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Lampert EJ, Rose PG, Yao M, DeBernardo R, Vargas RJ, Michener CM, Chambers LM. Efficacy and toxicity of carboplatin and gemcitabine administered on day 1 and day 8 (day1&8) versus day 1-only for platinum-sensitive recurrent epithelial ovarian cancer. Int J Gynecol Cancer 2023:ijgc-2022-004199. [PMID: 37024239 DOI: 10.1136/ijgc-2022-004199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE To compare response rate, progression-free survival, overall survival, and toxicity of carboplatin and gemcitabine administered on day 1 and day 8 (day1&8) versus a modified day 1-only regimen in recurrent platinum-sensitive ovarian cancer. METHODS A retrospective single-institution cohort study was performed in women with recurrent platinum-sensitive ovarian cancer between January 2009 and December 2020 treated with carboplatin and gemcitabine on a 21-day cycle. The impact of dosing schedule on response rate, progression-free survival, overall survival, and toxicities was assessed with univariate and multivariate models. RESULTS Of 200 patients, 26% (n=52) completed day 1&8, 21.5% (n=43) started day 1&8 but dropped day 8, and 52.5% (n=105) received day 1-only. There were no differences in demographics. Median starting carboplatin and gemcitabine doses were area under curve (AUC) 5 and 600 mg/m2 for day 1-only versus AUC4 and 750 mg/m2 among day 1&8, respectively (p<0.001). A total of 43 patients (45.3%) dropped day 8 primarily due to neutropenia (51.2%) or thrombocytopenia (30.2%). The response rates were 69.3% for day 1&8-completed, 67.5% for day 1&8-dropped, and 67.6% for day 1-only (p=0.92). Median progression-free survival was 13.1, 12.1, and 12.4 months for day 1&8-completed, day 1&8-dropped, and day 1-only, respectively (p=0.29). Median overall survival was 28.2, 33.5, and 34.3 months for the above groups (p=0.42). The rate of grade 3/4 hematologic toxicity (48.9% vs 31.4%, p=0.002), dose reductions (58.9% vs 33.7%, p<0.001), blood transfusions (22.1% vs 10.5%, p=0.025), and treatment with pegfilgrastim (64.2% vs 51%, p=0.059) were higher among day 1&8 versus day 1-only, respectively. CONCLUSIONS There was no difference in response rate, progression-free survival, or overall survival for day 1&8 versus day 1-only, regardless of whether day 8 was dropped. Day 1&8 was associated with greater hematologic toxicity. A modified day 1-only regimen may represent an alternative to day 1&8 and warrants prospective study.
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Affiliation(s)
- Erika J Lampert
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter G Rose
- Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Meng Yao
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert DeBernardo
- Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Roberto J Vargas
- Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chad M Michener
- Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura M Chambers
- Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio, USA
- Division of Gynecologic Oncology, The Ohio State University, Columbus, Ohio, USA
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Insights into ovarian cancer: chemo-diversity, dose depended toxicities and survival responses. Med Oncol 2023; 40:111. [PMID: 36871128 DOI: 10.1007/s12032-023-01976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/09/2023] [Indexed: 03/06/2023]
Abstract
Ovarian cancer has been one of the serious concerns for female health and medicinal practitioner all over the world. The wellness of over cancer patient is associated with survival responses which depends on many factors including chemotherapeutic diversity; treatment protocol; dose-dependent toxicity such as hematological toxicity and non-hematological toxicity. We found that the studied treatment regimens (TRs) (1-9) showed varying degree of hematological toxicities like moderate neutropenia (< 20%) critical neutropenia (> 20%), negligible leucopenia, critical leucopenia (> 20%), moderate thrombocytopenia (< 20%), critical thrombocytopenia (> 20%), moderate anemia (< 20%) and critical anemia (> 20%). The studied TRs showed varying degree of non-hematological toxicities like moderate nausea-vomiting (< 20%), critical nausea-vomiting (> 20%), moderate alopecia (< 20%), critical alopecia (> 20%), moderate fatigue (< 20%), critical fatigue (> 20%), moderate neurotoxicity (< 20%), critical neurotoxicity (> 20%), moderate diarrheas (< 20%). The studied TRs showed varying degree of survival responses like critical partial response (> 35%), remarkable overall responses (> 60%), critical overall responses (< 60%), remarkable stable disease (> 20%), critical stable disease (< 20%) and moderate progressive disease (< 20%). Out of the studied TRs 1-9, in case of TR 6, moderate non-hematological toxicity (NHT) and effective survival response (SR) is being diluted by critical hematological toxicity (HT). On the other hand, TR 8, 9 is showing critical HT, NHT and SR. Our analysis revealed that the toxicity of the existing therapeutic agents can be controlled through judicious decision of drug administration cycles and combination therapies.
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Baert T, Ferrero A, Sehouli J, O'Donnell DM, González-Martín A, Joly F, van der Velden J, Blecharz P, Tan DSP, Querleu D, Colombo N, du Bois A, Ledermann JA. The systemic treatment of recurrent ovarian cancer revisited. Ann Oncol 2021; 32:710-725. [PMID: 33675937 DOI: 10.1016/j.annonc.2021.02.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
Treatment approaches for relapsed ovarian cancer have evolved over the past decade from a calendar-based decision tree to a patient-oriented biologically driven algorithm. Nowadays, platinum-based chemotherapy should be offered to all patients with a reasonable chance of responding to this therapy. The treatment-free interval for platinum is only one of many factors affecting patients' eligibility for platinum re-treatment. Bevacizumab increases the response to chemotherapy irrespective of the cytotoxic regimen and can be valuable in patients with an urgent need for symptom relief (e.g. pleural effusion, ascites). For patients with recurrent high-grade ovarian cancer, which responds to platinum-based treatment, maintenance therapy with a poly(ADP-ribose) polymerase inhibitor can be offered, regardless of the BRCA mutation status. Here we review contemporary decision-making processes in the systemic treatment of relapsed ovarian cancer.
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Affiliation(s)
- T Baert
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany; Department of Oncology, KU Leuven, Leuven, Belgium.
| | - A Ferrero
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, Mauriziano Hospital, Turin, Italy
| | - J Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité-University hospital Berlin, Berlin, Germany
| | - D M O'Donnell
- Department of Oncology, St. James's Hospital, Dublin, Ireland
| | - A González-Martín
- Medical Oncology Department, Clínica Universidad de Navarra University Hospital, Madrid, Spain
| | - F Joly
- Department of Oncology, Centre Francois Baclesse, Caen, France
| | - J van der Velden
- Department of Medical Oncology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - P Blecharz
- Department of Gynecologic Oncology, Center of Oncology, M. Sklodowska-Curie Institute, Krakow, Poland
| | - D S P Tan
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - D Querleu
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - N Colombo
- Department of Medicine and Surgery, European Institute of Oncology IRCCS, Milan, Italy; University of Milan-Bicocca, Milan, Italy
| | - A du Bois
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - J A Ledermann
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
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A phase II randomized controlled study of pegylated liposomal doxorubicin and carboplatin vs. gemcitabine and carboplatin for platinum-sensitive recurrent ovarian cancer (GOTIC003/intergroup study). Int J Clin Oncol 2019; 24:1284-1291. [DOI: 10.1007/s10147-019-01471-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/15/2019] [Indexed: 11/25/2022]
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A phase I pharmacokinetic and pharmacodynamic study of GTI-2040 in combination with gemcitabine in patients with solid tumors. Cancer Chemother Pharmacol 2018; 82:533-539. [PMID: 30022224 DOI: 10.1007/s00280-018-3647-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE GTI-2040 is a novel antisense oligonucleotide inhibitor of the R2 subunit of ribonucleotide reductase. This phase I study assessed safety and maximum tolerated dose (MTD) of GTI-2040 in combination with weekly gemcitabine in patients with advanced solid tumors. METHODS GTI-2040 was given as a 14-day continuous intravenous infusion, while gemcitabine was administered on days 1, 8, and 15. This combination was repeated every 4 weeks and study followed a modified 3 + 3 Fibonacci schema. Incidence, severity of adverse events, pharmacokinetics (PK), and pharmacodynamics (PD) was assessed. Responses were assessed using RECIST criteria version 1.0 with CT scans performed after every other cycle. RESULTS A total of 16 patients received at least one dose of GTI-2040/gemcitabine and were included in the safety analysis. The MTD of this regimen is 100 mg/m2/day of GTI-2040 over 14 days combined with 400 mg/m2/day of gemcitabine administered weekly on days 1, 8, and 15. The dose-limiting toxicities (DLTs) included grade 3 fatigue and thrombocytopenia with hematemesis (both at 100/600 mg/m2/day). The most common adverse events were grade 1/2 fatigue, nausea, vomiting, diarrhea, and anorexia. There was no evidence of alteration in gemcitabine PKs. PD modulation of R2mRNA expression in peripheral blood mononuclear cells was observed. No objective tumor response was observed although stable disease was seen in 25% patients. CONCLUSIONS The combination of GTI-2040 and gemcitabine has an acceptable safety profile in a heavily pre-treated patient population with advanced solid tumors. No clear signal of anti-tumor activity was observed; however, several patients had prolonged stable disease.
