Baseline QoL Can Predict Survival in Platinum-Resistant Ovarian Cancer

Baseline quality of life (QoL) measures predict early cessation of chemotherapy and overall survival in women with platinum-resistant/refractory, recurrent ovarian cancer (PRR-ROC), according to a study presented at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 3–7 in Chicago (abstract 5508).

The results suggest that assessing baseline QoL in women with PRR-ROC might help identify which patients are unlikely to benefit from palliative chemotherapy, said lead study author Felicia Roncolato, MBChB, FRACP, of St. George Hospital in Sydney, Australia, on behalf of the Gynecologic Cancer Intergroup Symptom Benefit Group.

“In women with PRR-ROC, global health status, physical function, role function and abdominal/[gastrointestinal] symptoms were independent predictors of overall survival,” Dr. Roncolato said. “These factors were also significantly associated with early cessation of chemotherapy.”

Most patients diagnosed with advanced ovarian cancer develop platinum resistant/refractory disease. The median progression-free survival time for recurrent ovarian cancer is 3 months, and median overall survival is less than 12 months. There is little evidence that chemotherapy improves overall survival in PRR-ROC, but palliative chemotherapy is frequently undertaken to help maintain quality of life.

It is unclear how best to identify which patients are likely to benefit, or not to benefit, from palliative chemotherapy. To address this gap, the researchers studied baseline QoL and clinical factors to determine associations with overall survival and early chemotherapy cessation.

The CGIG Symptom Benefit Study enrolled 570 women with PRR-ROC and measured QoL using several instruments: the EORTC QLQ-C30 and QLQ-OV28 subscales. These scores’ associations with overall survival and chemotherapy cessation were determined in univariate and multivariate statistical analyses. 

Median progression-free survival was 3.6 months (3.1–3.9 months) and median overall survival was 11.1 months (9.5–12 months). Physical function, role function, global health status, and abdominal/gastrointestinal symptoms were all associated with overall survival (P < .001). Low global health status, role function, and physical function, as well as high abdominal/gastrointestinal symptoms scores, were associated with halting chemotherapy within 2 months.

Baseline health-related QoL scores predicted very poor survival among a subset of women with PRR-ROC, and together with prognostic clinical factors like hemoglobin, ascites, neutrophil-to-lymphocyte ratio, platelet counts, and serum CA-125, improved overall survival prediction.

This could improve patient risk-stratification for clinical trials, aid clinical decision-making, and improve patient/doctor communication about prognosis and treatment planning, Dr. Roncolato said.