Platinum-based chemotherapy (PBC) should not be delayed in favor of non-platinum-based therapy (NPBC) in patients with partially platinum-sensitive ovarian cancer (OC), according to a study published in the Journal of Clinical Oncology.1

Many patients with OC who undergo primary surgery and respond to PBC eventually experience relapse and disease progression. There is evidence that shows that the efficacy of subsequent PBC increases with a longer platinum-free interval (PFI), and administering NPBC to prolong the PFI may improve outcomes.

The phase 3 MITO-8 study (ClinicalTrials.gov Identifier: NCT00657878) randomly assigned 215 patients with partially platinum-sensitive OC who experienced disease progression 6 to 12 months after their last platinum therapy to the standard arm or experimental arm.  Patients in the standard arm received PBC at current relapse and NPBC at subsequent relapse, and patients in the experimental arm received NPBC at current relapse and PBC at subsequent relapse.

Patients in the experimental arm experienced a significantly prolonged PFI from random assignment (7.8 months vs 0.01 months) and from last platinum injection prior to enrollment into the study (median 15.8 months vs 8 months).

The median overall survival (OS) was 21.8 months (95% CI, 16.3-29.3) in the experimental arm vs 24.5 months (95% CI, 22.41-33.6) in the standard arm (P = .83), demonstrating no benefit for OS.

Patients in the experimental arm had a significantly shorter progression-free survival with median 12.8 months vs 16.4 months for the standard arm (hazard ratio, 1.41; 95% CI, 1.04-1.92; P = .025). 

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The study ended prematurely due to slow enrollment.

The authors concluded by stating platinum rechallenge should “not be delayed in favor of nonplatinum treatment in patients with partially platinum-sensitive OC.”

Reference

  1. Pignata S, Scambia G, Bologna A, et al. Randomized controlled trial testing the efficacy of platinum-free interval prolongation in advanced ovarian cancer: the MITO-8, MaNGO, BGOG-Ov1, AGO-Ovar2.16, ENGOT-Ov1, GCIG study. J Clin Oncol. 2017 Aug 21. doi: 10.1200/JCO.2017.73.4293