Procedural interventions for oligoprogression during treatment with immune checkpoint blockade in gynecologic malignancies: A case series Journal Article
| Authors: | Sia, T. Y.; Wan, V.; Finlan, M.; Zhou, Q. C.; Iasonos, A.; Zivanovic, O.; Sonoda, Y.; Chi, D. S.; Long Roche, K.; Jewell, E.; Tew, W. P.; O'Cearbhaill, R. E.; Cohen, S.; Makker, V.; Liu, Y. L.; Friedman, C. F.; Kyi, C.; Zamarin, D.; Gardner, G. |
| Article Title: | Procedural interventions for oligoprogression during treatment with immune checkpoint blockade in gynecologic malignancies: A case series |
| Abstract: | Objective To evaluate the feasibility and outcomes of performing procedural interventions, defined as surgical resection, tumor ablation, or targeted radiation therapy, for oligoprogressive disease among patients with gynecologic malignancies who are treated with immune checkpoint blockade. Methods Patients with gynecologic cancers treated with immune checkpoint blockade between January 2013 and October 2021 who underwent procedural interventions including surgical resection, interventional radiology ablation, or radiation therapy for oligoprogressive disease were identified. Procedures performed before immune checkpoint therapy initiation or ≥6 months after therapy completion were excluded. Long immunotherapy duration prior to intervention was defined as ≥6 months. Progression-free survival and overall survival were calculated from procedure date until disease progression or death, respectively. Results During the study period, 886 patients met inclusion criteria and received immune checkpoint blockade therapy. Of these, 34 patients underwent procedural interventions for oligoprogressive disease; 7 underwent surgical resection, 3 underwent interventional radiology ablation, and 24 underwent radiation therapy interventions. Primary disease sites included uterus (71%), ovary (24%), and cervix (6%). Sites of oligoprogression included abdomen/pelvis (26%), bone (21%), lung (18%), distant lymph node (18%), brain (9%), liver (6%), and vagina (3%). Most tumors (76%) did not exhibit microsatellite instability or mismatch repair deficiency. Approximately half (53%) of the patients had long immune checkpoint therapy duration prior to intervention. Median progression-free survival following the procedure was 5.3 months (95% CI, 3.1–9.9), and median overall survival was 21.7 months (95% CI, 14.9–not estimable). Long versus short immune checkpoint therapy duration prior to procedure and length of immune checkpoint therapy had no effect on progression-free or overall survival. Conclusions Procedural interventions for patients with oligoprogression on immune checkpoint blockade therapy are feasible and demonstrate favorable outcomes. With expanding use of immune checkpoint therapy, it is important to investigate combined modalities to maximize therapeutic benefit for patients with gynecologic cancers. © IGCS and ESGO 2024. |
| Keywords: | adult; aged; cancer surgery; retrospective studies; major clinical study; overall survival; multimodality cancer therapy; treatment duration; cancer radiotherapy; combined modality therapy; brain tumor; brain neoplasms; pelvis; cancer immunotherapy; metastasis; progression free survival; vagina; cohort analysis; retrospective study; protein tyrosine kinase inhibitor; genital neoplasms, female; ovary; liver; abdomen; brain; mismatch repair; microsatellite instability; lymph node; bone; lung; interventional radiology; cytotoxic t lymphocyte antigen 4; uterus; uterine cervix; female genital tract tumor; programmed death 1 ligand 1; programmed death 1 receptor; progression-free survival; female genital tract cancer; tumor ablation; immune checkpoint inhibitor; humans; human; female; article; immune checkpoint inhibitors |
| Journal Title: | International Journal of Gynecological Cancer |
| Volume: | 34 |
| Issue: | 4 |
| ISSN: | 1048-891X |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2024-04-01 |
| Start Page: | 594 |
| End Page: | 601 |
| Language: | English |
| DOI: | 10.1136/ijgc-2023-004842 |
| PUBMED: | 38296517 |
| PROVIDER: | scopus |
| PMCID: | PMC11108643 |
| DOI/URL: | |
| Notes: | Article -- MSK corresponding author is Ginger Gardner -- Source: Scopus |
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