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. 2021 Aug;6(4):100229.
doi: 10.1016/j.esmoop.2021.100229. Epub 2021 Aug 7.

Clinical benefit of systemic therapies for recurrent ovarian cancer-ESMO-MCBS scores

K E Broekman  1 , M van Kruchten  1 , H van Tinteren  2 , C Sessa  3 , M Jalving  1 , A K L Reyners  4
Affiliations

Clinical benefit of systemic therapies for recurrent ovarian cancer-ESMO-MCBS scores

K E Broekman et al. ESMO Open. 2021 Aug.

Abstract

Background: Licensed systemic treatment options for platinum-sensitive recurrent ovarian cancer are platinum-based chemotherapy and maintenance treatment with bevacizumab and poly (ADP-ribose) polymerase inhibitors. For platinum-resistant disease, several non-platinum options are available. We aimed to assess the clinical benefit of these treatments according to the European Society of Medical Oncology (ESMO)-Magnitude of Clinical Benefit Scale (MCBS).

Materials and methods: A PubMed search was carried out including all studies evaluating systemic treatment of recurrent epithelial ovarian cancer, from 1990 onwards. Randomised trials with an adequate comparator and design showing a statistically significant benefit of the study arm were independently scored by two blinded observers using the ESMO-MCBS.

Results: A total of 1127 papers were identified, out of which 61 reported results of randomised trials of sufficient quality. Nineteen trials showed statistically significant results and the studied treatments were graded according to ESMO-MCBS. Only three treatments showed substantial benefit (score of 4 on a scale of 1-5) according to the ESMO-MCBS: platinum-based chemotherapy with paclitaxel in the platinum-sensitive setting and the addition of bevacizumab to chemotherapy in the platinum-resistant setting. The WEE1 inhibitor adavosertib (not licensed) also scores a 4, based on a recent small phase II study. Assessment of quality-of-life data and toxicity using the ESMO-MCBS showed to be complex, which should be taken into account in using this score for clinical decision making.

Conclusion: Only a few licensed systemic therapies for recurrent ovarian cancer show substantial clinical benefit based on ESMO-MCBS scores. Trials demonstrating overall survival benefit are sparse.

Keywords: ESMO-MCBS; chemotherapy; clinical benefit; ovarian cancer; targeted therapy.

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Conflict of interest statement

Disclosure MJ serves on the advisory board of AstraZeneca and Merck, with funding to institution. The remaining authors have declared no conflicts of interest.

Figures

Figure 1
Figure 1
CONSORT diagram. Flow chart showing the search strategy and steps in selection and grading of trials. ESMO, European Society of Medical Oncology; MCBS, Magnitude of Clinical Benefit Scale; RCT, randomised controlled trial
Figure 2
Figure 2
Relative difference in MCBS between comparators in platinum-sensitive (A) and platinum-resistant (B) ovarian cancer. An overview of the relative benefit between the different arms and comparators studied and graded for the platinum-sensitive and -resistant setting is provided. The distance between two comparators is representative for the MCBS grading with larger distance representing more benefit according to MCBS for the intervention versus. comparator. ∗In the MITO16b study, carboplatin doublets studied were carboplatin with either paclitaxel, gemcitabine or liposomal doxorubicin. MCBS, Magnitude of Clinical Benefit Scale; OS, overall survival; PFS, progression-free survival; PLD, liposomal doxorubicin; PRO, patient-reported outcomes; QoL, quality of life.
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