Jeffrey C. Goh

Durvalumab versus Physician’s Choice Chemotherapy in Recurrent Ovarian Clear Cell Adenocarcinoma (MOCCA/APGOT-OV2/GCGS-OV3): A Multicenter, Randomized, Phase 2 Trial

Abstract Purpose: The optimal treatment of recurrent ovarian clear cell carcinoma (rOCCC) remains unknown. This is the first randomized trial to compare durvalumab with chemotherapy in rOCCC. Patients and Methods: MOCCA is a randomized, phase 2 trial conducted in Singapore, Korea, and Australia. Eligible patients had rOCCC with recurrence after platinum-based chemotherapy, Eastern Cooperative Oncology Group performance status ≤2, and no prior immune checkpoint blockade. Patients were randomly assigned (2:1) to durvalumab (1,500 mg every 4 weeks) or chemotherapy. Patients progressing on chemotherapy were allowed to cross over to durvalumab. The primary outcome was progression-free survival. Secondary outcomes included overall survival, objective response rates, and safety. Results: Forty-eight eligible women were assigned to durvalumab (N = 31) or chemotherapy (N = 17). The median progression-free survival was 7.6 [95% confidence interval (CI), 7.0–16.0] and 14.0 (95% CI, 7.0–32.9) weeks with durvalumab and chemotherapy, respectively (HR = 1.6; 95% CI, 0.8–3.0; P = 0.92). The median overall survival was 37.9 (95% CI, 21.7–143.0) and 40.6 (95% CI, 25.0–not reached) weeks, respectively (HR = 1.5; 95% CI, 0.7–3.3; P = 0.85). The difference in objective response rates between the groups was not statistically significant (durvalumab 9.7% vs. physician’s choice chemotherapy 18.8%; difference −9.1%; 95% CI, −31.3% to 12.9%; P = 0.83). Fewer all-grade (35.5% vs. 68.8%) and high-grade (9.7% vs. 31.3%) treatment-related adverse events were observed for durvalumab. PD-L1 combined positive score (CPS)+ was observed in 28.9% (CPS ≥1%) and 10.5% (CPS ≥10%) of patients. PIK3CA mutations were associated with time to progression on durvalumab ≥12 weeks [relative risk (mutated vs. wild-type) 2.83; 95% CI, 1.16–14.17]. Conclusions: Durvalumab was well-tolerated but did not improve efficacy outcomes compared with chemotherapy in rOCCC.

Metastatic Cervical Cancer in the Asia-Pacific Region: Current Treatment Landscape and Barriers

Abstract Despite treatment advances for metastatic cervical cancer (mCC), the Asia-Pacific region faces significant barriers in treatment accessibility, availability, and healthcare infrastructure. This study explored the treatment landscape and barriers for mCC in the Asia-Pacific. A descriptive, cross-sectional, web-based study evaluating cervical cancer treatment patterns was conducted among medical, radiation, and gynecologic oncologists and gynecologists in the Chinese mainland (n = 80), Australia, the Philippines, South Korea, and Taiwan (n = 20 each). Eligible respondents were primarily involved in direct patient care (≥60%) and were key treatment deciders with ≥5 years of experience. Among patients with cervical cancer of 160 physicians, 10.9% had metastatic disease, of which 50.3% were aged 41 to 60 years and had Eastern Cooperative Oncology Group scores of 0 to 2 (78.7%). Top treatment modalities included systemic therapy (ST) alone (43.6%) and radiotherapy + ST (33.4%). Top first-line regimens were carboplatin/cisplatin + paclitaxel ± bevacizumab (42.3% and 33.1%, respectively), and the top second-line treatment regimens were carboplatin + paclitaxel + bevacizumab (12.0%) and cisplatin + paclitaxel + bevacizumab (11.5%). PD-L1 testing was more common in South Korea (80.8%) than in the Chinese mainland (48.8%) and Taiwan (26.4%). Treatment drivers included National Comprehensive Cancer Network guidelines (82.7%), disease stage (87.4%), Eastern Cooperative Oncology Group status (83.5%), comorbidities (59.1%), drug efficacy (88.2%), safety (84.3%), and accessibility (66.9%). Treatment challenges included poor prognosis (26.8%), patient affordability (21.3%), and limited treatment option availability (19.7%). In bevacizumab-reimbursed locations, patient tolerability and insufficient medical resources persisted. In conclusion, approximately 11% of cervical cancer cases were metastatic. Treatment preferences were radiotherapy and ST, with funding, cost, accessibility, and availability challenges. Policies supporting reimbursement and accessibility could encourage the adoption of effective alternative therapies. Significance: The findings offer valuable insights about current treatments and the related unmet needs in funding, cost, accessibility, and availability across the Asia-Pacific region. These further highlight areas of importance and the need for implementing reimbursement policies and enhancing accessibility to support the adoption of effective, advanced treatments.