Positive long-term follow-up results from the PAOLA-1 and SOLO-1 Phase III trials of AstraZeneca and MSD’s Lynparza (olaparib) with or without bevacizumab demonstrated clinically meaningful improvements in overall survival (OS). Further results showed class-leading progression-free survival (PFS) in combination with bevacizumab for homologous recombination deficiency (HRD)-positive patients, versus active comparator, bevacizumab, and as monotherapy for patients with BRCA mutations, versus placebo, respectively.
Both trials which were conducted in biomarker-selected, newly diagnosed patients with advanced ovarian cancer in the 1st-line maintenance setting also demonstrated a consistent safety profile.1,2
The results for PAOLA-1 (Abstract #LBA29) and SOLO-1 (Abstract #517O) were presented on 9 September at the 2022 European Society of Medical Oncology (ESMO) and SOLO-1 results were published in Journal of Clinical Oncology.
Ovarian cancer is one of the most common gynaecologic cancers, with a poor prognosis and a high mortality rate.3 Over two thirds of patients are diagnosed with advanced disease, and approximately 50-70% of these patients die within five years.4,5 Up to one in five women with advanced ovarian cancer have a BRCA mutation, and roughly half of women have HRD-positive tumours (which includes those with a BRCA mutation).6-8
Professor Isabelle Ray-Coquard, principal investigator from the PAOLA-1 trial and President of the Gineco group, said: “For women facing an advanced ovarian cancer diagnosis who are HRD-positive, a targeted treatment in the 1st-line maintenance setting is critical to helping them live longer. These latest results at the five-year landmark demonstrate that olaparib with bevacizumab reduces the risk of death by 38% in HRD-positive patients compared to bevacizumab alone, further reinforcing the clinically meaningful long-term survival benefit of this combination. This should be promising news for both clinicians and patients, as we see these additional data show that this combination may allow patients more time with family and loved ones. These results also highlight the importance of biomarker testing as part of a precision medicine approach to guide treatment decisions in ovarian cancer patients.”
Professor Paul DiSilvestro, investigator from the SOLO-1 trial and Director of the Program in Women’s Oncology at Women and Infants Hospital in Providence, Rhode Island, said: “The long-term results from SOLO-1 confirm that olaparib continues to elicit a clinically meaningful improvement in overall survival in the 1st-line maintenance setting for more than seven years. Achieving long-term survival for patients with newly diagnosed advanced ovarian cancer is critical because the 1st-line setting offers the greatest potential to impact patient survival.”
Susan Galbraith, Executive Vice President, Oncology R&D, AstraZeneca, said: “Historically the five year survival rate of newly diagnosed patients with advanced ovarian cancer is 30-50%. In that context, it is phenomenal to share the long term overall survival data from both PAOLA-1 and SOLO-1, with two out of three patients still alive in these trials. We continue to believe in Lynparza’s ability to help biomarker-selected patients with advanced ovarian cancer to achieve better outcomes.”
Dr Eliav Barr, Senior Vice President, Head of Global Clinical Development and Chief Medical Officer, MSD Research Laboratories, said: “These latest data from the PAOLA-1 and SOLO-1 trials further highlight the importance of HRD testing, including for BRCA1/2 mutations, for all newly diagnosed advanced ovarian cancer patients at the point of diagnosis. Maintenance therapy with Lynparza may provide certain patients with HRD-positive and/or BRCA-mutated advanced ovarian cancer the opportunity to live longer.”
Updated results from the PAOLA-1 Phase III trial
Updated results from the PAOLA-1 Phase III trial demonstrate that Lynparza plus bevacizumab increased median overall survival to 56.5 months versus 51.6 months with bevacizumab alone, in patients with newly diagnosed advanced ovarian cancer irrespective of HRD status. This increase was not statistically significant.
In HRD-positive patients, Lynparza plus bevacizumab provided a clinically meaningful improvement in overall survival, reducing the risk of death by 38% versus bevacizumab (based on a HR of 0.62; 95% CI 0.45-0.85) despite PAOLA-1 having 30% Stage IV patients. 65.5% of patients treated with Lynparza plus bevacizumab were still alive at five years versus 48.4% of those treated with bevacizumab alone. Lynparza plus bevacizumab also improved median PFS to almost four years (46.8 months) versus 17.6 months with bevacizumab plus placebo and 46.1% of patients treated with Lynparza plus bevacizumab remain progression free at five years versus 19.2% of patients treated with bevacizumab alone. The safety and tolerability profile of Lynparza in this trial was in line with that observed in prior clinical trials, with no new safety signals.
Updated results from the SOLO-1 Phase III trial
Updated results from the SOLO-1 Phase III trial demonstrate that Lynparza provided a clinically meaningful improvement in overall survival (OS) versus placebo in patients with BRCA-mutated (BRCAm) newly diagnosed advanced ovarian cancer, reducing the risk of death by 45% (based on an HR of 0.55; 95% CI 0.40-0.76; nominal p=0.0004 [not statistically significant]). Median OS was still not reached with Lynparza versus 75.2 months with placebo. At the seven-year descriptive OS analysis, 67% of Lynparza patients were alive versus 47% of placebo patients (44% of whom had a subsequent PARP inhibitor) and 45% of Lynparza patients versus 21% of placebo patients were alive and had not received a first subsequent treatment.
Additional data showed median time to first subsequent therapy was 64 months with Lynparza versus 15.1 months with placebo. The safety and tolerability profile of Lynparza in this trial was in line with that observed in prior clinical trials, with no new safety signals.
Summary of results