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Poon C, Duan X, Chan C, Han W, Lin W. Nanoscale Coordination Polymers Codeliver Carboplatin and Gemcitabine for Highly Effective Treatment of Platinum-Resistant Ovarian Cancer. Mol Pharm 2016; 13:3665-3675. [PMID: 27712076 PMCID: PMC5673481 DOI: 10.1021/acs.molpharmaceut.6b00466] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Due to the ability of ovarian cancer (OCa) to acquire drug resistance, it has been difficult to develop efficient and safe chemotherapy for OCa. Here, we examined the therapeutic use of a new self-assembled core-shell nanoscale coordination polymer nanoparticle (NCP-Carbo/GMP) that delivers high loadings of carboplatin (28.0 ± 2.6 wt %) and gemcitabine monophosphate (8.6 ± 1.5 wt %). A strong synergistic effect was observed between carboplatin and gemcitabine against platinum-resistant OCa cells, SKOV-3 and A2780/CDPP, in vitro. The coadministration of carboplatin and gemcitabine in the NCP led to prolonged blood circulation half-life (11.8 ± 4.8 h) and improved tumor uptake of the drugs (10.2 ± 4.4% ID/g at 24 h), resulting in 71% regression and 80% growth inhibition of SKOV-3 and A2780/CDDP tumors, respectively. Our findings demonstrate that NCP particles provide great potential for the codelivery of multiple chemotherapeutics for treating drug-resistant cancer.
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Affiliation(s)
| | | | - Christina Chan
- Department of Chemistry, University of Chicago, 929 East 57th Street, Chicago, Illinois 60637, United States
| | - Wenbo Han
- Department of Chemistry, University of Chicago, 929 East 57th Street, Chicago, Illinois 60637, United States
| | - Wenbin Lin
- Department of Chemistry, University of Chicago, 929 East 57th Street, Chicago, Illinois 60637, United States
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Hefner J, Csef H. The Clinical Relevance of Beta Blockers in Ovarian Carcinoma: A Systematic Review. Geburtshilfe Frauenheilkd 2016; 76:1050-1056. [PMID: 27761025 DOI: 10.1055/s-0042-115016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The last ten years have seen hardly any improvement in the prognosis of ovarian carcinoma. There is a great need for new treatment strategies, and a recent retrospective study showing a survival advantage with the use of beta blockers met with a very positive response. This systematic review summarizes the current state of knowledge and research on the topic: A database analysis identified six clinical studies showing inconsistent results with respect to the administration of beta blockers and disease course. The 13 preclinical studies identified showed almost without exception both that catecholamines had detrimental effects on tumour progression, and that these effects could be influenced by pharmacological blockade. Overall the available evidence does not justify the use of beta blockers in clinical practice for ovarian carcinoma at the present time. This article also outlines details of research design required for further studies needed on the subject. Preclinical research findings are however very impressive: They not only form an important basis for the development of future clinical studies but also, through revealing new pathomechanisms, they already make an important contribution towards the development of new treatment strategies for ovarian carcinoma.
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Affiliation(s)
- J Hefner
- Arbeitsbereich Psychosomatische Medizin und Psychotherapie, Medizinische Klinik und Poliklinik II, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - H Csef
- Arbeitsbereich Psychosomatische Medizin und Psychotherapie, Medizinische Klinik und Poliklinik II, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
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Matulonis U, Berlin S, Lee H, Whalen C, Obermayer E, Penson R, Liu J, Campos S, Krasner C, Horowitz N. Phase I study of combination of vorinostat, carboplatin, and gemcitabine in women with recurrent, platinum-sensitive epithelial ovarian, fallopian tube, or peritoneal cancer. Cancer Chemother Pharmacol 2015; 76:417-23. [PMID: 26119093 DOI: 10.1007/s00280-015-2813-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/17/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Combining histone deacetylase inhibitors and chemotherapy is synergistic. This phase I study combined escalating vorinostat doses with constant doses of carboplatin and gemcitabine for the treatment of recurrent platinum-sensitive ovarian cancer. The objectives of this study were to determine the maximally tolerated dose of this combination; secondary objectives included preliminary response rate of this regimen and toxicity profile. METHODS Fifteen patients with relapsed ovarian cancer were enrolled into this phase I study. Doses of carboplatin and gemcitabine were AUC 4 on day 1 and 1000 mg/m(2) on days 1 and 8, respectively; cycles were administered every 21 days. Vorinostat was tested using four different schedules. The first dose level (DL A) tested vorinostat as daily oral dosing from days 1 to 14. DL B tested twice daily (BID) vorinostat dosing on days 1-3 and 8-10. DL C tested BID vorinostat dosing on days 1, 2, 8, and 9, starting vorinostat 1 day prior to initiation of carboplatin and gemcitabine, and DL D tested vorinostat on days 1 and 2 with chemotherapy starting on day 2. RESULTS All four DLs tested resulted in dose-limiting toxicities, and no MTD was determined. Toxicities were mostly hematologic. Seven patients were evaluable for RECIST assessment, and six of them had partial responses (PR) via RECIST. CONCLUSIONS Combination of carboplatin, gemcitabine, and vorinostat has activity in relapsed platinum-sensitive ovarian cancer, but was difficult to combine because of hematologic toxicities in this phase I study. No maximally tolerated dose was found, and the study was terminated early.
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Affiliation(s)
- Ursula Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA,
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Kose MF, Meydanli MM, Tulunay G. Gemcitabine plus carboplatin in platinum-sensitive recurrent ovarian carcinoma. Expert Rev Anticancer Ther 2014; 6:437-43. [PMID: 16503860 DOI: 10.1586/14737140.6.3.437] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although the general intent of treatment for patients with recurrent ovarian cancer is palliative, and cure does not seem to be a realistic objective in this setting, median overall survival is greater than 12 months in platinum-sensitive recurrent ovarian cancer. Patients with ovarian cancer can now expect that the time from first relapse of their disease to death will be longer than the period from diagnosis to that first relapse. There is current evidence from prospective randomized trials that carboplatin combined with either paclitaxel or gemcitabine confers a progression-free survival advantage over platinum monotherapy for patients with platinum-sensitive relapsed ovarian cancer. Since the efficacy of paclitaxel/platinum and gemcitabine/carboplatin regimens appears to be comparable based on similar progression-free survival (both combinations confer a 3-month advantage), toxicity profiles should be taken into account when deciding on the combination to be used. The gemcitabine/carboplatin combination should be preferred in patients with underlying peripheral neuropathy. Since alopecia associated with paclitaxel can diminish the overall quality of life, the gemcitabine plus carboplatin combination may be preferable for patients in whom alopecia is a major consideration. This review provides an update on the role of the gemcitabine/carboplatin combination in platinum-sensitive recurrent ovarian cancer.
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Affiliation(s)
- M Faruk Kose
- Department of Gynecologic Oncology, Etlik Maternity and Women's Health Teaching and Research Hospital, Ministry of Health, Ankara, Turkey.
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Treatment Patterns, Health Care Utilization, and Costs of Ovarian Cancer in Central and Eastern Europe Using a Delphi Panel Based on a Retrospective Chart Review. Int J Gynecol Cancer 2013; 23:823-32. [DOI: 10.1097/igc.0b013e318291e8ca] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
ObjectiveDespite the considerable disease burden of ovarian cancer, there were no cost studies in Central and Eastern Europe. This study aimed to describe treatment patterns, health care utilization, and costs associated with treating ovarian cancer in Hungary, Poland, Serbia, and Slovakia.MethodOverall clinical practice for management of epithelial ovarian cancer was investigated through a 3-round Delphi panel. Experts completed a survey based on the chart review (n = 1542). The survey was developed based on clinical guidelines and the International Federation of Gynecology and Obstetrics Annual Report. Means, ranges, and outlier values were discussed with the experts during a telephone interview. Finally, consensus estimates were obtained in face-to-face workshops. Based on these results, overall cost of ovarian cancer was estimated using a Markov model.ResultsThe patients included in the chart review were followed up from presurgical diagnosis and in each phase of treatment, that is, surgical staging and primary surgery, chemotherapy and chemotherapy monitoring, follow-up, and palliative care. The 5-year overall cost per patient was €14,100 to €16,300 in Hungary, €14,600 to €15,800 in Poland, €7600 to €8100 in Serbia, and €12,400 to €14,500 in Slovakia. The main components were chemotherapy-associated costs (68%–74% of the total cost), followed by cost of primary treatment with surgery (15%–21%) and palliative care (3%–10%).ConclusionsPatients with ovarian cancer consume considerable health care resources and incur substantial costs in Central and Eastern Europe. These findings may prove useful for clinicians and decision makers in understanding the economic implications of managing ovarian cancer in Central and Eastern Europe and the need for innovative therapies.
