Primary cytoreductive surgery and adjuvant hormonal monotherapy in women with advanced low-grade serous ovarian carcinoma

Reducing overtreatment without compromising survival?

Amanda Nickles Nickles Fader, Jennifer Bergstrom, Amelia Jernigan, Edward J. Tanner, Kara Long Roche, Rebecca Stone, Kimberly Levinson, Stephanie Ricci, Stephanie Wethingon, Tian-Li Wang, Ie Ming Shih, Bin Yang, Gloria Zhang, Deborah Kay Armstrong, Stephanie Gaillard, Chad Michener, Robert DeBernardo, Peter G. Rose

Research output: Contribution to journalArticle

Abstract

Objectives: Women with advanced-stage, low-grade serous ovarian carcinoma (LGSC) have low chemotherapy response rates and poor overall survival. Most LGSC tumors overexpress hormone receptors, which represent a potential treatment target. Our study objective was to determine the outcomes of patients with advanced-stage LGSC treated with primary cytoreductive surgery (CRS) and hormone therapy (HT). Methods: A retrospective study was performed at two academic cancer centers. Patients with Stage II-IV LGSC underwent either primary or interval CRS followed by adjuvant HT between 2004 and 2016. Gynecologic pathologists reviewed all cases. Two-year progression-free (PFS) and overall survival (OS) were calculated. Results: Twenty-seven patients were studied; primary CRS followed by HT were administered in 26, while 1 patient had neoadjuvant chemotherapy followed by CRS and HT. The median patient age was 47.5, and patients had Stage II (n = 2), Stage IIIA (n = 6), Stage IIIC (n = 18), and Stage IV (n = 1) disease. Optimal cytoreduction to no gross residual was achieved in 85.2%. Ninety six percent of tumors expressed estrogen receptors, while only 32% expressed progesterone receptors. Letrozole was administered post operatively in 55.5% cases, anastrozole in 37.1% and tamoxifen in 7.4%. After a median follow up of 41. months, only 6 patients (22.2%) have developed a tumor recurrence and two patients have died of disease. Median PFS and OS have not yet been reached, but 2-year PFS and OS were 82.8% and 96.3%, respectively, and 3-year PFS and OS were 79.0% and 92.6%, respectively. Conclusions: Our series describes the initial experience with cytoreductive surgery and hormonal monotherapy for women with Stage II-IV primary ovarian LGSC. While surgery remains the mainstay of treatment, chemotherapy may not be necessary in patients with advanced-stage disease who receive adjuvant hormonal therapy. A cooperative group, Phase III trial is planned to define the optimal therapy for women with this ovarian carcinoma subtype.

Original languageEnglish (US)
JournalGynecologic Oncology
DOIs
StateAccepted/In press - 2017

Fingerprint

Carcinoma
Survival
Hormones
letrozole
Therapeutics
Drug Therapy
Neoplasms
Medical Overuse
Progesterone Receptors
Tamoxifen
Estrogen Receptors
Retrospective Studies
Recurrence

Keywords

  • Cytoreductive surgery
  • Hormonal therapy
  • Low-grade serous carcinoma
  • Ovarian cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Primary cytoreductive surgery and adjuvant hormonal monotherapy in women with advanced low-grade serous ovarian carcinoma : Reducing overtreatment without compromising survival? / Nickles Fader, Amanda Nickles; Bergstrom, Jennifer; Jernigan, Amelia; Tanner, Edward J.; Roche, Kara Long; Stone, Rebecca; Levinson, Kimberly; Ricci, Stephanie; Wethingon, Stephanie; Wang, Tian-Li; Shih, Ie Ming; Yang, Bin; Zhang, Gloria; Armstrong, Deborah Kay; Gaillard, Stephanie; Michener, Chad; DeBernardo, Robert; Rose, Peter G.

In: Gynecologic Oncology, 2017.

