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Matthaiou EI, Guo Y, Barar J, Sandaltzopoulos R, Kandalaft LE, Li C, Coukos G, Omidi Y. TEM1-targeting PEGylated PLGA shikonin nanoformulation for immunomodulation and eradication of ovarian cancer. BIOIMPACTS : BI 2022; 12:65-86. [PMID: 35087718 PMCID: PMC8783079 DOI: 10.34172/bi.2021.23511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 11/21/2022]
Abstract
Introduction: Tumor endothelial marker 1 (TEM1) is expressed by tumor vascular endothelial cells in various cancers. Methods: Here, we developed poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) PEGylated with polyethylene glycol (PEG) and functionalized with anti-TEM1 antibody fragment (78Fc) and loaded them with necroptosis-inducing agent shikonin (SHK) (78Fc-PLGA-SHK NPs). Results: The nanoformulation showed a smooth spherical shape (~120 nm; the ζ potential of -30 mV) with high drug entrapment and bioconjugation efficiencies (~92% and ~90%, respectively) and a sustained-release profile in serum. Having significant toxicity in vitro (e.g., MS1 and TC1 cells), the nanoformulation dramatically increased the cytotoxicity in the TC1 murine lung carcinoma subcutaneous and intravenous/metastatic models as aggressive tumor models. The injection of the 78Fc-PLGA-SHK NPs to the MS1-xenograft mice resulted in significantly higher accumulation and effects in the TEM1-positive tumor targets, while they were excreted via urine track without retaining in the liver/spleen. In the TC1 subcutaneous model, C57/BL6 mice treated with the 78Fc-PLGA-SHK NPs revealed a significant therapeutic effect. The mice, which were tumor-free after receiving the nanoformulation, were re-challenged with the TC1 cells to investigate the immune response. These animals became tumor-free a week after the injection of TC1 cells. Conclusion: Based on these findings, we propose the 78Fc-PLGA-SHK NPs as a highly effective immunostimulating nanomedicine against the TEM1-expressing cells for targeted therapy of solid tumors including ovarian cancer.
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Affiliation(s)
- Efthymia-Iliana Matthaiou
- Ovarian Cancer Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
,Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Yi Guo
- Ovarian Cancer Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
,University of Shanghai, Shanghai, China
| | - Jaleh Barar
- Ovarian Cancer Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
,Research Center for Pharmaceutical Nanotechnology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Raphael Sandaltzopoulos
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Lana E. Kandalaft
- Ludwig Institute for Cancer Research, Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Chunsheng Li
- Ovarian Cancer Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
,Corresponding authors: Chunsheng Li, ; Yadollah Omidi,
| | - George Coukos
- Ovarian Cancer Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
,Ludwig Institute for Cancer Research, Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Yadollah Omidi
- Ovarian Cancer Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
,Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
,Corresponding authors: Chunsheng Li, ; Yadollah Omidi,
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2
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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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3
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Morales ASR, Joy JK, Zbona DM. Administration sequence for multi-agent oncolytic regimens. J Oncol Pharm Pract 2020; 26:933-942. [DOI: 10.1177/1078155219895070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The existence of a multitude of oncolytics regimens containing two or more agents (combination) outlines the need to define their most adequate sequence of administration. However, limited resources are currently available to specify a particular sequence, presenting challenges potentially impacting on patient safety, and Pharmacy & Infusion Nursing workflows. Methods A comprehensive literature search was performed leading to the compilation of a document containing drug administration sequencing instructions for our Nursing, Pharmacy, and Oncology providers to follow. Regimens prioritized in our literature review represented regimens selected as part of our approved Clinical Pathways, regimens inquiries from Pharmacy or Nursing, as well as less frequently used regimens. We stratified the regimens by tumor type and arranged them alphabetically by indication. Results A table was compiled containing all the supporting literature for the recommended drug administration sequences. If, in certain instances, no literature support was identified outlining rationale such as enhanced management of adverse effects, a specific institutional decision was made by our enterprise Medical Oncology Committee with recommendations from Pharmacy experts. The primary guiding principles for outlining our recommendations were the following: administration of vesicant agents first; administration of biologic agents first; administration of taxanes prior to platinum agents; and duration of infusion (shorter infusions prioritized). Conclusion This guideline is not exhaustive. The compilation provided here is intended to be utilized as guidance for oncolytics administration sequence. We will continue to review and incorporate treatment sequencing recommendations for additional regimens.