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Heitz F, du Bois A, Harter P, Lubbe D, Kurzeder C, Vergote I, Plante M, Pfisterer J. Impact of beta blocker medication in patients with platinum sensitive recurrent ovarian cancer-a combined analysis of 2 prospective multicenter trials by the AGO Study Group, NCIC-CTG and EORTC-GCG. Gynecol Oncol 2013; 129:463-6. [PMID: 23500609 DOI: 10.1016/j.ygyno.2013.03.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/07/2013] [Accepted: 03/07/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Retrospective analyses suggest that the treatment with beta blocker improves survival in patients with breast cancer and melanoma. The aim of this study was to investigate the impact of medication with beta blocker in patients with recurrent ovarian cancer. METHODS Included patients received treatment within two prospective clinical trials: AGO-OVAR 2.4 phase I trial (carboplatin/gemcitabine; N=25, protocol AGO-OVAR 2.4) and AGO led intergroup phase III trial (carboplatin vs carboplatin/gemcitabine; N=356, protocol AGO-OVAR 2.5, EORTC-GCG, NCIC CTG). Concurrent medication was documented after every cycle and thorough monitoring was conducted. RESULTS During the studies 38 patients (9.97%) received a beta blocker as co-medication. Patients treated with beta blockers were significantly older than patients not treated with beta blockers. Response rates to chemotherapy were not different between patients treated with beta blockers and those who were not. After a median follow-up of 17 months, 349 (91.6%) patients had progressive disease and 267 (70.1%) patients had died. No difference in median progression-free survival (7.79 vs 7.62 months (p=0.95)) and overall survival (21.2 vs 17.3 months (p=0.18)) was recorded for patients treated with and without beta blocker. In multivariate analyses including age, platinum free-interval, study treatment and ECOG performance status beta blocker treatment was not associated with a significant impact on progression-free survival (HR: 0.92; 95% CI: 0.65-1.31; p=0.65) and overall survival (HR:0.74; 95%CI: 0.49-1.11; p=0.15). CONCLUSIONS In this series of recurrent platinum-sensitive ovarian cancer patients it could not be confirmed whether beta blocker treatment was associated with better or worse outcome.
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Affiliation(s)
- Florian Heitz
- Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Department of Gynecology and Gynecologic Oncology, Henricistrasse 92, Essen, Germany.
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Abstract
The US FDA has recently approved the combination of carboplatin and gemcitabine as a second-line therapy for recurrent platinum-sensitive ovarian cancer. This article briefly reviews the pharmacokinetics and mechanism of action of gemcitabine and its synergistic effect with platinum. An overview of the literature on the role of gemcitabine in the treatment of epithelial ovarian cancer is also presented.
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Affiliation(s)
- Fadi Abushahin
- Department of Obstetrics & Gynecology, Section of Gynecologic Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Gordon AN, Teneriello M, Janicek MF, Hines J, Lim PC, Chen MD, Vaccarello L, Homesley HD, McMeekin S, Burkholder TL, Wang Y, Zhao L, Orlando M, Obasaju CK, Gill JF, Tai DF. Phase III trial of induction gemcitabine or paclitaxel plus carboplatin followed by paclitaxel consolidation in ovarian cancer. Gynecol Oncol 2011; 123:479-85. [PMID: 21978765 DOI: 10.1016/j.ygyno.2011.08.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 08/12/2011] [Accepted: 08/17/2011] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The safety and efficacy of gemcitabine plus carboplatin (GC) or paclitaxel plus carboplatin (TC) induction regimens with or without paclitaxel consolidation therapy were assessed in ovarian cancer (OC). METHODS Patients with stage IC-IV OC were randomized to either GC (gemcitabine 1,000 mg/m(2), days 1 and 8, plus carboplatin area under the curve [AUC] 5, day 1) or TC (paclitaxel 175 mg/m(2) plus carboplatin AUC 6, day 1) every 21 days for up to six cycles. Patients with complete response (CR) were allowed optional consolidation with paclitaxel 135 mg/m(2) every 28 days for ≤ 12 months. Patients without CR received single-agent crossover therapy at induction doses/schedules until CR, disease progression (PD), or unacceptable toxicity. PD or death in 636 patients was required to compare induction arms with 80% statistical power for progression-free survival (PFS), the primary endpoint. RESULTS Randomized induction therapy was received by 820 of 919 patients enrolled; 352 patients with CR received paclitaxel consolidation whereas 155 patients without CR received single-agent crossover therapy. PFS was similar for GC and TC (median, 20.0 and 22.2 months, respectively; P=.199). Despite high censoring rates (>52%), overall survival was longer for TC (median, 57.3 versus 43.8 months for GC; P=.013). Controlling for patient characteristics including performance status, residual tumor size, and tumor stage, there was no statistical difference in a multivariate analysis (HR=1.22; 95% CI=0.99-1.52; P=.067). CONCLUSIONS GC does not improve PFS over TC as first-line induction chemotherapy in OC. Although favoring TC, overall survival analyses were limited by the study design and high censoring rates.
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Affiliation(s)
- Alan N Gordon
- M.D. Anderson Cancer Center Orlando, 1400 S. Orange Avenue, Orlando, FL 32806, USA.
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Holloway RW, Grendys EC, Lefebvre P, Vekeman F, McMeekin S. Tolerability, efficacy, and safety of pegylated liposomal Doxorubicin in combination with Carboplatin versus gemcitabine-Carboplatin for the treatment of platinum-sensitive recurrent ovarian cancer: a systematic review. Oncologist 2010; 15:1073-82. [PMID: 20930103 PMCID: PMC3227899 DOI: 10.1634/theoncologist.2009-0331] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 07/26/2010] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare the tolerability, efficacy, and safety profiles of pegylated liposomal doxorubicin in combination with carboplatin (PLD-Carbo) with those of gemcitabine-carboplatin (Gem-Carbo) for the treatment of patients with platinum-sensitive recurrent ovarian cancer (PSROC) by reviewing the published literature. METHODS Using the PubMed database, a systematic review of peer-reviewed literature published between January 2000 and September 2009 was undertaken to identify studies related to the treatment of patients with PSROC with PLD-Carbo or Gem-Carbo. Studies reporting either response rate, progression-free survival (PFS), and/or overall survival (OS) were included. Treatment regimens, efficacy endpoints, and safety profiles were compared between the two combination therapies. RESULTS Ten studies evaluating 608 patients (PLD-Carbo: 5 studies, 278 patients; Gem-Carbo: 5 studies, 330 patients) were identified. The mean planned doses were: PLD, 34.8 mg/m(2) and Gem, 993 mg/m(2). The dose intensity reported in Gem trials was lower (75% of the planned dose) than the dose intensity reported in PLD trials (93.7% of the planned dose), suggesting better tolerability for the PLD-Carbo regimen. Among patients receiving PLD-Carbo, 60.2% achieved a response (complete, 27.0%; partial, 33.2%), versus 51.4% of patients treated with Gem-Carbo (complete, 19.2%; partial, 32.2%). The median PFS times were 10.6 months and 8.9 months in the PLD-Carbo and the Gem-Carbo populations, respectively. The median OS was longer for the PLD-Carbo regimen (27.1 months) than for the Gem-Carbo regimen (19.7 months). The hematological safety profiles were comparable in the two groups, although grade III or IV anemia (PLD-Carbo, 13.6%; Gem-Carbo, 24.5%) and neutropenia (PLD-Carbo, 45.5%; Gem-Carbo, 62.9%) were more common in patients receiving Gem-Carbo. CONCLUSION Results from this systematic analysis of peer-reviewed literature suggest that PLD-Carbo therapy is a rational alternative to Gem-Carbo for the treatment of patients with PSROC.
