911P - Etoposide benefit in 2nd line and beyond relapsed epithelial ovarian cancer (EOC): A population based analysis

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anticancer agents
Ovarian Cancer
Therapy
Biological Therapy
Presenter Aalok Kumar
Citation Annals of Oncology (2014) 25 (suppl_4): iv305-iv326. 10.1093/annonc/mdu338
Authors A. Kumar, N. Le, J. Santos, P. Hoskins
  • Medical Oncology, British Columbia Cancer Agency, V5Z4E6 - Vancouver/CA

Abstract

Aim

Etoposide is an option for treatment in women with EOC who relapse. Our aims were to characterize patterns of etoposide use in relapsed EOC and assess its benefit based on when etoposide was used.

Methods

Women with high grade serous ovarian cancer (HGSC) and treated at 1 of the British Columbia Cancer Agency (BCCA) centres with oral etoposide at recurrence/progression from years 2000-2010 were identified. Kaplan-Meier and Cox regression methods were used to correlate line of therapy of etoposide with overall survival (OS), progression free survival (PFS) and interval between etoposide start and next progression/death (EPFS).

Results

We identified 219 women who received etoposide at relapse, median age of 61 years. Majority had stage 3 disease at initial presentation (80%). Patients received etoposide in 2nd (17%), 3rd (30%), 4th (26%), 5th (17%) and 6-8th (11%) line of therapy. The median number of cycles received was 2-4 depending on line of therapy. Most patients discontinued etoposide due to progression (81%). Patients receiving etoposide in 4th-8th line of treatment had a significantly longer median OS and initial PFS vs. 2nd-3rd line (47.8 vs. 25.8 mo, p < 0.0001 and 16.1 vs. 12.1 mo, p < 0.0001, respectively). No significant difference was seen in median EPFS based on which line of therapy etoposide was used in, p = 0.685, or when dividing it by 2nd-3rd vs. 4th-8th (2.2 vs. 2.43 mo, p = 0.426). The 3 month EPFS rate was 32-48%, while the 6 month rate was 6-19%. Comparing the overall EPFS when etoposide was given as second line therapy or later (Table), the hazard ratios improved sequentially through 3rd, 4th and 5th line (HR 0.82, 0.77, 0.34), with a significance seen in 5th line therapy.

Conclusions

In this population based cohort study, the benefit of etoposide was similar regardless of the line of therapy it was instituted in. Etoposide remains an important option in the treatment of relapsed HGSC. The outcomes reported are likely the best possible as selection bias must have been operational to exclude from treatment of the ill or those deemed unlikely to benefit.

Variable EPFS
HR 95% CI p-value
Age at Diagnosis 0.99 0.98–1.01 0.89
Etoposide Line of Tx 2nd 3rd 4th 5th 6th-8th 1.00 0.82 0.77 0.34 1.03 0.53–1.29 0.49–1.23 0.19–0.63 0.59–1.82 0.39 0.27 0.0006 0.91

Disclosure

All authors have declared no conflicts of interest.