A real-world retrospective cohort study: the clinical outcomes and characteristics of platinum-resistant recurrent ovarian cancer.

Abstract

Background: Current clinical research on platinum-resistant recurrent ovarian cancer (PRROC) is primarily based on prospective clinical trials, while real-world evidence remains extremely scarce. The continuous accumulation of real-world evidence can effectively address the limitations of clinical trials, and real-world evidence is increasingly gaining recognition in guiding clinical practice. This study sought to describe the clinical outcomes and characteristics of patients diagnosed with PRROC in a real-world setting. Comparing clinical outcomes [e.g., progression-free survival (PFS) and overall survival (OS)] of PRROC patients provides researchers with valuable insights into the current treatment status, effectiveness, and contributory factors of PRROC.

Methods: Patients with histologically confirmed diagnosis of OC from six tertiary referral centers in China from January 2018 to December 2023 were recruited at diagnosis of PRROC. All study patients were followed up to December 1, 2023. We evaluated the characteristics, treatment patterns, and outcomes of these patients. In addition, the background characteristics of the patients were identified, and independent prognostic factors for OS were investigated.

Results: In this cohort of 504 patients diagnosed with PRROC, 277 patients (54.96%) received a single-agent non-platinum chemotherapy, and 227 patients (45.04%) received a platinum-containing regimen. Compared to the single-agent non-platinum chemotherapy group, the platinum-based combination chemotherapy group had significantly longer PFS [5.6 vs. 4.0 months, hazard ratio (HR): 0.431, 95% confidence interval (CI): 0.356-0.521, P<0.0001] and OS (15.9 vs. 13.0 months; HR: 0.766, 95% CI: 0.638-0.919, P=0.005). The poly (adenosine diphosphate-ribose) polymerase inhibitor (PARPi) monotherapy group tended to have not statistically significant improvement PFS (4.5 vs. 4.0 months; HR: 0.788, 95% CI: 0.573-1.085, P=0.15) and OS (13.1 vs. 13.0 months; HR: 1.101, 95% CI: 0.767-1.580, P=0.56) compared to the single-agent non-platinum chemotherapy group. Adding antiangiogenic therapy to platinum-based combination chemotherapy and single-agent non-platinum chemotherapy resulted in improved treatment efficiencies. Independent prognostic factors for OS were the progression-free interval (PFI), histological type, and clinical trial participation. In the subgroup of patients who received platinum-based combination chemotherapy, the patients with a PFI >3-6 months who were re-treated with platinum-based chemotherapy had longer OS than those with a PFI >0-3 months (16.47 vs. 12.83 months, HR: 1.522, 95% CI: 1.155-2.006, P=0.003).

Conclusions: In this real-world cohort, we found that patients diagnosed with PRROC, particularly those with a PFI of >3-6 months, experienced substantial benefits from the re-administration of platinum agents. Thus, platinum rechallenge therapy could represent a promising treatment approach for PRROC. Biomarkers of platinum sensitivity are needed in clinical practice to identify potential responders who should be offered re-treatment with platinum.