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du Bois A, Herrstedt J, Hardy-Bessard AC, Müller HH, Harter P, Kristensen G, Joly F, Huober J, Avall-Lundqvist E, Weber B, Kurzeder C, Jelic S, Pujade-Lauraine E, Burges A, Pfisterer J, Gropp M, Staehle A, Wimberger P, Jackisch C, Sehouli J. Phase III trial of carboplatin plus paclitaxel with or without gemcitabine in first-line treatment of epithelial ovarian cancer. J Clin Oncol 2010; 28:4162-9. [PMID: 20733132 DOI: 10.1200/jco.2009.27.4696] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE One attempt to improve long-term survival in patients with advanced ovarian cancer was thought to be the addition of more non-cross-resistant drugs to platinum-paclitaxel combination regimens. Gemcitabine was among the candidates for a third drug. PATIENTS AND METHODS We performed a prospective, randomized, phase III, intergroup trial to compare carboplatin plus paclitaxel (TC; area under the curve [AUC] 5 and 175 mg/m(2), respectively) with the same combination and additional gemcitabine 800 mg/m(2) on days 1 and 8 (TCG) in previously untreated patients with advanced epithelial ovarian cancer. TC was administered intravenously (IV) on day 1 every 21 days for a planned minimum of six courses. Gemcitabine was administered by IV on days 1 and 8 of each cycle in the TCG arm. RESULTS Between 2002 and 2004, 1,742 patients were randomly assigned; 882 and 860 patients received TC and TCG, respectively. Grades 3 to 4 hematologic toxicity and fatigue occurred more frequently in the TCG arm. Accordingly, quality-of-life analysis during chemotherapy showed a disadvantage in the TCG arm. Although objective response was slightly higher in the TCG arm, this did not translate into improved progression-free survival (PFS) or overall survival (OS). Median PFS was 17.8 months for the TCG arm and 19.3 months for the TC arm (hazard ratio [HR], 1.18; 95% CI, 1.06 to 1.32; P = .0044). Median OS was 49.5 for the TCG arm and 51.5 months for the TC arm (HR, 1.05; 95% CI, 0.91 to 1.20; P = .5106). CONCLUSION The addition of gemcitabine to carboplatin plus paclitaxel increased treatment burden, reduced PFS time, and did not improve OS in patients with advanced epithelial ovarian cancer. Therefore, we recommend no additional clinical use of TCG in this population.
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Affiliation(s)
- Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Dr Horst Schmidt Klinik, Ludwig-Erhard-Str 100, D-65199 Wiesbaden, Germany.
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16
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Harter P, Hilpert F, Mahner S, Heitz F, Pfisterer J, du Bois A. Systemic therapy in recurrent ovarian cancer: current treatment options and new drugs. Expert Rev Anticancer Ther 2010; 10:81-8. [PMID: 20014888 DOI: 10.1586/era.09.165] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Most patients with ovarian cancer relapse despite aggressive surgery and platinum-taxane-based primary chemotherapy. Further treatment depends on prior response and progression-free interval. Monotherapy is indicated in patients with so-called platinum-resistant or -refractory ovarian cancer. The standard treatment for patients with platinum-sensitive recurrent ovarian cancer is platinum-based combination chemotherapy. Cytoreductive surgery is also a treatment option in such patients. Actual treatment options and strategies in recurrent ovarian cancer will also be discussed. Furthermore, this review focuses on new drugs in the treatment of primary and recurrent ovarian cancer.
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Affiliation(s)
- Philipp Harter
- Department of Gynecology and Gynecologic Oncology, HSK, Dr Horst Schmidt Klinik, Ludwig-Erhard-Strasse 100, D-65199 Wiesbaden, Germany.
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17
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Treatment for recurrent ovarian cancer-at first relapse. JOURNAL OF ONCOLOGY 2009; 2010:497429. [PMID: 20066162 PMCID: PMC2801501 DOI: 10.1155/2010/497429] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 09/27/2009] [Accepted: 10/15/2009] [Indexed: 11/17/2022]
Abstract
Recurrent ovarian cancer is a lethal disease, and few patients can be cured. Although most patients receive standardized surgery and chemotherapy, the status of recurrent disease is heterogeneous. The site of recurrence and the survival intervals after recurrence are also widely distributed. Among a number of factors, many clinical trials identified time to recurrence was the factor most related to chemosensitivity at first relapse. The current recommendation for platinum sensitive ovarian cancer is a carboplatin containing combination chemotherapy. Generally, a single agent is chosen for platinum resistant ovarian cancer. Patients with single site recurrence and a long disease free interval are candidates for secondary cytoreduction, which may provide longer survival. There are several treatment choices at first relapse, and disease status, chemotherapy-free interval, and the patient's condition play a major role in the decision making process.
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18
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Gordon AN, Teneriello M, Lim P, Janicek MF, Burkholder TL, Wang Y, Orlando M, Obasaju CK, Gill JF, Tai DF. Phase III Trial of Induction Gemcitabine or Paclitaxel Plus Carboplatin Followed by Elective Paclitaxel Consolidation in Ovarian Cancer: Interim Analysis of Induction Chemotherapy. ACTA ACUST UNITED AC 2009. [DOI: 10.3816/coc.2009.n.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Alvarez RD, Mannel R, García AA, Gallion HH, Lucci J, Kilgore LC, Numnum TM, Zou SX, Orlando M, Tai DF. Fixed-dose rate gemcitabine plus carboplatin in relapsed, platinum-sensitive ovarian cancer patients: results of a three-arm Phase I study. Gynecol Oncol 2009; 115:389-95. [PMID: 19800673 DOI: 10.1016/j.ygyno.2009.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 09/01/2009] [Accepted: 09/07/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Standard infusion of gemcitabine plus carboplatin showed improved efficacy compared to carboplatin alone in patients with platinum-sensitive (Pt-S) ovarian cancer (OC). Fixed-dose rate (FDR) administration of gemcitabine produces more efficient intracellular phosphorylation of gemcitabine to its active form. This study was designed to identify the maximum tolerated dose (MTD), toxicity profile, and response rate of FDR gemcitabine plus carboplatin in Pt-S OC. METHODS Patients with measurable OC relapsing > or =6 months after exposure to platinum (N=60) were assigned to one of three treatment cohorts, each with a different delivery schedule and escalating doses of both FDR gemcitabine (10 mg/m(2)/min) and standard infusion carboplatin (60 min). MTDs were determined using dose-limiting toxicities (DLTs). Measurable disease was assessed using modified RECIST criteria. CA-125 levels were evaluated using Rustin criteria. Toxicities were assessed using NCI Common Toxicity Criteria, version 2.0. RESULTS The MTD of Arm 1 was FDR gemcitabine 1000 mg/m(2) on days 1 and 8 plus carboplatin AUC 5 on day 1, every 21 days. The MTD of Arm 2 was FDR gemcitabine 1000 mg/m(2) on days 1 and 8 plus carboplatin AUC 2.5+AUC 2.5 on days 1 and 8, every 21 days. Patient accrual on Arm 3 consisting of bi-weekly FDR gemcitabine plus carboplatin was terminated because dose level 1 exceeded the MTD. Overall response rates were 38.1% (Arm 1), 58.8% (Arm 2), and 44.4% (Arm 3). CONCLUSIONS FDR gemcitabine+carboplatin on a 21-day schedule was active and produced no unusual safety signals in patients with Pt-S OC.
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20
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Hoekstra AV, Hurteau JA, Kirschner CV, Rodriguez GC. The combination of monthly carboplatin and weekly paclitaxel is highly active for the treatment of recurrent ovarian cancer. Gynecol Oncol 2009; 115:377-81. [PMID: 19800107 DOI: 10.1016/j.ygyno.2009.08.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 08/19/2009] [Accepted: 08/27/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the response rate and toxicity of a regimen comprised of monthly carboplatin and weekly paclitaxel for recurrent ovarian cancer. METHODS We performed a retrospective chart review of patients with recurrent ovarian cancer treated between 2001 and 2006 at a single institution with carboplatin AUC 5 (day 1), and paclitaxel 80 mg/m(2) (days 1, 8, 15) of a 28-day cycle. Primary endpoints were response rate, progression-free survival and overall survival. RESULTS Twenty patients were treated with this regimen from 2001 to 2006. Stage ranged from stages IC to IV. All received intravenous platinum and taxane as their initial therapy. Histologic subtypes included papillary serous (17), carcinosarcoma (1), and clear cell (2). The median number of prior regimens was 1 (range 1-3). The overall response rate was 85.0% (15 complete responses, 2 partial responses). Patients with tumors categorized as platinum sensitive had a response rate of 93.3% (14/15) and those with tumors deemed platinum resistant had a response rate of 60.0% (3/5). The median survival has not yet been reached after a median follow-up of 28 months. Neutropenia was the only grade 3/4 toxicity, occurring in 7 patients (35.0%). Platinum hypersensitivity reactions occurred in 5 patients (25.0%) who all successfully continued treatment using a carboplatin desensitization protocol. CONCLUSIONS A monthly carboplatin and weekly paclitaxel regimen is highly active for women with recurrent platinum-sensitive and platinum-resistant epithelial ovarian cancer. The regimen is well tolerated. This pilot series demonstrates the potential for this regimen as treatment of choice among doublet first salvage regimens for patients with recurrent epithelial ovarian cancer, thus warranting multi-institutional study.
