Identifying prognostic factors and measuring the impact of adjuvant chemotherapy in patients with sex cord stromal tumors (SCST) are challenging and must be addressed with large cohorts.
Data from 13 TMRG network centers were collected and retrospectively analysed. In 2021, a total of 469 adult patients with malignant SCST receiving upfront surgery were enrolled and survival analyses were performed.
359 (75%) patients were diagnosed with adult Granulosa cell tumors, 61 (13%) Sertoli Leydig cell tumors, and 49 (10.4%) another rare sub-type. With 6.4 years of median follow up, 154 (32.8%) patients developed first recurrence. Of them, 82 (17.5%) a second recurrence and 49 (10.4%) a third recurrence. At initial diagnosis, adjuvant chemotherapy was administered in 67 (14.7%) patients. In the relapse setting, 125 (92.6%), 51 (71.8%) and 25 (59.5%) patients underwent surgery in the first, second and third relapse respectively. At recurrence, perioperative chemotherapy was administered in 79 (58.5%), 20 (28.2%) and 10 (23.8%) patients respectively in first, second and third relapse. In first-line therapy, age less than 70 years, FIGO stage and complete surgery were associated with longer PFS. Chemotherapy use had no impact on PFS in the early stage (FIGO I-II). PFS seemed similar using BEP or other chemotherapy regimens (HR 0.88 [0.43; 1.81]) in first-line, however, at relapse BEP regimen improves survival compared to all other regimens. In case of recurrence, PFS is statistically prolonged by complete surgery (HR 0.35 [0.18; 0.71]). Perioperative chemotherapy use did not impact on PFS.
Chemotherapy use has no impact on survival in the first-line or in the relapse setting. Only surgery and its quality demonstrate benefit for PFS in ovarian SCST in the first-line and in relapses. These data supported the need of randomized trial to confirm no benefice of Chemotherapy in SCT.
Centre Léon Bérard.
Has not received any funding.
P. Pautier: Financial Interests, Personal, Advisory Board, 2015, 2022: PharmaMar; Financial Interests, Institutional, Advisory Board, 2020: Roche, Clovis; Financial Interests, Institutional, Advisory Board, 2021: AstraZeneca; Financial Interests, Personal, Advisory Board, 2019-2020: AstraZeneca; Financial Interests, Institutional, Advisory Board: GSK; Financial Interests, Personal, Advisory Board, 2018-2019: Roche; Financial Interests, Institutional, Expert Testimony, 2022: MSD. A. Floquet: Financial Interests, Personal, Other, Consultancy: GSK; Financial Interests, Institutional, Invited Speaker: AstraZeneca, Clovis Oncology; Financial Interests, Personal, Invited Speaker, French coordinator - Duo Trial: AstraZeneca; Financial Interests, Personal, Invited Speaker, French Coordinator - Mirasol Trial: Immunogen. C. Pomel: Financial Interests, Personal, Advisory Board: Roche, GSK, PharmaMar, MSD; Financial Interests, Personal, Invited Speaker: Roche, GSK, PharmaMar; Financial Interests, Personal, Expert Testimony: Roche. Y. Fernandez: Financial Interests, Personal, Advisory Board: Tesaro. T. De La Motte Rouge: Financial Interests, Personal, Advisory Board: Pfizer, AstraZeneca, GSK, Clovis Oncology, Roche, Mylan, Tesaro; Financial Interests, Institutional, Advisory Board: MSD; Financial Interests, Institutional, Research Grant: Novartis, Pfizer, MSD, Seagen; Financial Interests, Institutional, Invited Speaker: Roche, AstraZeneca, GSK, MSD, Pfizer, Netris Pharma; Non-Financial Interests, Personal, Advisory Role: French National Cancer Institute, Unicancer; Non-Financial Interests, Personal, Principal Investigator: Arcagy. F. Selle: Financial Interests, Institutional, Invited Speaker: AstraZeneca, MSD, GlaxoSmithKline-Tesaro. I.L. Ray-Coquard: Financial Interests, Personal, Advisory Board: Roche, GSK, AstraZeneca, Mersana, Deciphera, Amgen, Oxnea, Merck Serono, Agenus, Novartis, Macrogenics, Clovis, EQRX, Adaptimmune, Eisai, SUTRO, BMS, Adaptimmune, Daiichi Sankyo; Financial Interests, Institutional, Other, COLIBRI translational research: BMS; Financial Interests, Institutional, Advisory Board, translational research NEOPREMBROV trial: MSD; Non-Financial Interests, Personal, Principal Investigator: PAOLA1; Non-Financial Interests, Personal, Other, President: GINECO. All other authors have declared no conflicts of interest.