Dr Chon on Durvalumab Plus Chemotherapy and Olaparib in Endometrial Cancer

Hye Sook Chon, MD, gynecologic oncologist, Gynecologic Oncology Program, Moffitt Cancer Center, discusses updated findings from the phase 3 DUO-E trial (NCT04269200) of frontline durvalumab (Imfinzi) plus carboplatin and paclitaxel followed by durvalumab with or without olaparib (Lynparza) in patients with advanced or recurrent endometrial cancer.

DUO-E enrolled patients with newly diagnosed International Federation of Gynecology and Obstetrics 2009 stage III or IV or recurrent endometrial cancer. The primary end point of the DUO-E trial was progression-free survival (PFS); overall response rate (ORR) and duration of response (DOR) served as key secondary end points.

In the intent-to-treat population, the median PFS was 15.1 months (95% CI, 12.6-20.7) with durvalumab plus chemotherapy andolaparib (n = 239) compared with 10.2 months (95% CI, 9.7-14.7) in the durvalumab and chemotherapy arm (n = 238; HR, 0.78; 95% CI, 0.61-0.99) and 9.6 months (95% CI, 9.0-9.9) in the chemotherapy alone arm (n = 241; HR, 0.55; 95% CI, 0.43-0.69; 

 < .0001). The HR between the durvalumab plus chemotherapy arm and the chemotherapy alone arm was 0.71 (95% CI, 0.57-0.89; 

 = .003). The 18-month PFS rates with durvalumab plus chemotherapy and olaparib, durvalumab and chemotherapy, and chemotherapy alone were 46.3%, 37.8%, and 21.7%, respectively.

The ORR was 63.6% in the durvalumab/chemotherapy/olaparib arm, including a 16.3% complete response (CR) rate. The respective ORRs in the durvalumab plus chemotherapy and chemotherapy alone arms were 61.9%, including a 12.9% CR rate, and 55.1%, including a 9.6% CR rate. The odds ratio between the durvalumab and olaparib arm vs the chemotherapy alone arm was 1.44 (95% CI, 0.95-2.18); this value was 1.32 (95% CI, 0.89-1.98) between the durvalumab plus chemotherapy and chemotherapy alone arms.

The median DORs in the durvalumab/chemotherapy/olaparib, durvalumab/chemotherapy, and chemotherapy alone arms were 21.3 months (IQR, 8.1-29.9), 13.1 months (IQR, 6.0-NR), and 7.7 months (IQR, 5.1-13.5), respectively. At 24 months, 47.1%, 38.0%, and 14.8% of patients in these respective arms remained on treatment.

Videos

Hye Sook Chon, MD, discusses the DUO-E trial of frontline durvalumab plus chemotherapy followed by durvalumab and olaparib in endometrial cancer.

Hye Sook Chon, MD, gynecologic oncologist, Moffitt Cancer Center, discusses challenges that are still faced in the maintenance setting in advanced ovarian cancer.

Frontline maintenance strategies are relatively new to the field of ovarian cancer, says Chon. Although PARP inhibitors have been shown to prolong progression-free survival when used as frontline maintenance therapy, the cost-effectiveness, toxicities, and quality of life (QoL) with these agents must also be considered. Typically, at this juncture, patients have already received surgery and chemotherapy, and posing the suggestion to begin maintenance treatment after they believed they were done with therapy is not easy, says Chon.

As long as patients tolerate their chemotherapy relatively well, it’s best to discuss the potential for maintenance therapy sooner rather than later. Patients expect to complete treatment following chemotherapy, but many of them may benefit from maintenance therapy, explains Chon. As such, patients who are counseled on the potential for maintenance therapy during their chemotherapy are less overwhelmed when the time comes for additional treatment, concludes Chon.

Hye Sook Chon, MD

Articles

Dr Chon on Durvalumab Plus Chemotherapy and Olaparib in Endometrial Cancer

Dr. Chon on Challenges With Maintenance Therapy in Ovarian Cancer