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Affiliation(s)
- Anna V Hoekstra
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, NorthShore University HealthSystem, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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21
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Gemcitabine plus carboplatin compared with carboplatin alone for platinum-sensitive recurrent ovarian cancer. Curr Oncol Rep 2008; 9:469-71. [DOI: 10.1007/s11912-007-0065-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Lorusso D, Di Stefano A, Fanfani F, Scambia G. Role of gemcitabine in ovarian cancer treatment. Ann Oncol 2008; 17 Suppl 5:v188-94. [PMID: 16807454 DOI: 10.1093/annonc/mdj979] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Newer agents and combinations are needed in order to improve current results in ovarian cancer treatment. Gemcitabine is a novel agent that has shown promising activity as a single agent in the treatment of platinum-resistant ovarian cancer and a favorable toxicity profile. Because of its clinical and preclinical synergism with platinum analogues, Gemcitabine has been combined with Carboplatin as a convincing approach in the treatment of platinum-sensitive recurrent ovarian cancer patients. Further combination of Gemcitabine and other agents, including paclitaxel, are also feasible and have been actively studied in order to establish the role of Gemcitabine in the management of treated and untreated ovarian cancer patients.
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Affiliation(s)
- D Lorusso
- Department of Oncology, Catholic University of the Sacred Heart, Campobasso, Rome, Italy
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23
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Pecorelli S, Odicino F. Which second-line treatment regimen should be used following relapse of platinum-sensitive ovarian cancer? NATURE CLINICAL PRACTICE. ONCOLOGY 2007; 4:340-1. [PMID: 17406383 DOI: 10.1038/ncponc0795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 02/26/2007] [Indexed: 05/14/2023]
Affiliation(s)
- Sergio Pecorelli
- Department of Obstetrics and Gynecology at the University of Brescia, Brescia, Italy.
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24
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Pfisterer J, Plante M, Vergote I, du Bois A, Hirte H, Lacave AJ, Wagner U, Stähle A, Stuart G, Kimmig R, Olbricht S, Le T, Emerich J, Kuhn W, Bentley J, Jackisch C, Lück HJ, Rochon J, Zimmermann AH, Eisenhauer E. Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: an intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG. J Clin Oncol 2006; 24:4699-707. [PMID: 16966687 DOI: 10.1200/jco.2006.06.0913] [Citation(s) in RCA: 514] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Most patients with advanced ovarian cancer develop recurrent disease. For those patients who recur at least 6 months after initial therapy, paclitaxel platinum has shown a modest survival advantage over platinum without paclitaxel; however, many patients develop clinically relevant neurotoxicity, frequently resulting in treatment discontinuation. Thus, an alternative regimen without significant neurotoxicity was evaluated by comparing gemcitabine plus carboplatin with single-agent carboplatin in platinum-sensitive recurrent ovarian cancer patients. METHODS Patients with platinum-sensitive recurrent ovarian cancer were randomly assigned to receive either gemcitabine plus carboplatin or carboplatin alone, every 21 days. The primary objective was to compare progression-free survival (PFS). RESULTS Three hundred fifty-six patients (178 gemcitabine plus carboplatin; 178 carboplatin) were randomly assigned. Patients received a median of six cycles in both arms. With a median follow-up of 17 months, median PFS was 8.6 months (95% CI, 7.9 to 9.7 months) for gemcitabine plus carboplatin and 5.8 months (95% CI, 5.2 to 7.1 months) for carboplatin. The hazard ration (HR) for PFS was 0.72 (95% CI, 0.58 to 0.90; P = .0031). Response rate was 47.2% (95% CI, 39.9% to 54.5%) for gemcitabine plus carboplatin and 30.9% (95% CI, 24.1% to 37.7%) for carboplatin (P = .0016). The HR for overall survival was 0.96 (95% CI, 0.75 to1.23; P = .7349). While myelosuppression was significantly more common in the combination, sequelae such as febrile neutropenia or infections were uncommon. No statistically significant differences in quality of life scores between arms were noted. CONCLUSION Gemcitabine plus carboplatin significantly improves PFS and response rate without worsening quality of life for patients with platinum-sensitive recurrent ovarian cancer.
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Affiliation(s)
- Jacobus Pfisterer
- Klinik für Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Michaelisstr 16, D-24105 Kiel, Germany.
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25
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Abstract
Ovarian cancer represents the leading cause of death from gynecologic neoplasms. The chance of response to secondary treatment is currently disappointing; few agents have shown notable activity in recurrent/progressive patients. Among these agents, gemcitabine represents one of the most interesting newer antineoplastic agents, showing significant activity, synergism with cisplatin, and a mild toxicity profile in both platinum-sensitive and platinum-resistant (and also taxane-pretreated) recurrent/progressive patients. Moreover, first-line combination chemotherapy including gemcitabine has shown promising response rates in phase I and II studies. The ongoing phase III, five-arm, randomized Gynecologic Oncology Group Protocol 182/International Collaborative Ovarian Neoplasm 5 study should clarify the clinical impact of the addition of a third drug to the standard paclitaxel plus carboplatin treatment regimen.
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Affiliation(s)
- Sergio Pecorelli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Brescia, Italy.
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26
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Pectasides D, Psyrri A, Pectasides M, Economopoulos T. Optimal therapy for platinum-resistant recurrent ovarian cancer: doxorubicin, gemcitabine or topotecan? Expert Opin Pharmacother 2006; 7:975-87. [PMID: 16722809 DOI: 10.1517/14656566.7.8.975] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ovarian cancer is more fatal than all the other gynaecological malignancies combined. Although most patients respond to first-line combination chemotherapy, the vast majority (50-75%) of patients with advanced disease will relapse. The management of patients with recurrent ovarian cancer is based on their response profile to platinum: patients with platinum-sensitive disease can be rechallenged with platinum-based chemotherapy, whereas the management of patients with platinum-resistant or -refractory disease remains an area of active investigation. In this review, the data for second-line therapy in this latter group of patients will be summarised and recommendations for their optimal management will be made.
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Affiliation(s)
- D Pectasides
- Second Department of Internal Medicine, Athens University, Attikon University Hospital, Rimini 1, Haidari, Athens, Greece.
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27
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Toschi L, Finocchiaro G, Bartolini S, Gioia V, Cappuzzo F. Role of gemcitabine in cancer therapy. Future Oncol 2006; 1:7-17. [PMID: 16555971 DOI: 10.1517/14796694.1.1.7] [Citation(s) in RCA: 237] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Gemcitabine, a pyrimidine nucleoside antimetabolite, is one of the most promising new cytotoxic agents. The drug has shown activity in a variety of solid tumors, and has been approved for the treatment of non-small cell lung cancer, pancreatic, bladder, and breast cancer. Recent data showed that gemcitabine is also active against ovarian cancer. Gemcitabine has a good toxicity profile, with myelosuppression being the most common side effect, while non-hematological events are relatively uncommon. The low toxicity profile makes the drug a valid option for unfit and elderly patients. Due to the synergistic activity with other chemotherapeutic compounds, mainly cisplatinum, several trials have been conducted to evaluate the efficacy and tolerability of gemcitabine in combination with other cytotoxic agents. Current clinical trials are evaluating the role of gemcitabine in combination with new targeted therapies.
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Affiliation(s)
- L Toschi
- Division of Medical Oncology, Department of Oncology, Bellaria Hospital, Via Altura 3, 40139, Bologna, Italy
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28
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Abstract
The majority of patients with ovarian cancer will relapse despite state-of-the-art first-line surgery and chemotherapy. There are two subgroups of patients with recurrent ovarian cancer: those with platinum-resistant disease and those with platinum-sensitive disease. Re-treatment with single-agent platinum has long been considered standard therapy for patients with platinum-sensitive disease, and, based on its favorable therapeutic profile, carboplatin has become the treatment agent of choice. High response rates are seen with platinum agents used in combination with paclitaxel or gemcitabine. The International Collaborative Group for Ovarian Neoplasia (ICON) and the Arbeitsgemeinschaft für Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) recently conducted a trial (ICON4/AGO-OVAR-2.2) comparing platinum monotherapy with platinum plus paclitaxel combined. Results showed that overall survival and progression-free survival are improved by combination therapy. Similarly, a significant benefit in progression-free survival for carboplatin plus gemcitabine versus carboplatin monotherapy was seen in the Gynecologic Cancer InterGroup trial. The toxicity profiles and schedules of carboplatin plus paclitaxel and carboplatin plus gemcitabine are different, with the taxane combination having greater neurotoxicity and alopecia, less hematologic toxicity, and requiring longer drug infusions (although fewer days of treatment per cycle) than the gemcitabine combination. Based on the results of these two trials, combination chemotherapy should be considered the standard treatment of recurrent platinum-sensitive ovarian cancer. The choice of treatment needs to take into account the increase in side effects when using combination chemotherapy compared with carboplatin monotherapy, and the different toxicities of the two combination regimens.