Research output: Contribution to journalArticle

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title = "Primary cytoreductive surgery and adjuvant hormonal monotherapy in women with advanced low-grade serous ovarian carcinoma: Reducing overtreatment without compromising survival?",
abstract = "Objectives: Women with advanced-stage, low-grade serous ovarian carcinoma (LGSC) have low chemotherapy response rates and poor overall survival. Most LGSC tumors overexpress hormone receptors, which represent a potential treatment target. Our study objective was to determine the outcomes of patients with advanced-stage LGSC treated with primary cytoreductive surgery (CRS) and hormone therapy (HT). Methods: A retrospective study was performed at two academic cancer centers. Patients with Stage II-IV LGSC underwent either primary or interval CRS followed by adjuvant HT between 2004 and 2016. Gynecologic pathologists reviewed all cases. Two-year progression-free (PFS) and overall survival (OS) were calculated. Results: Twenty-seven patients were studied; primary CRS followed by HT were administered in 26, while 1 patient had neoadjuvant chemotherapy followed by CRS and HT. The median patient age was 47.5, and patients had Stage II (n = 2), Stage IIIA (n = 6), Stage IIIC (n = 18), and Stage IV (n = 1) disease. Optimal cytoreduction to no gross residual was achieved in 85.2{\%}. Ninety six percent of tumors expressed estrogen receptors, while only 32{\%} expressed progesterone receptors. Letrozole was administered post operatively in 55.5{\%} cases, anastrozole in 37.1{\%} and tamoxifen in 7.4{\%}. After a median follow up of 41. months, only 6 patients (22.2{\%}) have developed a tumor recurrence and two patients have died of disease. Median PFS and OS have not yet been reached, but 2-year PFS and OS were 82.8{\%} and 96.3{\%}, respectively, and 3-year PFS and OS were 79.0{\%} and 92.6{\%}, respectively. Conclusions: Our series describes the initial experience with cytoreductive surgery and hormonal monotherapy for women with Stage II-IV primary ovarian LGSC. While surgery remains the mainstay of treatment, chemotherapy may not be necessary in patients with advanced-stage disease who receive adjuvant hormonal therapy. A cooperative group, Phase III trial is planned to define the optimal therapy for women with this ovarian carcinoma subtype.",
keywords = "Cytoreductive surgery, Hormonal therapy, Low-grade serous carcinoma, Ovarian cancer",
author = "{Nickles Fader}, {Amanda Nickles} and Jennifer Bergstrom and Amelia Jernigan and Tanner, {Edward J.} and Roche, {Kara Long} and Rebecca Stone and Kimberly Levinson and Stephanie Ricci and Stephanie Wethingon and Tian-Li Wang and Shih, {Ie Ming} and Bin Yang and Gloria Zhang and Armstrong, {Deborah Kay} and Stephanie Gaillard and Chad Michener and Robert DeBernardo and Rose, {Peter G.}",
year = "2017",
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T1 - Primary cytoreductive surgery and adjuvant hormonal monotherapy in women with advanced low-grade serous ovarian carcinoma

T2 - Reducing overtreatment without compromising survival?

AU - Nickles Fader, Amanda Nickles

AU - Bergstrom, Jennifer

AU - Jernigan, Amelia

AU - Tanner, Edward J.

AU - Roche, Kara Long

AU - Stone, Rebecca

AU - Levinson, Kimberly

AU - Ricci, Stephanie

AU - Wethingon, Stephanie

AU - Wang, Tian-Li

AU - Shih, Ie Ming

AU - Yang, Bin

AU - Zhang, Gloria

AU - Armstrong, Deborah Kay

AU - Gaillard, Stephanie

AU - Michener, Chad

AU - DeBernardo, Robert

AU - Rose, Peter G.

