Survey Shows Patients Consider Several Factors of Maintenance Therapy for Ovarian Cancer Treatment

Jalid Sehouli, MD

Patients with ovarian cancer (OC) were unified in their responses regardless of age, disease stage, or whether they had primary or recurrent disease, and were more likely to opt to receive maintenance therapy if it could offer delay of disease progression and allow patients to maintain or improve their quality of life (QoL), according to findings from a survey reported at the European Society of Gynaecological Oncology (ESGO) 2017 Congress.

The survey was disseminated to patients participating in the randomised double-blind phase IV ENGOT-OV22 trial. The ENGOT-OV22 survey asked, “What do primary and recurrent OC patients expect from maintenance therapy?” “We wondered what was important in choosing to undergo maintenance therapy and decided to ask the patients themselves,” said Jalid Sehouli, MD, of the Charité Universitätsmedizin Berlin in Berlin, Germany.

Maintenance therapy is based upon the understanding that patients achieving clinical remission following surgery and chemotherapy for ovarian cancer have a 60% to 70% chance of developing recurrent disease with 2 years, according to Sehouli. Several clinical trials have shown promise with various drugs but guidelines are still under development.

In all, 1954 patients from centers in 10 European and Eastern European countries responded to the survey. The majority (67.0%) was age 51 to 70 years. Primary ovarian cancer was diagnosed in 49.6% of patients, 36.3% had relapsed ovarian cancer and the disease stage was unknown for 6.9% of respondents. The International Federation of Gynecology and Obstetrics (FIGO) stage of the primary disease was III to IV in 43.7% of respondents, unknown in 32.1%, and I to II in 14.3%. Most subjects (64.3%) were currently undergoing treatment, but this treatment consisted of a maintenance regimen for just 29.3%.

Regarding living situation, 81.7% of respondents did not live alone, and 61.4% said that they took tablets daily for comorbidities. Of these, patients reported that they took a mean of 3.3 tablets (range, 5 to 35 tablets) per day.

“Comedication and patient age do not seem to negatively influence patients’ preference towards maintenance therapy,” Sehouli noted.

The investigators found that patient age (P = .564), prior surgery (P = .074), and living situation (P = .471), did not associate significantly with the respondents’ choice to undergo maintenance therapy.

However, patients receiving maintenance therapy had FIGO stage III to IV disease at the primary diagnosis significantly more often (P = .001), and also had recurrent disease (P = .001).

However, age did play a role in disease management. Whereas there was no difference between older and younger patients receiving chemotherapy for their disease, fewer patients aged 70 years and older underwent surgery for their tumor (P <.001). In addition, Patients aged 70 or more years were more likely to live alone (P <.001), and more often had FIGO disease stage III to IV (P <.001). Patients in this age group also took significantly more tablets daily for co-morbidities (P <.001).

“Only a few patients under maintenance therapy described their health status as bad,” said Sehouli.

A positive note resounded when just 2% and 7% of patients currently undergoing maintenance therapy regarded their current state of health as very bad or bad, respectively. Most patients (37%) responded neutral, 35% said well, and nearly 20% of patients described their current health status as very well.

Regarding patients’ expectation for maintenance therapy, 50% of patients with recurrent disease and 45% of patients with primary disease responded that they anticipated maintenance therapy to prevent disease progression for 6 months, and this expectation was similar in both older and younger patients. Just over 30% of primary cancer patients and 20% of patients with recurrent disease expected maintenance therapy to delay disease recurrence by 6 to 12 months, and fewer than 5% of patients with each disease stage anticipated progression delay of 24 to 36 months with maintenance therapy. Again, age played no role in the expectation of disease progression delay with maintenance.

Importantly, the patients expressed preferences for the delivery of maintenance therapy; 42.9% of respondents preferred oral tablets, 32.1% had no preference, and 25% of patients preferred intravenous administration. An equal 35% of patients preferred a regimen of daily oral therapy and IV administration every 3 weeks. Just under 20% of patients preferred twice daily oral administration, 7% preferred weekly infusion, and less than 3% stated they would like an ‘other schedule.’

Patients were quite knowledgeable about the types of adverse effects that could be experienced, and voiced their concerns about which were least tolerable. The adverse effects of most concern reported by between 35% and 40% of patients were polyneuropathy, nausea, hair loss, and vomiting. Approximately 25% of patients were concerned about fatigue and the risk of infection, while 20% of respondents cited edema and high blood pressure as undesirable adverse effects. Less than 20% of patients listed neutropenia, constipation, diarrhea, stomachache, skin rash, anemia and bleeding disturbances as the adverse effects of most concern. This panel was similar between patients with primary or recurrent disease and among both younger and older patients.

The personal objective most patients listed for choosing a maintenance therapy were increasing the chance of effecting a cure (75%) improved quality of life (QoL; 14%), non-deterioration of QoL (40%), tumor shrinkage (45% of patients with recurrent disease vs 32% of primary disease patients), and decreased CA-125 (40% or less).

There was a consensus that maintenance therapy should delay tumor progression by 6 or more months; more than 60% of patients with primary or recurrent disease, and both older and younger patients expressed this as the main deciding factor for maintenance therapy.

“There is a high need for more information and patient education regarding maintenance therapy goals and side effects,” Sehouli pointed out.

Rohr I, Keller M, Chekerov R, et al. What are the expectations and preferences of patients with ovarian cancer to a maintenance theray? A NOGGO/ENGOT-OV22 survey (expression IV) in 2101 patients. Abstract presented at: 2017 ESGO Congress; November 4-7, 2017; Vienna, Austria.