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Affiliation(s)
- Jacobus Pfisterer
- Klinik für Gynäkologie und Geburtshilfe Campus Kiel, Universitätsklinikum Schleswig-Holstein, Germany.
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29
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Abstract
Epithelial ovarian carcinoma is still the most common cause of death from gynecologic cancer in the USA and Europe. Only 20-30% of patients are diagnosed at the initial stage where appropriate staging surgery can be curative. Patients with high-risk Stage I disease can benefit from adjuvant chemotherapy with platinum-based schedules. The treatment of patients with advanced disease consists of a staging surgery with maximum cytoreductive effort, followed by chemotherapy with a platinum-taxane combination. Unfortunately, the majority of patients with advanced disease will relapse and become candidates for additional chemotherapy. In those patients with recurrence over 6 months after initial therapy (platinum sensitive), combinations of paclitaxel plus carboplatin and carboplatin plus gemcitabine have shown a benefit over carboplatin alone. Patients with early relapse should be managed with supportive care and sequential monotherapy if chemotherapy is indicated.
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Affiliation(s)
- Antonio J González-Martín
- Servicio Oncología Médica, Hospital Ramón y Cajal, Ctra de Colmenar Viejo Km 9, 100, 28034-Madrid, Spain.
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30
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Fuso L, Amant F, Neven P, Berteloot P, Vergote I. Gemcitabine-carboplatin-paclitaxel combination as first-line therapy in advanced ovarian carcinoma: a single institution phase II study in 24 patients. Int J Gynecol Cancer 2006; 16 Suppl 1:60-7. [PMID: 16515569 DOI: 10.1111/j.1525-1438.2006.00315.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Single-agent gemcitabine demonstrated response rates of 11-60% in platinum/paclitaxel-resistant ovarian cancer. Twenty-four patients with epithelial ovarian cancer were treated with gemcitabine 800 mg/m2 on days 1 and 8, carboplatin area under the curve 5 on day 1, and paclitaxel 175 mg/m2 over 3 h on day 1 every 3 weeks for six cycles. Median age was 54 years, and FIGO stage distribution was IIC, 1 patient, III, 18, and IV, 5. A total of 22 (92%) patients completed all the six planned courses of chemotherapy. Doses were reduced in 8 out of 24 (33%) patients. Of the 17 patients with measurable disease, 15 underwent an interval debulking surgery. Prior to interval debulking surgery, all 15 patients had a partial response according to the response evaluation criteria in solid tumors criteria. Overall in the 17 patients with measurable disease, the response rate at the end of the first-line chemotherapy (including interval debulking) was 94% (14 [82%] complete response and 2 [12%], partial response). One patient (6%) received only one cycle due to early progression. Using the CA125 criteria as defined by the Gynecologic Cancer Intergroup, all patients had at least a partial response prior to interval debulking, and the overall response rate of the whole first-line chemotherapy and interval debulking (n= 15) was observed in 21 out of 23 patients (91%). The dose-limiting toxicity was bone marrow toxicity. Median overall survival was 28 months, and the 2-year actuarial survival was 73%. The gemcitabine, carboplatin, paclitaxel triplet has an acceptable toxicity with high response rates as first-line therapy in advanced ovarian cancer.
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Affiliation(s)
- L Fuso
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Hospitals Leuven, Katholieke Universiteit, Leuven, Belgium
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31
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Ledermann JA, Raja F. Management Strategies for Partially Platinum-Sensitive Ovarian Cancer. ACTA ACUST UNITED AC 2006. [DOI: 10.2165/00024669-200605050-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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32
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Lorusso D, Ferrandina G, Fruscella E, Marini L, Adamo V, Scambia G. Gemcitabine in epithelial ovarian cancer treatment: current role and future perspectives. Int J Gynecol Cancer 2005; 15:1002-13. [PMID: 16343176 DOI: 10.1111/j.1525-1438.2005.00331.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Newer agents and combinations are needed in order to improve current results in ovarian cancer treatment. Gemcitabine is a novel agent that has shown consistent activity as a single agent in the treatment of platinum-resistant ovarian cancer and a favorable toxicity profile. Because of its clinical and preclinical synergism with platinum analogs, gemcitabine has been combined with carboplatin as a convincing approach in the treatment of platinum-sensitive recurrent ovarian cancer patients. Further combination of gemcitabine and other agents, including paclitaxel, is also feasible and has been actively studied in order to establish the role of gemcitabine in the management of treated and untreated ovarian cancer patients.
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Affiliation(s)
- D Lorusso
- Department of Oncology, Catholic University of the Sacred Heart, Campobasso, Italy
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33
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Abstract
Ovarian cancer remains the number one gynecological killer in the Western world. Most ovarian cancer patients present with advanced-stage disease and are treated with cytoreductive surgery followed by combination chemotherapy. While the majority of patients respond to treatment, most will relapse such that the 5-year survival rates for advanced disease are approximately 20-25%. Overall survival and progression-free survival (PFS) are the primary endpoints in clinical trials in patients with advanced ovarian cancer. In patients with early-stage ovarian cancer, PFS may be the preferred trial endpoint, whereas in patients with recurrent ovarian cancer, the primary goal of therapy remains palliation and control of symptoms. Recent studies in recurrent disease have demonstrated that chemotherapy can improve the endpoints of PFS and overall survival, and so they are being used as the primary endpoints for comparing new regimens in phase III trials in relapsed patients. However, it would be easier to compare new treatment modalities if a uniformly accepted instrument was available that could evaluate quality of life and symptom control.
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Affiliation(s)
- R F Ozols
- Division of Medical Science, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
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34
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Pfisterer J, Vergote I, Du Bois A, Eisenhauer E. Combination therapy with gemcitabine and carboplatin in recurrent ovarian cancer. Int J Gynecol Cancer 2005; 15 Suppl 1:36-41. [PMID: 15839957 DOI: 10.1111/j.1525-1438.2005.15355.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Many patients with advanced ovarian cancer will develop recurrent disease. For those patients who have recurrence of disease at least 6 months after initial therapy, the paclitaxel-platinum combination has been shown to be a superior treatment to platinum monotherapy. However, many patients develop clinically relevant neurotoxicity, frequently resulting in treatment discontinuation. The efficacy and safety of an alternative regimen that does not show significant neurotoxicity were evaluated by comparing gemcitabine-carboplatin with carboplatin in platinum-sensitive recurrent ovarian cancer patients in a Gynecologic Cancer InterGroup trial of the Arbeitsgemeinschaft Gynakologische Onkologie Ovarian Cancer Study Group, the National Cancer Institute of Canada Clinical Trials Group, and the European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group. Participants with recurrent platinum-sensitive ovarian cancer were randomly assigned to receive either gemcitabine-carboplatin or carboplatin every 21 days. The primary objective was to compare progression-free survival (PFS) between the groups. From September 1999 to April 2002, 356 patients (178 participants received gemcitabine-carboplatin, 178 received carboplatin only) were randomized to treatment. Patients received six cycles of either gemcitabine-carboplatin or carboplatin. With a median follow-up of 17 months, median PFS was 8.6 months for gemcitabine-carboplatin (95% confidence interval [CI] 7.9-9.7 months) and 5.8 months for carboplatin (95% CI 5.2-7.1 months; hazard ratio [HR] 0.72 [95% CI 0.58-0.90; P = 0.0032]). The response rate for the gemcitabine-carboplatin group was 47.2% (95% CI 39.9-54.5%) and 30.9% for carboplatin group (95% CI 24.1-37.7%; P = 0.0016). The HR for overall survival was 0.96 (95% CI 0.75-1.23; P = 0.7349). Patients treated with gemcitabine-carboplatin reported significantly faster palliation of abdominal symptoms and a significantly improved global quality of life. Gemcitabine-carboplatin treatment significantly improves the PFS of patients with platinum-sensitive recurrent ovarian cancer.
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Affiliation(s)
- J Pfisterer
- Klinik für Gynäkologie und Geburtshilfe Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel Germany.