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Affiliation(s)
| | - Jamie K Joy
- Cancer Treatment Centers of America Global, Boca Raton, FL, USA
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4
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Weng CS, Wu CC, Chen TC, Chen JR, Huang CY, Chang CL. Retrospective Analysis Of Comparative Outcomes In Recurrent Platinum-Sensitive Ovarian Cancer Treated With Pegylated Liposomal Doxorubicin (Lipo-Dox) And Carboplatin Versus Paclitaxel And Carboplatin. Cancer Manag Res 2019; 11:9899-9905. [PMID: 31819627 PMCID: PMC6877447 DOI: 10.2147/cmar.s217329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/15/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose The aim of this study is to analyze the outcomes of platinum-sensitive (PS) recurrent ovarian cancer treated with pegylated liposomal doxorubicin and carboplatin (CD) versus paclitaxel and carboplatin (CP). Clinical features were examined to characterize the patient population that would benefit from CD. Materials and methods This is a retrospective review of 122 cases at a tertiary hospital. Patients with PS recurrent ovarian cancer who received CD or CP were included. Progression-free survival (PFS) and overall survival (OS) were evaluated through the Kaplan–Meier method and log-rank test. Cox proportional hazards regression was used to examine PFS predictors. Results In total, 122 patients (75% with first recurrence and 25% with second recurrence) were included. The majority of the patients were diagnosed at an advanced stage and with the histology of serous carcinoma. Median PFS and OS were 14.8 and 55.5 months in the CD group and 13.5 and 56.8 months in the CP group. Subgroup analysis of patients revealed that the CD group had longer median PFS than the CP group among patients with PFI>12 months. Additionally, during the second recurrence, longer PFS was observed in the CD group than in the CP group (medians 22.3 and 13.5 months, respectively, p = 0.019). Conclusion Comparable outcomes in recurrent platinum-sensitive ovarian cancer treated with CD versus CP were presented in this study. Longer PFS in CD group was observed among patients with PFI for more than 12 months or in second recurrence.
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Affiliation(s)
- Chia-Sui Weng
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chao-Chih Wu
- Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan
| | - Tze-Chien Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jen-Ruei Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chueh-Yi Huang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Long Chang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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5
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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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6
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Tripodi E, Cormio G, De Giorgi U, Valabrega G, Rubino D, Lepori S, Maltese G, Sabatucci I, Lorusso D. Pegylated liposomal doxorubicin re-challenge in patients with ovarian cancer relapse: a multicenter retrospective study. Int J Gynecol Cancer 2019; 29:153-157. [PMID: 30640698 DOI: 10.1136/ijgc-2018-000034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/30/2018] [Accepted: 09/06/2018] [Indexed: 11/03/2022] Open
Abstract
BackgroundPegylated liposomal doxorubicin (PLD) is an active and well-tolerable treatment in ovarian cancer relapse, either alone or in combination with other drugs. No data are available on the possibility to rechallenge PLD treatment in long survivor patients with recurrent ovarian cancer, as evaluated for platinum agent, paclitaxel and gemcitabine. The aim of the present study was to evaluate the anti-tumor activity and the toxicity profile of re-challenge of PLD in recurrent ovarian cancer patients.MethodsData on 27 patients with epithelial ovarian cancer treated in the last ten years (2007-2017) with palliative PLD rechallenge were included in this multicenter retrospective Italian study.ResultsThe objective response rate to PLD re-treatment were complete response in 19%, partial response in 30% and stable disease in 37%. Only 1 case of G4 hematological toxicity was reported. No patient experienced severe cardiac impairment (G2-4).ConclusionPLD rechallenge represents an active and safe possibility of treatment for long survivor ovarian cancer patients.
