Outcome according to residual disease (surgeon's report vs pre‐chemotherapy imaging) in patients with bevacizumab‐treated ovarian cancer: Analysis of the ROSiA study

• Published in: Journal of surgical oncology Vol. 120; no. 4; pp. 786 - 793
• Main Authors: Korach, Jacob, Colombo, Nicoletta, Mendiola, Cesar, Selle, Frédéric, Dolado, Ignacio, Donica, Margarita, Oza, Amit M.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.09.2019
• Subjects: Adenocarcinoma, Clear Cell - diagnostic imaging; Adenocarcinoma, Clear Cell - mortality; Adenocarcinoma, Clear Cell - pathology; Antineoplastic Agents, Immunological - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; bevacizumab; Bevacizumab - therapeutic use; Cancer surgery; Carcinosarcoma - diagnostic imaging; Carcinosarcoma - mortality; Carcinosarcoma - pathology; Female; Follow-Up Studies; Humans; imaging; Immunotherapy; Medical prognosis; Monoclonal antibodies; Neoplasm, Residual - diagnostic imaging; Neoplasm, Residual - mortality; Neoplasm, Residual - pathology; Ovarian cancer; Ovarian Neoplasms - diagnostic imaging; Ovarian Neoplasms - mortality; Ovarian Neoplasms - pathology; Prognosis; progression‐free survival; Surgeons; Surgeons - statistics & numerical data; Survival Rate; Targeted cancer therapy; Tomography, X-Ray Computed - methods; visible residuum; bevacizumab; ovarian cancer; imaging; visible residuum; progression-free survival
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.25647

Background and Objectives The single‐arm ROSiA study evaluated frontline bevacizumab for advanced ovarian cancer. We explored how discordant surgically and radiologically assessed postoperative residual disease affects outcomes. Methods After debulking surgery, 1021 patients received 4 to 8 cycles of carboplatin‐paclitaxel plus bevacizumab until progression or up to 24 months. The primary endpoint was safety; progression‐free survival (PFS) was a secondary endpoint. We performed post hoc exploratory PFS analyses in four subgroups: surgeon‐reported no visible residuum (NVR) without target lesions; surgeon‐reported NVR with target lesions; macroscopic (≤1 cm) residuum; and >1 cm residuum. Results Surgical and radiological assessments were concordant in 94% of patients; 61 patients (6%; 21% of those with surgeon‐reported NVR) had NVR with target lesions. Median PFS was numerically longest in patients with concordant surgically/radiologically assessed NVR (35.5 months), intermediate for surgeon‐reported NVR with target lesions (31.8 months), and shortest for visible residuum (27.9 and 20.2 months for visible residuum ≤1 and >1 cm, respectively). One‐year and 2‐year PFS rates showed the same pattern. Conclusions These analyses suggest that prognosis is potentially worse in patients with radiologically detected target lesions despite surgeon‐reported NVR compared with concordant NVR by both assessment methods. Postsurgical imaging may add valuable prognostic information.