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Multimodal screening can lead to earlier diagnosis of high-grade serous ovarian cancer and improve short-term treatment outcomes, but this does not translate to a substantial improvement in survival, according to researchers.
The researchers found that patients with high-grade serous ovarian cancer were less likely to be diagnosed with advanced disease if they underwent annual multimodal screening. However, the potential survival benefit of this screening was “small,” according to the researchers. They reported these findings in The Lancet Oncology.
This trial (UKCTOCS; ClinicalTrials.gov Identifier: NCT00058032) included 202,562 postmenopausal women (aged 50-74 years) from the general population. They were randomly assigned 2:1:1 to no ovarian cancer screening (n=101,314), annual multimodal screening (n=50,625), or annual screening with ultrasound (n=50,623).
In this exploratory analysis, the researchers looked specifically at the 1209 patients diagnosed with high-grade serous ovarian cancer — 259 patients (0.5%) in the multimodal screening group, 250 (0.5%) in the ultrasound screening group, and 520 (0.5%) in the no-screening group.
The researchers mainly compared patients who underwent multimodal screening to those who did not undergo screening. Patients in the multimodal screening group were less likely than those in the no-screening group to be diagnosed with advanced-stage disease — 75% and 86%, respectively (P =.0003).
Patients in the multimodal screening group were more likely than those in the no-screening group to:
- Undergo primary surgery (61% and 42%, respectively; P <.0001)
- Have no residual disease after debulking surgery (46% vs 30%; P <.0001)
- Receive primary treatment that included both surgery and chemotherapy (74% vs 64%; P =.003).
There was no significant difference between the multimodal screening group and the no-screening group for receipt of first-line combination chemotherapy (55% and 56%, respectively; P =.69).
The median follow-up was 9.4 years in the multimodal screening group and 9.5 years in the no-screening group. The 5-year overall survival (OS) rate was 83% in both the multimodal screening group and the no-screening group (absolute difference, -0.3%; 95% CI, -5.6 to 5.3). The 10-year OS rate was 46% and 45%, respectively (absolute difference, 1.5%, 95% CI -5.9 to 9.0).
The 15-year OS rate was 24% in the multimodal screening group and 18% in the no-screening group (absolute difference, 6.7%; 95% CI, 0.40 to 13.0). The 18-year OS rate was 21% and 14%, respectively (absolute difference, 6.9%; 95% CI, 0.61 to 13.2).
When the researchers repeated this analysis using all randomized patients as the denominator, there was no difference in OS between the multimodal screening group and the no-screening group.
The researchers also noted that there were no differences between the ultrasound screening group and the no-screening group for any of the comparisons.
“At present, general population screening for ovarian cancer cannot be recommended because there was no mortality benefit in UKCTOCS,” the researchers wrote. “However, to our knowledge, the trial provides the first evidence that screening can detect high-grade serous tubo-ovarian cancer earlier than no screening and improve short-term treatment outcomes.”
“The potential survival benefit was small, most likely due to modest gains in early detection and treatment improvement,” the researchers added. “This suggests that newer technologies that can detect more women with high-grade serous cancer earlier, coupled with treatment improvements and a better understanding of tumor biology, are likely to achieve a mortality benefit. The cumulative results of the trial findings suggest that surrogate endpoints for disease-specific mortality are currently unreliable in ovarian cancer screening trials.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Menon U, Gentry-Maharaj A, Burnell M, et al. Tumour stage, treatment, and survival of women with high-grade serous tubo-ovarian cancer in UKCTOCS: An exploratory analysis of a randomised controlled trial. Lancet Oncol. Published online September 2023. doi:10.1016/S1470-2045(23)00335-2
This article originally appeared on Cancer Therapy Advisor