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Rose PG. Gemcitabine reverses platinum resistance in platinum-resistant ovarian and peritoneal carcinoma. Int J Gynecol Cancer 2005; 15 Suppl 1:18-22. [PMID: 15839954 DOI: 10.1111/j.1525-1438.2005.15357.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Platinum compounds are the key components of chemotherapy for ovarian cancer. Preclinical models in an ovarian cancer cell line (A2780) have demonstrated synergistic activity when gemcitabine is added to cisplatin compared with either single agent alone. Furthermore, the combination leads to increased platinum-adduct retention as a result of decreased DNA repair compared with cisplatin alone. Inhibition of specific exonucleases, such as excision repair cross-complementation group 1 (ERCC1), is integral to the platinum-gemcitabine synergy. In platinum-sensitive recurrent ovarian cancer patients (defined as those patients whose cancer recurs after > 6 months following primary therapy), platinum and gemcitabine have demonstrated an improvement in progression-free survival compared with platinum alone. This is also true for the patients who are only moderately platinum sensitive (defined as those patients who have cancer recurring 6-12 months after primary therapy). Increasing numbers of phase II experiences have demonstrated the activity of the platinum-gemcitabine combination in patients defined as platinum resistant (those with disease progression on therapy or whose disease recurs within 6 months of a platinum-based regimen).
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Affiliation(s)
- P G Rose
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Kose MF, Sufliarsky J, Beslija S, Saip P, Tulunay G, Krejcy K, Minarik T, Fitzthum E, Hayden A, Melemed A. A phase II study of gemcitabine plus carboplatin in platinum-sensitive, recurrent ovarian carcinoma. Gynecol Oncol 2005; 96:374-80. [PMID: 15661224 DOI: 10.1016/j.ygyno.2004.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Gemcitabine and carboplatin each have demonstrated effectiveness without increased neurotoxicity in pretreated patients with ovarian cancer. We evaluated the efficacy and safety of gemcitabine plus carboplatin in patients with recurrent ovarian cancer in a multicenter phase II study. METHODS Women with histologically proven measurable or evaluable epithelial ovarian cancer (any FIGO) who relapsed > or =6 months after discontinuation of first-line, platinum-containing therapy received gemcitabine 1000 mg/m(2) on days 1 and 8 and carboplatin AUC 4 on day 1 (after gemcitabine) every 21 days for up to six cycles. RESULTS Of the 40 enrolled/evaluable patients, 6 (15%) had complete response and 19 (47.5%) had partial response (PR), including one patient with PR in nonmeasurable disease (PRNM), for an overall response rate of 62.5% (95% CI, 45.8-77.3%). The median duration of response was 7.8 months (95% CI, 6.7-10.0), the median time to progressive disease was 9.6 months (95% CI, 8.5-11.0), and the median time to treatment failure was 9.3 months (95% CI, 8.2-10.4). The main grade 3/4 toxicities were neutropenia (78% of patients), leukopenia (30%), thrombocytopenia (18%), and anemia (15%); no grade 4 nonhematologic toxicities occurred, and grade 3 nonhematologic toxicities were mild. CONCLUSIONS The combination of gemcitabine and carboplatin is active and feasible in platinum-sensitive patients with recurrent ovarian cancer. This regimen is undergoing further evaluation in a large phase III trial.
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Affiliation(s)
- M F Kose
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, SSK Maternity and Women's Health Teaching Hospital, Ankara TR-06100, Turkey.
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Abstract
Ovarian cancer is increasingly recognized as a chronic disease whose treatment is often characterized by administration of multiple, sequential active agents, each of which may or may not be accompanied by a tumor response. Despite the large proportion of patients who relapse and undergo longer-term treatment, the question of optimal treatment duration has not been fully addressed to date. For patients who progress on therapy, the answer is straightforward: they are switched to another active agent, presumably having a different mechanism of action from previous therapies with, ideally, limited overlapping toxicities. However, for patients who remain in partial response or who have stable disease, the answer is less apparent and less clear. The majority of oncologists believe that treatment beyond 6 cycles of a given therapy does not provide any additional benefit to patients. There are some data to support that treatment strategy. However, with the advent of new, less toxic agents, treatment to progression should be further explored. Agents that are potentially well suited for extended treatment intervals may include such properties as absence of cumulative toxicity, non-cross-resistance, positive benefit on quality of life, and convenient schedule. A number of active agents in ovarian cancer (platinum, paclitaxel, topotecan, liposomal doxorubicin, docetaxel, gemcitabine, and etoposide) will be reviewed in the context of what is known about cumulative toxicity, potential adverse effects on patients' quality of life, and evidence addressing the potential benefits of longer-term treatment.
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Affiliation(s)
- Thomas J Herzog
- Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
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Ledermann JA, Wheeler S. How Should We Manage Patients with “Platinum-Sensitive” Recurrent Ovarian Cancer? Cancer Invest 2004; 22 Suppl 2:2-10. [PMID: 15573740 DOI: 10.1081/cnv-200030117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Decisions about the treatment of recurrent ovarian cancer are usually based on the treatment-free interval. Patients relapsing with an interval of more than six months are usually retreated with platinum-based chemotherapy. Non platinum drugs (such as paclitaxel, gemcitabine, liposomal doxorubicin or topotecan) are also active in relapsed disease. A high response rate is consistently seen with combinations of platinum and these drugs in phase II trials. ICON 4, the first large-scale randomised trial in 'platinum-sensitive' relapsed ovarian cancer demonstrated a survival benefit for using platinum-based therapy in combination with paclitaxel. More studies are needed to explore other combinations of treatment in this group of women as the choice and timing of second-line therapy needs to take account of the benefits and toxicity of treatment.
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Eltabbakh GH, Yildirim Z, Adamowicz R. Paclitaxel and Carboplatin as Second-Line Therapy in Women With Platinum-Sensitive Ovarian Carcinoma Treated With Platinum and Paclitaxel as First-Line Therapy. Am J Clin Oncol 2004; 27:46-50. [PMID: 14758133 DOI: 10.1097/01.coc.0000046120.23169.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The study was performed to assess response rate, progression-free interval (PFI), and side effects of the combination paclitaxel and carboplatin as second-line therapy among women with platinum-sensitive epithelial ovarian carcinoma (EOC). Thirty women who achieved partial surgical response at second-look surgery (n = 8) or who had recurrence (n = 22) more than 6 months after treatment with platinum-based chemotherapy were treated with paclitaxel (135 mg/m2 for 3 hours) and carboplatin (area under the concentration-time curve 5) every 3 weeks. Response rate, PFI, and side effects of treatment were recorded. One hundred sixty-seven cycles of treatment (median = 6, range = 2-11) were administered. Among 22 patients with measurable or assessable disease, 14 had complete response and 3 had partial response. Five patients had progressive disease. The overall response rate was 77%. The median PFI was 10 months (range = 1-29). Among 22 patients in whom recurrence or progression developed after second-line therapy, the median interval was 9 months (range = 1-26). The incidence of grade III or IV neutropenia, leukopenia, and thrombocytopenia was 48%, 27%, and 3%, respectively. One patient discontinued treatment secondary to persistent thrombocytopenia. Eight patients died secondary to their disease. It was concluded that the combination paclitaxel and carboplatin has a high success rate, long duration of response, and is well tolerated as a second-line therapy among patients with platinum-sensitive EOC.
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Affiliation(s)
- Gamal H Eltabbakh
- Department of Obstetrics and Gynecology, University of Vermont/Fletcher Allen Health Care, Burlington, Vermont, USA
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Abstract
OBJECTIVES To review chemotherapy options for patients with newly diagnosed or relapsed advanced ovarian cancer. DATA SOURCES Published literature. CONCLUSION Primary chemotherapy for newly diagnosed, advanced ovarian cancer consisting of a platinum compound and a taxane is commonly associated with myelosuppression, nausea/vomiting, alopecia, and sensory/motor neuropathy. For recurrent disease, numerous chemotherapy agents are effective, including rechallenging the patient with a platinum and/or a taxane or using newer agents such as pegylated liposomal doxorubicin, topotecan, and gemcitabine. In platinum-resistant disease, selection is based mainly on the toxicity profile, because palliation and quality of life are important. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses play a valuable role in ovarian cancer care by proactively meeting patient information needs.
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Affiliation(s)
- Peter G Rose
- MetroHealth Medical Center, Cancer Care Pavilion, Room 2017, 2500 MetroHealth Dr, Cleveland, OH 44109, USA
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González-Martín A. Is combination chemotherapy superior to single-agent chemotherapy in second-line treatment? Int J Gynecol Cancer 2003; 13 Suppl 2:185-91. [PMID: 14656278 DOI: 10.1111/j.1525-1438.2003.13361.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Treatment of relapsed ovarian carcinoma is still a matter of controversy. One important question to be solved is the potential superiority of combination chemotherapy over single-agent chemotherapy. This is a field in which a nonconclusive small number of randomized clinical trials have been conducted, and therefore, definitive conclusions are lacking. Patients with recurrent platinum-resistant disease are better treated with sequential single agent, because of higher toxicity without clear benefit usually associated with combination chemotherapy. In patients with platinum-sensitive disease, we can choose between three options: single-agent carboplatin, single-agent new drug or platinum combination-based therapy. In this paper, we will review these options and recently closed or ongoing randomized clinical trials in this setting.
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Abstract
OBJECTIVE Used alone, gemcitabine has shown modest, albeit significant, activity in patients with ovarian cancer. The response rate is usually greater when it is used in combination with other agents, and many combinations of gemcitabine show promise. This review summarizes the results of clinical trials where gemcitabine has been used in combination with other cytotoxic agents for the treatment of ovarian cancer in both newly diagnosed patients and those whose disease recurred despite heavy prior treatment. METHODS The results of several clinical trials in which gemcitabine was used in combination with platinum compounds, paclitaxel, or other chemotherapeutic agents as either first-line or salvage therapy of ovarian cancer were reviewed. RESULTS Gemcitabine appears to act synergistically when combined with a platinum compound, producing response rates as high as 71% in previously untreated patients. The addition of paclitaxel to this combination was even more effective for first-line therapy. When used in the salvage setting, combinations of gemcitabine with cisplatin or carboplatin and/or other cytotoxic agents were also effective and well tolerated. CONCLUSIONS Combinations of gemcitabine with platinum compounds and/or other chemotherapeutic agents have significant activity with acceptable toxicity in patients with ovarian cancer, whether used as first-line therapy or in the salvage setting. The exact dosing and different mechanism of action of gemcitabine make it attractive for these combinations.
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Affiliation(s)
- David G Mutch
- Department of Gynecologic Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Copeland LJ, Bookman M, Trimble E. Clinical trials of newer regimens for treating ovarian cancer: the rationale for Gynecologic Oncology Group Protocol GOG 182-ICON5. Gynecol Oncol 2003; 90:S1-7. [PMID: 12927999 DOI: 10.1016/s0090-8258(03)00337-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The current standard of chemotherapy for previously untreated patients with stage III/IV ovarian cancer who have undergone optimal or suboptimal cytoreductive surgery leaves room for improvement in terms of response rate and both progression-free and overall survival. Gynecologic Oncology Group (GOG) 182-ICON5 is a five-arm international collaborative study designed to improve on the efficacy of standard platinum/taxane therapy by incorporating newer cytotoxic agents in sequential doublet and triplet combinations. METHODS The evolution of a standard regimen for treating advanced ovarian cancer is reviewed, and the reasons for selecting carboplatin and paclitaxel for the control arm of the study are presented. Among the newer agents available for the experimental treatment arms, three stood out-gemcitabine, polyethylene-glycol (PEG)-liposomal doxorubicin, and topotecan-based on evidence of their activity demonstrated in previous phase I and II trials and, with appropriate dosage modifications, manageable toxicity when used in combination with platinum. RESULTS GOG 182-ICON5 is now in its second year of accrual. Patient recruitment, which is anticipated to grow to between 3400 and 4000 patients by the time the study is closed, is meeting expectations, and no problems have been encountered, except for the initial slow pace of recruitment outside of the United States. CONCLUSIONS Combination chemotherapy using newer cytotoxic agents with demonstrated activity in treating advanced-stage ovarian cancer and the ability to enhance platinum-based therapies appears to offer hope of prolonging life and reducing mortality from this disease.
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Affiliation(s)
- Larry J Copeland
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA.
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Goff BA, Thompson T, Greer BE, Jacobs A, Storer B. Treatment of recurrent platinum resistant ovarian or peritoneal cancer with gemcitabine and doxorubicin: A phase I/II trial of the Puget Sound Oncology Consortium (PSOC 1602). Am J Obstet Gynecol 2003; 188:1556-62; discussion 1562-4. [PMID: 12824993 DOI: 10.1067/mob.2003.398] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to determine the degree of toxicity, response rate, and evaluate quality of life (QOL) in women receiving gemcitabine in combination with doxorubicin for platinum-resistant and refractory ovarian or peritoneal cancer. STUDY DESIGN This was a phase I/II prospective trial. MATERIALS AND METHODS Nine patients were enrolled in the phase I portion. Initial doses of gemcitabine, 800 mg/m(2) intravenously on days 1, 8, and 15, and doxorubicin, 25 mg/m(2) intravenously on days 1, 8, and 15 in a 28-day cycle resulted in dose limiting toxicity secondary to thrombocytopenia and neutropenia. Forty patients were treated on the phase II portion with gemcitabine, 700 mg/m(2) intravenously on days 1 and 8, and doxorubicin 20 mg/m(2) intravenously on days 1 and 8 with granulocyte colony-stimulating factor administered on days 2 to 7 and 9 to 14 in a 21-day cycle. QOL was assessed with Fact-O. RESULTS The median number of previous chemotherapy regimens for the 49 women was 2 (range 1-5). There were 2 complete and 9 partial responses, for an overall response rate of 24%. Median duration of response was 5 months. Fourteen women (31%) had stable disease with median duration of response of 5 months. Median survival for the entire group was 12 months. Toxicity was primarily hematologic, and only 3 patients discontinued therapy because of toxicity. QOL surveys indicated that this was a well-tolerated regimen. CONCLUSION The combination of gemcitabine and doxorubicin can be safely administered. Overall, approximately 55% of women with platinum-resistant ovarian or peritoneal cancer benefit from this regimen with response or stabilization of disease.
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Affiliation(s)
- Barbara A Goff
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, 98195-6460, USA
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Rose PG, Mossbruger K, Fusco N, Smrekar M, Eaton S, Rodriguez M. Gemcitabine reverses cisplatin resistance: demonstration of activity in platinum- and multidrug-resistant ovarian and peritoneal carcinoma. Gynecol Oncol 2003; 88:17-21. [PMID: 12504621 DOI: 10.1006/gyno.2002.6850] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Preclinical models in an ovarian cancer cell line (A2780) demonstrate synergistic activity with the combination of gemcitabine and cisplatin compared to either single agent alone. Platinum resistance is related to expression of excision repair proteins, one of which (ERCC-1) has been identified as playing a critical role in the synergy of gemcitabine and cisplatin. We evaluated the cisplatin and gemcitabine regimen in patients with platinum refractory and multidrug refractory ovarian and peritoneal carcinoma. METHODS Gemcitabine (750 mg/m(2)) was administered intravenously over 30 min followed by cisplatin (30 mg/m(2)) on Days 1 and 8 every 21 days. Day 8 therapy was canceled for an absolute neutrophil count <1000/mm(3) or platelet count <75,000/mm(3). Sequential dose reductions of gemcitabine to 600, 400, and 300 mg/m(2) were prescribed in the event of canceled therapy, neutropenic sepsis, or severe thrombocytopenia (platelets <20,000/m(3)). RESULTS Thirty-six platinum- and paclitaxel-resistant patients were studied. Thirty-five were evaluable for response, of which 6 had progressed on gemcitabine as a single agent. Fifteen of the patients responded (42.9%, 95% CI 28.0-59.1%). Eleven were partial clinical responses and 4 were complete clinical responses, with 4 of the 6 patients who had failed gemcitabine as a single agent responding. Among the responding patients the median response duration was 11 months (range 4-14 months). For all patients the progression-free interval was 6 months (range 1-14 months). The median survival was 12 months. CONCLUSION The combination of gemcitabine and cisplatin is active in patients who are platinum resistant. Additionally, activity is demonstrated even in patients who have previously been resistant to gemcitabine.
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Affiliation(s)
- Peter G Rose
- Case Western Reserve University and Ireland Cancer Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Ohio 44106, USA
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Abstract
In this era of advanced medical technology, recurrent ovarian cancer continues to be a therapeutic dilemma. Most of these patients will succumb to their disease process. For this reason, it is of paramount importance for all clinicians to recognize that the primary goal of salvage therapy is to maximize disease-free survival and quality of life. With this goal in mind, they can offer patients a variety of different modalities to control disease, including second-look surgery, secondary or interval cytoreduction, second-line chemotherapy, hormonal therapy, and immunotherapy. The role of second-look surgery has yet to be delineated, but the modality can be helpful in evaluating disease status and guiding further therapy in patients receiving first-line platinum-based chemotherapy or in research protocols. Interval cytoreductive surgery has been shown to confer a survival advantage in a small subset of patients with localized resectable disease proven to be platinum sensitive. The choice of chemotherapeutic agents and the prognosis depend directly on whether the patient is a platinum-sensitive responder. Many agents are approved for the treatment of recurrent ovarian cancer, and the treatment of each patient should be individualized depending on the cumulative toxicities and performance status. Extensive ongoing research trials are underway to elucidate the best salvage therapy.
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Affiliation(s)
- Emery Salom
- Familial Breast/Ovarian Cancer Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Miami School of Medicine, Florida 33136, USA
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