Impact of adding the immune checkpoint inhibitor atezolizumab to first-line chemotherapy on progression-free survival in poor-prognosis ovarian cancer: A retrospective analysis from the IMagyn050 trial

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology Pub Date : 2025-04-25 DOI:10.1016/j.ygyno.2025.04.577

Benoit You , Charles Anderson , Sabrina Chiara Cecere , Aurore Carrot , Tashanna Myers , Florian Heitz , Sudarshan Sharma , Fatih Selçukbiricik , Carol Aghajanian , Josefin Fernebro , Stephanie Blank , Maria Elena Laudani , Premal H. Thaker , Mayu Yunokawa , Lyndsay Willmott , Alla Lisyanskaya , Roberto Hegg , Yvette He , Charles Landen , Yvonne G. Lin , Kathleen N. Moore

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引用次数: 0

Abstract

Purpose

Adding the anti-PD-L1 antibody atezolizumab to frontline chemotherapy-bevacizumab regimen did not improve progression-free survival (PFS) in ovarian cancer (OC) patients in IMagyn050 trial. This post-hoc analysis assessed the efficacy of atezolizumab in a subgroup of patients with particularly poor prognosis, as defined by the GCIG meta-analysis—characterized by a poor chemosensitivity and a suboptimal surgical resection.

Methodology

This analysis included 1199 evaluable participants with ≥3 available CA-125 concentrations, as required for KELIM score. The prognostic factors were identified through univariable and multivariable analyses. If both the KELIM score (unfavorable <1.0, vs favorable ≥1.0) and surgical outcome (suboptimal, vs optimal resection) demonstrated independent prognostic value, they were to be combined into prognostic subgroups. The PFS benefit of atezolizumab versus placebo was then evaluated within each of these defined subgroups.

Results

Both the KELIM score and surgical outcome were independent prognostic factors. Combining these two parameters generated three distinct prognostic subgroups. In the poor prognosis subgroup (n = 269), defined by both an unfavorable KELIM score (<1.0) and suboptimal cytoreduction, the addition of atezolizumab was associated with a significantly longer median PFS compared to placebo (14.3 vs 11.3 months; HR 0.75, 95 % CI 0.59–0.95). This benefit was observed in both neoadjuvant and adjuvant settings. No significant PFS benefit was observed in the other prognostic subgroups.

Conclusion

The poor prognostic OC patient subgroup, may have an extension of PFS from treatment intensification with atezolizumab added to frontline chemotherapy-bevacizumab regimen. This hypothesis-generating outcome warrants further understanding on the added role of ICI in the frontline setting.

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在一线化疗中加入免疫检查点抑制剂atezolizumab对不良预后卵巢癌无进展生存期的影响：来自IMagyn050试验的回顾性分析

目的在IMagyn050试验中，在一线化疗-贝伐单抗方案中添加抗pd - l1抗体atezolizumab并未改善卵巢癌（OC）患者的无进展生存期（PFS）。这项事后分析评估了atezolizumab在预后特别差的亚组患者中的疗效，如GCIG荟萃分析所定义的，其特征是化疗敏感性差和手术切除不理想。该分析纳入1199名可评估的受试者，CA-125浓度≥3，符合KELIM评分要求。通过单变量和多变量分析确定影响预后的因素。如果KELIM评分（不利1.0 vs有利≥1.0）和手术结果（次优vs最佳切除）均显示出独立的预后价值，则将其合并为预后亚组。然后在每个定义的亚组中评估atezolizumab与安慰剂的PFS益处。结果KELIM评分和手术结果均为独立的预后因素。结合这两个参数产生了三个不同的预后亚组。在不良预后亚组（n = 269）中，由不利的KELIM评分（<1.0）和次优的细胞减少来定义，与安慰剂相比，atezolizumab的添加与更长的中位PFS相关(14.3个月vs 11.3个月；Hr 0.75, 95% ci 0.59-0.95)。在新辅助和辅助设置中都观察到这种益处。在其他预后亚组中未观察到明显的PFS获益。结论预后不良的OC患者亚组，在一线化疗-贝伐单抗方案的基础上加用阿特唑单抗强化治疗可能会延长PFS。这一假设产生的结果保证了对ICI在一线环境中的附加作用的进一步理解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gynecologic oncology 医学-妇产科学

CiteScore

8.60

自引率

6.40%

发文量

1062

审稿时长

37 days

期刊介绍： Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy