Epithelial ovarian cancer and brain metastases: might theBRCAstatus, PARP inhibitor administration, and surgical treatment impact the survival?

Abstract

ObjectiveTo evaluate disease characteristics and survival according toBRCAstatus, administration of poly-(ADP-ribose) polymerase inhibitors (PARPi), and surgery in patients with ovarian cancer and brain metastases.MethodsThis is a monocentric retrospective cohort of patients with ovarian cancer and brain metastases treated between 2000 and 2021. Data were collected by a retrospective review of medical records and analyzed according to: (1)BRCAmutation; (2) PARPi before and after brain metastases; (3) surgery for brain metastases.ResultsEighty-five patients with ovarian cancer and brain metastasis and knownBRCAstatus (31BRCAmutated (BRCAm), 54BRCAwild-type (BRCAwt)) were analyzed. Twenty-two patients had received PARPi before brain metastases diagnosis (11BRCAm, 11BRCAwt) and 12 after (8BRCAm, 4BRCAwt). Brain metastases occurred >1 year later in patients who had received previous PARPi. Survival was longer in theBRCAm group (median post-brain metastasis survival:BRCAm 23 months vsBRCAwt 8 months, p=0.0015). No differences were found based onBRCAstatus analyzing the population who did not receive PARPi after brain metastasis (median post-brain metastasis survival:BRCAm 8 months vsBRCAwt 8 months, p=0.31). In theBRCAm group, survival was worse in patients who had received previous PARPi (median post-brain metastasis survival: PARPi before, 7 months vs no-PARPi before, 24 months, p=0.003). If PARPi was administered after brain metastases, survival of the overall population improved (median post-brain metastasis survival: PARPi after, 46 months vs no-PARPi after, 8 months, p=0.00038).In cases of surgery for brain metastases, the prognosis seemed better (median post-brain metastasis survival: surgery 13 months vs no-surgery 8 months, p=0.036). Three variables were significantly associated with prolonged survival at multivariate analysis:BRCAmutation, multimodal treatment, and ≤1 previous chemotherapy line.ConclusionsBRCAmutations might impact brain metastasis occurrence and lead to better outcomes. In a multimodal treatment, surgery seems to affect survival even in cases of extracranial disease. PARPi use should be considered as it seems to prolong survival if administered after brain metastasis.