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Impact of BRCA1/2 Mutations on the Efficacy of Secondary Cytoreductive Surgery

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Phase III trials evaluating the role of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer have pointed to the importance of patient selection. Two studies showed conflicting results regarding the benefit of SCS in BRCA1/2 mutation carriers. Our aim was to evaluate the impact of SCS on recurrent ovarian cancer according to BRCA1/2 status.

Methods

All patients with ovarian carcinoma with platinum-sensitive recurrent disease and tested for BRCA1/2 germline mutations were included. Cox regression and log rank test were used to evaluate the impact of SCS on progression-free survival (PFS) and the influence of BRCA1/2 mutations on the effect of SCS.

Results

127 patients were included, 45.6% were treated with SCS and chemotherapy and 54.3% treated with chemotherapy only. Patients treated with SCS were younger, presented better performance status, had lower CA125, and had a longer platinum-free interval. In multivariate analysis SCS was associated with longer PFS (HR 0.42, 95% CI 0.25–0.72, p = 0.002). BRCA1/2 mutations were found in 35 patients (27.5%), and 11.8% of patients were treated with PARP inhibitors. Although not statistically significant, both BRCA1/2 wild type patients (PFS: 21.6 vs 18.4 months; p = 0.114) and BRCA1/2 mutation carriers (PFS: 23.1 vs 18.2 months, p = 0.193) appeared to derive benefit from SCS.

Discussion

The present study suggests a benefit of SCS irrespective of BRCA1/2 status among patients mostly not treated with PARP inhibitor. Further data on post hoc analysis from the phase III trials are warranted to confirm whether BRCA1/2 mutated patients should be selected for SCS.

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Authors and Affiliations

  1. Department of Medical Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil

    Felipe Leonardo Estati MD, Rafaela Pirolli MD, Viviane Teixeira Loiola de Alencar MD, Adriana Regina Gonçalves Ribeiro MD, MSc, Maria Nirvana Formiga MD, PhD, Andrea Paiva Gadelha Guimarães MD, MSc & Alexandre André Balieiro Anastácio da Costa MD, PhD

  2. Department of Oncogenetics, A.C. Camargo Cancer Center, São Paulo, SP, Brazil

    Maria Nirvana Formiga MD, PhD

  3. Genomics and Molecular Biology Group, A.C. Camargo Cancer Center, São Paulo, SP, Brazil

    Giovana Tardin Torrezan PhD & Dirce Maria Carraro PhD

  4. Department of Gynecology Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil

    Glauco Baiocchi MD, PhD

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  1. Felipe Leonardo Estati MD
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Correspondence to Alexandre André Balieiro Anastácio da Costa MD, PhD.

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Estati, F.L., Pirolli, R., de Alencar, V.T.L. et al. Impact of BRCA1/2 Mutations on the Efficacy of Secondary Cytoreductive Surgery. Ann Surg Oncol 28, 3637–3645 (2021). https://doi.org/10.1245/s10434-020-09366-w

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