJuR_c__d9gA619</recordid><startdate>202307</startdate><enddate>202307</enddate><creator>Peters, Inge T.A.</creator><creator>Marchetti, Claudia</creator><creator>De Palma, Antonella</creator><creator>Giannarelli, Diana</creator><creator>Carcagnì, Antonella</creator><creator>Scambia, Giovanni</creator><creator>Fagotti, Anna</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7098-8956</orcidid><orcidid>https://orcid.org/0000-0002-6085-1195</orcidid></search><sort><creationdate>202307</creationdate><title>Cytoreductive surgery for advanced epithelial ovarian cancer in the poly(ADP-ribose) polymerase inhibitors era—Is it time for a new paradigm shift? A systematic review and meta-analysis</title><author>Peters, Inge T.A. ; Marchetti, Claudia ; De Palma, Antonella ; Giannarelli, Diana ; Carcagnì, Antonella ; Scambia, Giovanni ; Fagotti, Anna</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-742cae75156169fcf5d3417a6f9ec0feaad4875b9c548cd62371ff041bc9b53f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Carcinoma, Ovarian Epithelial - drug therapy</topic><topic>Carcinoma, Ovarian Epithelial - surgery</topic><topic>Cytoreduction Surgical Procedures</topic><topic>Cytoreductive surgery</topic><topic>Epithelial ovarian cancer</topic><topic>Female</topic><topic>Humans</topic><topic>Ovarian Neoplasms - drug therapy</topic><topic>Ovarian Neoplasms - surgery</topic><topic>PARP inhibitors</topic><topic>Poly(ADP-ribose) Polymerase Inhibitors - therapeutic use</topic><topic>Postoperative residual disease</topic><topic>Progression-Free Survival</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Peters, Inge T.A.</creatorcontrib><creatorcontrib>Marchetti, Claudia</creatorcontrib><creatorcontrib>De Palma, Antonella</creatorcontrib><creatorcontrib>Giannarelli, Diana</creatorcontrib><creatorcontrib>Carcagnì, Antonella</creatorcontrib><creatorcontrib>Scambia, Giovanni</creatorcontrib><creatorcontrib>Fagotti, Anna</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cancer (1990)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Peters, Inge T.A.</au><au>Marchetti, Claudia</au><au>De Palma, Antonella</au><au>Giannarelli, Diana</au><au>Carcagnì, Antonella</au><au>Scambia, Giovanni</au><au>Fagotti, Anna</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cytoreductive surgery for advanced epithelial ovarian cancer in the poly(ADP-ribose) polymerase inhibitors era—Is it time for a new paradigm shift? A systematic review and meta-analysis</atitle><jtitle>European journal of cancer (1990)</jtitle><addtitle>Eur J Cancer</addtitle><date>2023-07</date><risdate>2023</risdate><volume>187</volume><spage>77</spage><epage>86</epage><pages>77-86</pages><issn>0959-8049</issn><eissn>1879-0852</eissn><abstract>In patients with newly diagnosed advanced high-grade serous and endometrioid epithelial ovarian cancer (EOC) first-line maintenance therapy with poly(ADP-ribose) polymerase inhibitors (PARPi) tremendously improved progression-free survival (PFS). Yet, data on the effect of PARPi in proportion to postoperative residual disease status were lacking.
A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items of Systematic reviews and Meta-Analysis (PRISMA) guidelines. We searched Medline/Pubmed, Embase and Cochrane databases as well as meeting abstracts until 18th March 2023. Hazard ratios (HRs) alongside their 95% confidence intervals (CIs) for PFS were extracted from the studies. A subgroup analysis was conducted to examine the effect of PARPi according to postoperative residual disease.
A total of six phase III randomised controlled trials were included and comprised SOLO 1, PAOLA 1, PRIMA, PRIME, ATHENA-MONO and VELIA. Patients who received PARPi following complete gross resection showed greatest PFS benefit. Compared with placebo, maintenance with PARPi significantly improved PFS in patients with macroscopic residual disease (pooled HR 0.55; 95% CI 0.44–0.68). This magnitude was comparable to that found in patients with complete gross resection (pooled HR 0.53; 95% CI 0.41–0.67).
Patients with macroscopic residual disease benefit from PARPi at the same extent as cases with complete gross resection. However, patients with complete gross resection who were treated with PARPi show the most favourable PFS rates. Hence, the pursuit of achieving complete cytoreduction remains valid in the PARPi era.
•The benefit from PARPi is the same in patients with and without residual disease.•Complete gross resection followed by PARPi results in the most favourable PFS rates.•In the PARPi era, achieving complete gross resection remains the leading principle.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>37130463</pmid><doi>10.1016/j.ejca.2023.03.035</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-7098-8956</orcidid><orcidid>https://orcid.org/0000-0002-6085-1195</orcidid></addata></record> |
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| ispartof | European journal of cancer (1990), 2023-07, Vol.187, p.77-86 |
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| subjects | Carcinoma, Ovarian Epithelial - drug therapy Carcinoma, Ovarian Epithelial - surgery Cytoreduction Surgical Procedures Cytoreductive surgery Epithelial ovarian cancer Female Humans Ovarian Neoplasms - drug therapy Ovarian Neoplasms - surgery PARP inhibitors Poly(ADP-ribose) Polymerase Inhibitors - therapeutic use Postoperative residual disease Progression-Free Survival |
| title | Cytoreductive surgery for advanced epithelial ovarian cancer in the poly(ADP-ribose) polymerase inhibitors era—Is it time for a new paradigm shift? A systematic review and meta-analysis |
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