Katherine C. Kurnit, MD
Results from a recent retrospective study indicate that treatment with a gastrointestinal (GI)-based adjuvant chemotherapy regimen may be more beneficial than that of a gynecologic-based one in patients with mucinous ovarian cancer, said lead author Katherine C. Kurnit, MD.1
“Right now, mucinous ovarian cancer is treated a lot like other epithelial ovarian cancers,” said Kurnit, a fellow in gynecologic oncology at The University of Texas MD Anderson Cancer Center. “A lot of our data are from other mostly high-grade serious ovarian cancer patients, and so, we usually use routine gynecologic-based regimens, which is carboplatin and paclitaxel, most recently.”
However, because outcomes for patients with mucinous ovarian cancer are poor, researchers have been working on exploring other approaches to better treat this subtype of patients. For example, the GOG 241 study looked at the use of carboplatin/paclitaxel with or without bevacizumab (Avastin) or oxaliplatin/capecitabine with or without bevacizumab in chemotherapy-naïve patients with mucinous ovarian cancer, including those with recurrent stage I disease. Unfortunately, the trial was stopped early in 2013 due to poor accrual—50 patients were enrolled—and thus, researchers were unable to make any conclusions.2
Keeping this in mind, Kurnit and her team at The University of Texas MD Anderson Cancer Center collaborated with researchers of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medicine and conducted a retrospective cohort study to determine whether the use of a GI-based regimen would be associated with a difference in survival compared with use of a gynecologic-based regimen in patients with mucinous ovarian cancer who received postoperative adjuvant chemotherapy.
Results suggested an improvement in progression-free survival (PFS) in patients who received a GI-based treatment (not reached) compared with that of a gynecologic type (26 months; P
= .04). Overall survival (OS) was also improved with a GI regimen, with which the median OS was not reached versus 67 months with a gynecologic-based treatment (P
= .02). However, the role of bevacizumab in these regimens remains unclear, Kurnit explained.
In an interview with OncLive
during the 2019 SGO Annual Winter Meeting, Kurnit discussed the clinical implications of these findings and where research should go in the future.
OncLive: Could you discuss the GOG 241 trial and the challenges that were faced?
: Because patients [with mucinous ovarian cancer] may not respond as well to many of the routine regimens as patients with high-grade serious ovarian cancer, the Gynecologic Oncology Group (GOG) put together a trial that specifically [focused on] patients with mucinous ovarian cancer, and looked at whether a GI-type regimen might [lead to] better survival outcomes for these patients.
They were looking at survival outcomes, comparing a gynecologic-type regimen with and without bevacizumab and a GI-type regimen with and without bevacizumab, and they had 4 different arms that they were investigating.
They opened, and unfortunately, didn’t accrue very well, so they ended up having to close early. When they looked back at the patients who were enrolled, they found that a lot of them did not actually have primary ovarian cancer, and many of them were metastatic from mostly GI sites. Therefore, the study itself was limited by difficulties accruing, but also in the patients with unintended nonovarian cancer who were enrolled.
What was the rationale behind your study?
For our study, we wanted to further investigate this question and see if we had enough patients that we could see, from a retrospective cohort study design, whether there would be a difference between these 2 regimens.
There, we at The University of Texas MD Anderson Cancer Center collaborated with the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medicine and reviewed our patients with mucinous ovarian cancer from the past several decades. We just looked back to see which regimens they received, [noting if] they received bevacizumab, and compared outcomes for those who had received a gynecologic-type regimen versus a GI-type regimen. Other groups have probably looked at their data, but this is probably the largest group trying to evaluate this specific question since that GOG trial completed.
What were your methods?
Our goal was to compare GI-type regimens—those including capecitabine, 5-fluorouracil, oxaliplatin, or some sort of combination—with the gynecologic-based regimens, which is a carboplatin- or cisplatin-based regimen, usually with a taxane. Then, they were allowed to have bevacizumab or not.