Hormonal Maintenance Therapy for Women With Low-Grade Serous Cancer of the Ovary or Peritoneum

Abstract

The purpose of this study was to examine outcomes associated with hormonal maintenance therapy (HMT) compared with routine observation (OBS) after primary cytoreductive surgery and platinum-based chemotherapy in women with stage II to IV low-grade serous carcinoma of the ovary or peritoneum. Patients and MethodsEligibility criteria for patients from our database were: treatment with primary surgery followed by platinumbased chemotherapy, stage II to IV disease, at least 2 years of follow-up for patients who had not experienced recurrence, and adequate clinical information. The two groups were compared for progressionfree survival (PFS) and overall survival, and a multivariable Cox regression analysis was performed. Subset analyses for patients who were disease free or had persistent disease were also performed. ResultsBetween 1981 and 2013, 203 eligible patients-133 who underwent OBS and 70 who received HMT-were seen at our institution. Median PFS for patients who underwent OBS was 26.4 months, compared with 64.9 months for those who received HMT (P , .001). No statistically significant difference in overall survival was observed between the two groups (102.7 v 115.7 months, respectively). For subgroups of women who were disease free or had persistent disease, median PFS was superior for those who received HMT (81.1 v 30.0 months; P , .001 and 38.1 v 15.2 months; P , .001, respectively). Women who received HMT had a significantly lower risk of disease progression compared with those who underwent OBS (hazard ratio, 0.44; 95% CI, 0.31 to 0.64; P , .001). ConclusionWomen with stage II to IV low-grade serous carcinoma who received HMT after primary treatment had significantly longer PFS compared with women who underwent OBS. These findings warrant further investigation using a prospective trial design.

Low‐grade serous ovarian carcinoma: A comprehensive literature review

“…Given its relative chemoresistance, some clinicians have abandoned adjuvant chemotherapy in favour of hormonal therapy, whereas others are awaiting results of prospective clinical trials …”

“…LGSOCs commonly arise in serous borderline tumours (SBOT) and have a high prevalence of BRAF (0–33%, average 5%) and KRAS (19–55%) mutations, with research suggesting NRAS mutations may be an oncogenic driver in their progression . LGSOCs have greater expression of oestrogen receptors (ER) and progesterone receptors (PR) and are typically TP53 wild‐type . Cumulative research suggests a role of the mitogen‐activated protein kinase (MAPK) pathway in their pathogenesis and there is growing evidence regarding targeted agents in management …”

“…All pivotal clinical trials guiding management of EOC are over‐representative of HGSOC, thus findings cannot be unconditionally applied to rarer subtypes . However, many centres manage women similarly due to the paucity of prospective clinical trials in LGSOC . Retrospective studies demonstrate poor response rates to systemic therapy, highlighting the need for novel treatment strategies.…”

Low grade serous ovarian carcinoma: identifying variations in practice patterns

“…Hormone antagonistic therapy has demonstrated significant benefit in prolonging time to disease progression in retrospective studies 11. However, respondents in this survey did not commonly elect to use hormone antagonism as consolidation therapy after primary treatment with no evidence of disease.…”

Ovarian cancer in adolescents and young adults

“…LGSCs commonly express estrogen (ER) and progesterone receptors (PR). A retrospective study has shown benefit of antiestrogens in the adjuvant setting . Another case series demonstrated response to bevacizumab .…”