The data are in favor of these very interesting results, and if confirmed by a prospective clinical trial, they may be able to change routine practice in the future.— Isabelle Ray-Coquard, MD, PhD
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Isabelle Ray-Coquard, MD, PhD, of the Centre Leon Berard, Claude Bernard, and Professor at Claude Bernard University Lyon, France, was the study’s formal discussant. She noted the “great benefits” provided by hormonal therapy in terms of progression-free survival and, in the subset with no evidence of disease, even overall survival.
“Remember that 40% of patients did not recur with hormonal therapy,” she emphasized. The very good outcomes in patients with no evidence of disease highlight the value of optimal debulking as a positive prognostic factor, she added.
Based on a very large database with systematic histologic central review, the study addresses an unmet need, “as chemotherapy is not an optimal option in this disease,” Dr. Ray-Coquard declared.
Words of Caution
“On the other hand, it’s a retrospective study over a long period of treatment, is monocentric and therefore not reproducible, and may contain bias, as treatment was by physician choice and several different hormonal therapies were used,” Dr. Ray-Coquard continued. “The cohorts were also unbalanced for no evidence of disease, vs persistent disease, and we don’t have information on estrogen receptor/progesterone receptor and BRAF status, which are important factors.”
Since median time to relapse was delayed, more than 30 months, in patients without evidence of disease in the surveillance arm, it would be informative to have data about response rate and time to second disease progression in both arms, she added. Dr. Ray-Coquard also questioned whether bevacizumab (Avastin) might be a good control arm for patients with advanced disease, since it has been shown to improve outcomes in low-grade serous carcinoma.
Altogether, Dr. Ray-Coquard concluded, “The data are in favor of these very interesting results, and if confirmed by a prospective clinical trial, they may be able to change routine practice in the future.” ■
Disclosure: Dr. Ray-Coquard has received honoraria from AstraZeneca, PharmaMar, and Roche as well as consulted for AbbVie, Amgen, and Pfizer.
Women with stage II–IV low-grade serous carcinoma who received hormonal maintenance therapy following primary treatment had a significantly better outcome, compared with women who underwent surveillance.— David Marc Gershenson, MD
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