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Joyce F. Liu, MD, MPH
Joyce F. Liu, MD, MPH
Posted: Thursday, January 23, 2025
In patients with newly diagnosed BRCA1/2 wild-type ovarian cancer, increasing genomic instability may be associated with significantly improved survival outcomes, according to results of a recent single-institution, retrospective chart review published in Gynecologic Oncology. Genomic instability was scored as a continuous variable, with homologous recombinant deficiency (HRD) status defined as a genomic instability score of 42 or greater, described Rachel N. Grisham, MD, of Memorial Sloan Kettering Cancer Center, New York, and colleagues. Patients with a score of less than 42 were categorized with homologous recombination proficiency (HRP).
The researchers identified 352 patients over about 3 years for their cohort: 249 (70.7%) designated as HRP, 69 (19.6%) as HRD, and 34 (9.7%) with inconclusive results. The median progression-free survival was 35.4 months in patients with HRD ovarian cancer vs 14.9 months in those with HRP disease (P < .001). Median overall survival was not reached for HRD vs 36.2 months for HRP (P = .002). The study’s sample size limited the investigators’ ability to determine whether an increasingly higher genomic instability score above the HRP cutoff of 42 would continue to be associated with better outcomes, they explained.
Additionally, noted the authors, patients with HRP status who were treated with PARP inhibitor maintenance had lower median progression-free survival than did those who did receive this treatment (12.7 vs 15.2 months). This finding warrants further evaluation, declared the team.
Dr. Grisham and co-investigators noted that among the HRD, HRP, and inconclusive groups, similar patient characteristics included residual disease, stage, self-reported race, and upfront chemotherapy regimen. However, compared with patients who had HRP ovarian cancers, those with HRD tumors were significantly more likely to have high-grade serous histology (P < .001), to be younger at diagnosis (P < .001), and to receive PARP inhibition as part of a maintenance regimen (P < .001).
Disclosure: For full disclosures of the study authors, visit gynecologiconcology-online.net.
