Overall survival with relacorilant and nab-paclitaxel in patients with platinum-resistant ovarian cancer (ROSELLA): a phase 3 randomised controlled trial

Clinical Snapshot

Key Findings

• P Value: p=0.0004

• Effect Size: 4.1-month median overall survival improvement; 19% absolute improvement in 18-month survival (46% vs 27%)

• Primary Outcome: Overall survival: median 16.0 months (relacorilant combination) vs 11.9 months (nab-paclitaxel monotherapy)

• Nnt Or Sensitivity: NNT approximately 5 for preventing one death at 18 months (based on 19% absolute risk reduction)

• Confidence Interval: HR 0.65 (95% CI 0.51-0.83)

Clinical Application

Requires oral relacorilant administration around IV nab-paclitaxel schedule, manageable in standard oncology practice with appropriate monitoring for haematological toxicity Relevant to Australian practice where platinum-resistant ovarian cancer represents significant unmet need. TGA approval would be required for relacorilant. PBS listing considerations would need cost-effectiveness evaluation given survival benefit. Patients with platinum-resistant ovarian cancer who have received 1-3 previous therapy lines, particularly those who have received bevacizumab and/or PARP inhibitors

Abstract

BACKGROUND: Relacorilant is a selective glucocorticoid receptor antagonist that increases the sensitivity of many cancer cell types to chemotherapy. The efficacy and safety of relacorilant plus nab-paclitaxel were assessed in the phase 3 ROSELLA (GOG-3073, ENGOT-ov72, APGOT-Ov10, and LACOG-0223) trial; the combination showed significant improvement in progression-free survival among patients with platinum-resistant ovarian cancer compared with nab-paclitaxel monotherapy. Results of the final overall survival analysis are reported here. METHODS: In this open-label phase 3 trial, patients were randomly assigned 1:1 to receive relacorilant (150 mg orally the day before, day of, and day after nab-paclitaxel infusion) plus nab-paclitaxel (80 mg/m2 intravenously on days 1, 8, and 15 of each 28-day cycle) or nab-paclitaxel monotherapy (100 mg/m2 intravenously on the aforementioned schedule). Patients, aged 18 years or older, with one to three lines of previous anticancer therapy and platinum-resistant disease (progression <6 months from their last dose of platinum) were eligible. The trial was conducted at 117 hospitals and community oncology centres in 14 countries across Australia, Europe, Latin America, North America, and South Korea. Progression-free survival, assessed by blinded independent central review, and overall survival (time from randomisation to death from any cause) were dual primary endpoints. Additional prespecified endpoints included safety, second progression-free survival (time from randomisation to disease progression on subsequent anticancer therapy or death due to any cause, whichever occurred first), and patient-reported outcomes. This trial is registered at ClinicalTrials.gov, NCT05257408, and is ongoing. FINDINGS: Between Jan 5, 2023, and April 8, 2024, 381 patients were randomly assigned to the relacorilant combination group (n=188) or the nab-paclitaxel monotherapy group (n=193). All patients had received bevacizumab; 167 (44%) had received three previous lines of therapy, and 234 (61%) had received a poly(ADP-ribose) polymerase inhibitor. At a median follow-up of 24·8 months (95% CI 23·6-25·7), the addition of relacorilant to nab-paclitaxel resulted in a statistically and clinically significant improvement in overall survival compared with nab-paclitaxel monotherapy (hazard ratio for death 0·65 [95% CI 0·51-0·83]; p=0·0004); 18-month overall survival was 46% and 27%, respectively. The median overall survival in the relacorilant combination group was extended by 4·1 months compared with the nab-paclitaxel monotherapy group (16·0 [95% CI 13·0-18·3] vs 11·9 months [10·0-13·8]). Subsequent anticancer treatments were similar across study groups. Adverse events were similar in both groups when adjusted for duration of study treatment. Neutropenia (121 [64%]), anaemia (115 [61%]), fatigue (101 [54%]), and nausea (82 [44%]) were the most common adverse events in the relacorilant combination group. No new safety signals were observed with additional follow-up since the primary analysis. INTERPRETATION: The addition of relacorilant to nab-paclitaxel led to significantly longer overall survival in patients with platinum-resistant ovarian cancer, without the need for biomarker selection. The findings support relacorilant plus nab-paclitaxel as a potential new standard treatment option for patients with platinum-resistant ovarian cancer. FUNDING: Corcept Therapeutics.

References

1. 1.Lorusso, D., Gladieff, L., O'Malley, D. M., Kim, J.-W., Garbaos, G., Fagotti, A., Gilbert, L., Mileshkin, L., Quesada, S., Hopp, E., Lee, Y. J., Oaknin, A., Scaranti, M., Kim, B.-G., Clamp, A., Prillaman, C., Diakos, C., Bagaméri, A., Leiser, A. L., ... Olawaiye, A. B. (2026). Overall survival with relacorilant and nab-paclitaxel in patients with platinum-resistant ovarian cancer (ROSELLA): a phase 3 randomised controlled trial. *Lancet*, Article 10.1016/S0140-6736(26)00462-9. https://doi.org/10.1016/S0140-6736(26)00462-9