Gorodnova, T. V., Sokolenko, A. P., Kotiv, K. B., Ivantsov, A. O., Kondratyev, S. V., Berlev, I. V., & Imyanitov, E. N. (2024). Platinum Resistance after Neoadjuvant Chemotherapy. Voprosy Onkologii, 70(1), 82–87. https://doi.org/10.37469/0507-3758-2024-70-1-82-87

Abstract

Introduction. In BRCA1-associated ovarian carcinomas, platinum resistance may occur already during neoadjuvant chemotherapy due to selection and repopulation of cells with reduced or partially preserved DNA mismatch repair function. The use of platinum-free adjuvant chemotherapy (ACT) in patients without loss of BRCA1 heterozygosity in residual tumor (noLOH) may improve the outcomes of combination treatment for patients with advanced ovarian cancer. Aim. To analyze the results of using platinum-free ACT based on the doxorubicin and paclitaxel (AT) regimen in patients without loss of BRCA1 heterozygosity in the residual tumor within the framework of a prospective randomized trial.

Materials and Methods. The prospective clinical trial NCT04747717 included 22 patients in the mitomycin C and cisplatin (MP) group and 15 patients randomized to the group with paclitaxel and carboplatin (TCbP) standart of treatment. Two patients from the MP group received a combination of AT in the adjuvant regimen.

Results. MR group showed restoration of BRCA1 heterozygosity in the residual tumor tissue in 5/18 (28 %) patients, whereas in TCbP group, BRCA1 noLOH status was observed in 3/10 (30 %) patients. Both patients who were treated with the adjuvant platinum-free AT regimen were in clinical remission of 41 and 17 months at the time of outcome assessment.

Conclusion. Switching chemotherapy in the postoperative period to platinum-free regimens in patients with changes in LOH status is a promising approach to the treatment of BRCA1-associated ovarian carcinomas.

https://doi.org/10.37469/0507-3758-2024-70-1-82-87

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