Survival differences in advanced gynecological cancers after the development of immune checkpoint inhibitors and targeted therapy: United States SEER-based population study.

Abstract

e17652 Background: Immune checkpoint inhibitors (ICI) are being used for advanced gynecological cancers (cervix, endometrium, and ovary). Antiangiogenic (AA) agents/chemotherapy (Chem) and PARP inhibitors (PARPi) were approved in 2014. ICI was approved in 2017. ICI±AA/PARPi/Chem (comb) has been used since 2017. We aim to study survival differences before and after these approvals. Methods: We used Surveillance, Epidemiology and End Results (SEER) research plus database (Nov 2024 submission,17 registries). Patients aged ≥ 20 years; all histology of cervix, uterus and ovarian cancer with “distant” (combined summary stage) from 2011 to 2019 were included. Time was stratified as 2011-2013, 2014-2016, 2017-2019. OS in these time periods was calculated using Kaplan Meier (KM) method and was compared with log rank tests. Multivariate analysis was done using cox proportional hazard ratios, and p < 0.05 was considered for statistical significance. IBM SPSS was used for analysis. Results: Out of 36535 patients, 4172 had cervical cancer, 9832 had endometrial cancer, and 22531 had ovarian cancer. All years of diagnosis had 5-year survival except for 2019, which had 4-year survival. The survival difference among three timelines was statistically significant (log rank test, χ2 = 8.128, p=0.017). Stratified analysis showed cervical cancer (χ2 = 7.781, p = 0.020) and endometrial cancer (χ2 = 11.36, p = 0.003) had improved survival except ovarian cancer (χ2 = 0.615, p=0.735), across these timelines. On multivariate analysis, 2011-2013 had a significantly higher risk of dying compared to 2017-2019. 2014-2016 had no significant difference in risk of dying compared to 2017-2019 (see table). Conclusions: In this population-based study, use of ICI showed survival benefits in advanced gynecological cancers of cervical and uterine origin, supporting clinical trials. Increased mortality risk in non-Hispanic Black race, older age ≥40 years, divorced/widowed status should guide further measures. Elevated CA125 increases mortality risk. Survival in ovarian cancer is not promising, but future analysis with new databases that include recent trials will help show changing survival. Multivariate analysis. Variables HR (95% CI) p-value Age <40 y 0.629 (0.591-0.669) <0.001 ≥40 y Ref Year group 2011-2013 1.043 (1.012-1.074) 0.006 2014-2016 1.028 (0.998-1.059) 0.064 2017-2019 Ref Race/origin Non-Hispanic White Ref Non-Hispanic Black 1.271 (1.228-1.316) <0.001 Non-Hispanic Asian/Pacific Islander 0.839 (0.803-0.876) <0.001 Hispanic 0.898 (0.869-0.929) <0.001 Chemotherapy Yes 0.38 (0.37-0.39) <0.001 No/unknown Ref CA125 status (Ovary) Positive/Elevated 1.182 (1.028-1.360) 0.019 Negative Ref Marital status Single/unmarried 0.923 (0.868-0.981) 0.01 Married 0.794 (0.749-0.842) <0.001 Divorced/widowed 1.128 (1.063-1.198) <0.001 Unknown Ref