Carmine De Angelis

Trabectedin maintenance therapy after liposomal doxorubicin plus trabectedin combination in patients with relapsed ovarian cancer: the randomized, phase II TRAMANT study

TRAMANT was a multicenter, randomized phase II study assessing the non-inferiority of trabectedin (TRB) as maintenance therapy in patients with relapsed ovarian cancer who responded to initial treatment with pegylated liposomal doxorubicin (PLD) + TRB. Patients with partially platinum-sensitive recurrent ovarian cancer, defined by a platinum-free interval of 6-12 months, were randomly assigned to receive either TRB alone or continued combination therapy. The primary endpoint was progression-free survival, with secondary endpoints including overall survival, objective response rate, and quality of life assessments. Sixty-seven patients were enrolled (median age, 59 years; range; 41-74); most had International Federation of Gynecology and Obstetrics stage III disease (70%) and high-grade serous carcinoma (85%). The median time to recurrence after prior platinum therapy was 8.5 months (range; 6-12), and the median follow-up was 24 months (range; 6-44). Patients received a median of 6 cycles in both arms. Median progression-free survival was 9.8 months with TRB and 16.6 months with PLD + TRB; overall survival was comparable (19.1 vs 23.8 months). Grade 3-4 adverse events occurred in 21% (TRB) and 17% (PLD + TRB), with neutropenia and anemia being the most common toxicities. The results suggest that TRB may be a viable maintenance option for patients with relapsed ovarian cancer, providing a sustained response with favorable tolerability. Nonetheless, the small sample size underscores the need for further research to validate these findings. Studies with larger cohorts are necessary to confirm these results and optimize treatment strategies for recurrent ovarian cancer.