PY - 2017

Y1 - 2017

N2 - Objectives: Women with advanced-stage, low-grade serous ovarian carcinoma (LGSC) have low chemotherapy response rates and poor overall survival. Most LGSC tumors overexpress hormone receptors, which represent a potential treatment target. Our study objective was to determine the outcomes of patients with advanced-stage LGSC treated with primary cytoreductive surgery (CRS) and hormone therapy (HT). Methods: A retrospective study was performed at two academic cancer centers. Patients with Stage II-IV LGSC underwent either primary or interval CRS followed by adjuvant HT between 2004 and 2016. Gynecologic pathologists reviewed all cases. Two-year progression-free (PFS) and overall survival (OS) were calculated. Results: Twenty-seven patients were studied; primary CRS followed by HT were administered in 26, while 1 patient had neoadjuvant chemotherapy followed by CRS and HT. The median patient age was 47.5, and patients had Stage II (n = 2), Stage IIIA (n = 6), Stage IIIC (n = 18), and Stage IV (n = 1) disease. Optimal cytoreduction to no gross residual was achieved in 85.2%. Ninety six percent of tumors expressed estrogen receptors, while only 32% expressed progesterone receptors. Letrozole was administered post operatively in 55.5% cases, anastrozole in 37.1% and tamoxifen in 7.4%. After a median follow up of 41. months, only 6 patients (22.2%) have developed a tumor recurrence and two patients have died of disease. Median PFS and OS have not yet been reached, but 2-year PFS and OS were 82.8% and 96.3%, respectively, and 3-year PFS and OS were 79.0% and 92.6%, respectively. Conclusions: Our series describes the initial experience with cytoreductive surgery and hormonal monotherapy for women with Stage II-IV primary ovarian LGSC. While surgery remains the mainstay of treatment, chemotherapy may not be necessary in patients with advanced-stage disease who receive adjuvant hormonal therapy. A cooperative group, Phase III trial is planned to define the optimal therapy for women with this ovarian carcinoma subtype.

AB - Objectives: Women with advanced-stage, low-grade serous ovarian carcinoma (LGSC) have low chemotherapy response rates and poor overall survival. Most LGSC tumors overexpress hormone receptors, which represent a potential treatment target. Our study objective was to determine the outcomes of patients with advanced-stage LGSC treated with primary cytoreductive surgery (CRS) and hormone therapy (HT). Methods: A retrospective study was performed at two academic cancer centers. Patients with Stage II-IV LGSC underwent either primary or interval CRS followed by adjuvant HT between 2004 and 2016. Gynecologic pathologists reviewed all cases. Two-year progression-free (PFS) and overall survival (OS) were calculated. Results: Twenty-seven patients were studied; primary CRS followed by HT were administered in 26, while 1 patient had neoadjuvant chemotherapy followed by CRS and HT. The median patient age was 47.5, and patients had Stage II (n = 2), Stage IIIA (n = 6), Stage IIIC (n = 18), and Stage IV (n = 1) disease. Optimal cytoreduction to no gross residual was achieved in 85.2%. Ninety six percent of tumors expressed estrogen receptors, while only 32% expressed progesterone receptors. Letrozole was administered post operatively in 55.5% cases, anastrozole in 37.1% and tamoxifen in 7.4%. After a median follow up of 41. months, only 6 patients (22.2%) have developed a tumor recurrence and two patients have died of disease. Median PFS and OS have not yet been reached, but 2-year PFS and OS were 82.8% and 96.3%, respectively, and 3-year PFS and OS were 79.0% and 92.6%, respectively. Conclusions: Our series describes the initial experience with cytoreductive surgery and hormonal monotherapy for women with Stage II-IV primary ovarian LGSC. While surgery remains the mainstay of treatment, chemotherapy may not be necessary in patients with advanced-stage disease who receive adjuvant hormonal therapy. A cooperative group, Phase III trial is planned to define the optimal therapy for women with this ovarian carcinoma subtype.

KW - Cytoreductive surgery

KW - Hormonal therapy

KW - Low-grade serous carcinoma

KW - Ovarian cancer

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