Abstract 573P
Background
Complete resection significantly improves survival in ovarian cancer patients with a platinum sensitive recurrence who fulfil the AGO score. We assessed the association of levels of CA125 at relapse with surgical and oncological outcome.
Methods
CA125 at the time of surgery was classified as normal (Group A: <35 U/ml) versus elevated (Group B: 35 U/ml - 350 U/ml) versus strongly elevated (Group C: > 350 U/ml). We assessed surgical outcome by CA125 and explored the prognostic value of CA125.
Results
Baseline CA125 was available in 91% (370/407) of randomized patients, 181 randomized to chemotherapy alone and 189 to additional surgery. Median CA125 values and classified cohorts did not differ significantly between patients in the chemotherapy arm vs patients in the surgical arm. The complete resection rate in the 176 patients undergoing surgery was 74% (group A versus B versus C: 83% (48/58) and 72% (74/103) and 53% (8/15) (p=0.053), respectively). There were no relevant differences regarding surgical procedures, but there was a slightly longer duration of surgery (210 vs 223 vs 240 minutes), higher blood loss (195 vs 275 vs 350 ml), higher rate of infections (16 vs 17 vs 47%) in group A vs B vs C. Rate of relaparotomy was low in all cohorts (0%, 6%, and 7%, resp.). Higher CA125 levels were associated with shorter OS in the entire population (median OS: group A 59 months vs group B 52 months, HR 1.26 (95%CI: 0.92-1.71) versus group C 35 months, HR 2.05 (95% CI: 1.33-3.16); log-rank p=0.002). Similarly, in the chemotherapy alone arm (median OS: group A 53 months vs group B 48 months, HR 1.24 (95% CI: 0.81-1.90) versus group C 35 months, HR 1.90 (95% CI: 1.09-3.30)) and in the surgical arm (median OS: group A 61 months vs group B 52 months, HR 1.32 (95% CI: 0.84-2.05) versus group C 35 months, HR 2.06 (95% CI: 1.00-4.26)). Median OS in group C from surgical arm favoured complete resection compared to incomplete resection (HR 0.22 (95% CI: 0.04-1.31); log-rank p=0.049).
Conclusions
CA 125 levels at the time of relapse are associated with overall survival independent of treatment strategy. In this AGO score preselected population, the benefit from complete resection is independent from CA125.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
AGO Research GmbH, AGO Study Group.
Funding
AGO Research GmbH.
Disclosure
J. Sehouli: Financial Interests, Personal, Advisory Board: Roche, GSK, AstraZeneca, MSD, Tesaro; Financial Interests, Personal, Invited Speaker: Eisei; Financial Interests, Institutional, Funding: Roche, GSK, AstraZeneca; Financial Interests, Institutional, Invited Speaker: Novocure; Non-Financial Interests, Institutional, Proprietary Information: ENGOT/NOGGO; Non-Financial Interests, Leadership Role, Council Member: ESGO. I.B. Vergote: Financial Interests, Personal, Advisory Board, Consulting: Agenus (2021), Aksebio China (2021), AstraZeneca (2021-2022), Bristol Myers Squibb (2021), Deciphera Pharmaceuticals (2021), Eisai (2021), F. Hoffmann-La Roche Ltd (2021), Genmab (2021), GSK (2021), ImmunoGen Inc. (2021-2022), Jazzpharma (2021-2022), Karyopharm (2021), MSD (2021-2022), Novocure (2020-2022), Novartis (2021), Oncoinvent AS (2021-2022), Seagen (2021), Sotio a.s. (2021-2022); Financial Interests, Institutional, Advisory Board, Consulting: AstraZeneca (2019-2020), Deciphera Pharmaceuticals (2020), Elevar Therapeutics (2020), F. Hoffmann-La Roche Ltd (2019-2020), Genmab (2019-2020), GSK (2019-2020), Mersana (2020), MSD (2019-2020), Oncoinvent AS (2019-2020), Sotio a.s. (2019-2020), Verastem Oncology (2020), Zentalis (2020), Amgen (Europe) 2019, Clovis Oncology Inc (2019), Carrick Therapeutics (2019), Millennium Pharmaceuticals (2019); Financial Interests, Institutional, Research Grant, Contracted Research ( via KU Leuven): Oncoinvent AS (2019-2020); Financial Interests, Institutional, Research Grant, Contracted Research (via KU Leuven): Genmab (2019); Financial Interests, Institutional, Research Grant, Corporate sponsored research: Amgen (2019-2020), Roche (2019-2020). J. Classe: Financial Interests, Personal, Advisory Board: Roche, AstraZeneca, vifor; Financial Interests, Personal, Invited Speaker: Glaxo Smith Kline, Clovis, MSD. P. Hillemanns: Financial Interests, Personal, Invited Speaker, Lecture Fee: Roche, MSD, AstraZeneca. M.R. Mirza: Financial Interests, Personal, Advisory Board: AstraZeneca, Biocad, GSK, Karyopharm, Merck, Roche, Zailab; Financial Interests, Personal, Invited Speaker: AstraZeneca, GSK, Karyopharm; Financial Interests, Personal, Stocks/Shares: Karyopharm; Financial Interests, Institutional, Research Grant: GSK, AstraZeneca, ultimovacs, Apexigen; Financial Interests, Institutional, Invited Speaker: Deciphera; Non-Financial Interests, Advisory Role: Ultimovacs, Apexigen. P. Follana: Financial Interests, Personal, Invited Speaker: GSK, EISAI, MSD; Financial Interests, Personal, Expert Testimony: CLOVIS, NOVARTIS; Financial Interests, Personal, Advisory Board: AZ; Financial Interests, Personal, Other, Congress invitation: GILEAD. A. Hasenburg: Financial Interests, Personal, Advisory Board: PharmaMar, Promedicis GmbH, Roche Pharma AG, Tesaro Bio Germany GmbH, AstraZeneca, LEO Pharma, GSK, MSD; Financial Interests, Personal, Other: MedConcept GmbH, Medicultus, Softconsult, Streamedup GmbH, Clovis Oncology; Financial Interests, Personal, Invited Speaker: MedUpdate GmbH. K. Lindemann: Financial Interests, Personal, Invited Speaker: GSK; Financial Interests, Personal, Advisory Board: MSD, EISAI. J. Kim: Financial Interests, Personal, Advisory Board: Takeda Korea, GSK Korea, Boryung, Vifor Pharma, MSD Korea; Financial Interests, Personal, Invited Speaker: CMIC, AstraZeneca, Janssen; Financial Interests, Personal, Expert Testimony: LG Pharma. A. Poveda: Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Advisory Board: AstraZeneca, Clovis, GSK, MSD, PharmaMar, Roche, Tesaro/GSK. F. Raspagliesi: Financial Interests, Personal, Other: MSD, PharmaMar. C.A. Haslund: Financial Interests, Personal, Invited Speaker: MSD; Non-Financial Interests, Institutional, Principal Investigator: BMS, Celgene Aps., GSK, MSD, Tesaro. A. du Bois: Financial Interests, Personal, Advisory Board: AstraZeneca, Clovis, GSK / Tesaro, Genmab, Amgen; Financial Interests, Personal, Invited Speaker: Zodiac. P. Harter: Financial Interests, Personal, Advisory Board, Value includes honoraria for lectures: AstraZeneca; Financial Interests, Personal, Advisory Board, includes honoraria for lectures: GSK, Roche, MSD; Financial Interests, Personal, Invited Speaker: Amgen, Stryker, Zailab; Financial Interests, Personal, Advisory Board: Clovis, ImmunoGen; Financial Interests, Personal, Other, IDMC member: Sotio; Financial Interests, Institutional, Invited Speaker: AstraZeneca, Roche, GSK, Genmab, ImmunoGen; Financial Interests, Institutional, Funding: Seagen, Clovis. All other authors have declared no conflicts of interest.