- •BRCA+ patients identified by genetic sequencing have superior outcomes compared to BRCA - patients when treated with IP chemotherapy.
- •BRCA mutated patients may be a group that would benefit most from IP chemotherapy.
- •The benefit for BRCA mutated patients were seen at doses of cisplatin lower than those used in GOG 172.
To compare the outcomes after intraperitoneal (IP) chemotherapy in patients with and without pathogenic BRCA mutations.
Patients with high grade ovarian cancer who were treated with adjuvant IP chemotherapy in the initial setting between 2005 and 2016 were identified. Outcomes were compared between patients with pathogenic mutations in BRCA (BRCA+) and those who tested negative or were unknown (BRCA−).
A total of 100 eligible patients were identified. The median follow-up was 47.0 months (range, 6.6–144.1 months). Of these 100 patients, 77 patients underwent BRCA testing; 25 patients (32%) were BRCA+ (23 germline, 2 somatic). No differences were noted between groups with respect to number of IP cycles, stage, or residual disease after surgery. The median progression-free survival (PFS) was longer in the BRCA+ group; median PFS was not reached in the BRCA+ group compared to 17.3 months in the BRCA− group (HR = 0.38; 95% CI 0.20–0.73, P = 0.003). Median overall survival (OS) was longer in the BRCA+ group at 110.4 months versus 67.1 months (HR = 0.28, 95% CI 0.11–0.73, P = 0.009).
Pathogenic BRCA mutations are more common than expected in optimally resected ovarian cancer patients selected for IP therapy. IP therapy was associated with a dramatic improvement in PFS and OS in BRCA+ patients compared with BRCA− patients. This improvement is greater than has been reported for BRCA+ patients with IV chemotherapy. The magnitude of this benefit suggests that patients with pathogenic mutations in BRCA may benefit from IP therapy.
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Published online: October 08, 2018
Accepted: October 1, 2018
Received in revised form: September 28, 2018
Received: July 8, 2018
© 2018 Elsevier Inc. All rights reserved.