Unveiling primary platinum resistant ovarian cancer: Demographic and clinical perspectives from multicenter cancer registry in India.
Authors: Singh Lakhwinder , Sehrawat Amit , N Sathya , Philips Ashwin Oommen , Panda Soumya Surath , Cyriac Sunu Lazar , Rathnam Krishnakumar , S V Saju , Moharana Lalatendu , Samantaray Lipsita , KUMAR Y SUSHEEL , Batta Nishant , Rajaram Shalini , sundriyal Deepak , Singh Ashok , P Veena , Chaturvedula Latha , Toi Pampa Ch , V C Sunitha , Ganesan Prasanth 
Published: June 2024

e17572

Background: Ovarian cancer is the third most common cancer among women in India, with 47,333 cases and 32,978 deaths reported in 2022. A significant subset (20%) of patients experience primary platinum resistance, leading to treatment failure and poor outcomes. Methods: This study, conducted between January 2022 and December 2023 across six participating Indian institutes within the Network of Oncology Clinical Trials of India (NOCI), funded by BIRAC, entailed the prospective compilation of demographic and clinical data from ovarian cancer patients within the network's cancer registry. Demographic data and clinical characteristics were summarized using descriptive statistics. The Kaplan-Meier method estimated progression-free survival (PFS) rates. The association of PFS and clinical factors was modeled using Cox proportional hazard ratios. Results: Over two years, 452 cases of advanced ovarian cancer underwent platinum-based chemotherapy as primary treatment. Among these, 97 (21.4%) patients experienced progression (72 with progressive disease, 25 deceased due to progression), with 69 (15.3%) exhibiting primary platinum-resistant disease. The median age of the primary platinum-resistant group was 52 years (range: 13-86), with a BMI of 22.9 kg/m² (15.2-34.7). Notably, 76.8% were postmenopausal, and 52.2% had an ECOG PS >2. Median CA125 levels were 720.2 U/mL (7-12000), and median hemoglobin and serum albumin values were 11.0 gm/dL (8-13) and 3.19 gm/dL (2-4.6), respectively. Epithelial ovarian cancer accounted for 89.9% of cases, with 89% presenting with stage III-IV disease. Ascites and peritoneal disease were observed in 79.9% and 71% of patients respectively. Standard platinum and taxane combination chemotherapy was administered to 81.2% of patients, with 72.1% receiving >3 cycles of platinum-based chemotherapy. However, only 26.5% of these patients underwent surgery. Notably, 92.8% of patients were unable to afford germline BRCA mutational testing, and only one patient in this cohort received PARP inhibitor maintenance therapy. The median PFS for the platinum-resistant group was 5.1 months (95% CI: 3.94-6.26) compared to 13.6 months (95% CI: 12.49-14.65) for the platinum-sensitive recurrence group, while the median overall survival (OS) was not reached in either group. Conclusions: This pioneering multicentric study sheds light on the landscape of primary platinum-resistant ovarian cancer in India, revealing critical gaps in molecular testing utilization and targeted therapeutic interventions. The findings underscore the urgent need for improved access to advanced diagnostic tools and tailored treatments in low- and middle-income countries (LMICs). Enrolling patients in clinical trials exploring diverse targeted agents is imperative to advance ovarian cancer care and enhance outcomes in these regions.