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Affiliation(s)
- Elisa Tripodi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy.,Gynecologic Oncology Unit, University of Bari, Bari, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Daniela Rubino
- SSD Oncologia Medica Istituto "F.Addarii", Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefano Lepori
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppa Maltese
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ilaria Sabatucci
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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7
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Annunziata CM, Kohn EC. Clinical trials in gynecologic oncology: Past, present, and future. Gynecol Oncol 2017; 148:393-402. [PMID: 29212614 DOI: 10.1016/j.ygyno.2017.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/17/2017] [Accepted: 11/20/2017] [Indexed: 12/18/2022]
Abstract
The Gynecologic Oncology Group has historically performed ground-breaking, practice-changing clinical trials in women's cancers. The current standard of care for initial treatment of ovarian, endometrial, cervical, and trophoblastic cancers was determined by clinical trials completed within this cooperative group structure. For example, trial GOG-0111 set the standard for combining platinum and taxane chemotherapy in ovarian cancer, and more recently GOG-0240 provided evidence for adding bevacizumab to chemotherapy for women with advanced cervical cancer. The landscape of clinical trial design has markedly changed in recent decades, with a clear emphasis on streamlining drug development towards specific patient populations and indications for investigational agents. Translational science in gynecologic cancers can set the stage for rapid and efficient introduction of new therapies for our patients. The gynecologic oncology community of researchers and clinicians is well positioned to enter into the new era of drug development, with breakthrough discoveries increasing each year. It is clear that we must incorporate smarter clinical trial design to get the right drugs to the right patients expeditiously, so we can continue to improve outcome for women with gynecologic cancers.
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Affiliation(s)
- Christina M Annunziata
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States.
| | - Elise C Kohn
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
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8
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Figueiredo SA, Salvador JA, Cortés R, Cascante M. Design, synthesis and biological evaluation of novel C-29 carbamate celastrol derivatives as potent and selective cytotoxic compounds. Eur J Med Chem 2017; 139:836-848. [DOI: 10.1016/j.ejmech.2017.08.058] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 12/31/2022]
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9
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Mori K, Horinouchi M, Domitsu A, Shimotahira T, Soutome S, Yamaguchi T, Oho T. Proper oral hygiene protocols decreased inflammation of gingivitis in a patient during chemotherapy with bevacizumab: a case report. Clin Case Rep 2017; 5:1352-1357. [PMID: 28781858 PMCID: PMC5538079 DOI: 10.1002/ccr3.1034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/28/2017] [Accepted: 05/08/2017] [Indexed: 11/10/2022] Open
Abstract
The case is a woman who had a diagnosis of ovarian cancer and endometrial cancer. After surgical therapy, platinum-based adjuvant treatment was performed, followed by additional bevacizumab administration. Because considerable gingivitis appeared, a proper approach for oral hygiene was performed. As a result, the symptom was reduced considerably.
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Affiliation(s)
- Kazuyo Mori
- Division of Clinical Engineering Kagoshima University Hospital Kagoshima Japan
| | - Miho Horinouchi
- Division of Clinical Engineering Kagoshima University Hospital Kagoshima Japan
| | - Ayumi Domitsu
- Division of Clinical Engineering Kagoshima University Hospital Kagoshima Japan
| | - Takako Shimotahira
- Division of Clinical Engineering Kagoshima University Hospital Kagoshima Japan
| | - Sakiko Soutome
- Perioperative Oral Management Center Nagasaki University Hospital Nagasaki Japan
| | - Taihei Yamaguchi
- Department of Preventive Dentistry Research Field in Dentistry, Medical and Dental Sciences Area Kagoshima University Kagoshima Japan
| | - Takahiko Oho
- Department of Preventive Dentistry Research Field in Dentistry, Medical and Dental Sciences Area Kagoshima University Kagoshima Japan
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Nguyen J, Solimando DA, Waddell JA. Carboplatin and Liposomal Doxorubicin for Ovarian Cancer. Hosp Pharm 2016; 51:442-9. [PMID: 27354744 DOI: 10.1310/hpj5106-442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr, President, Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203, e-mail: OncRxSvc@comcast.net; or J. Aubrey Waddell, Professor, University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar Alexander Parkway, Maryville, TN 37804, e-mail: waddfour@charter.net.
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DOXIL when combined with Withaferin A (WFA) targets ALDH1 positive cancer stem cells in ovarian cancer. ACTA ACUST UNITED AC 2016; 4. [PMID: 27668267 DOI: 10.14343/jcscr.2016.4e1002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ovarian cancer is a highly aggressive and deadly disease. Currently, the treatment for ovarian cancer entails cytoreductive surgery followed by chemotherapy, mainly cisplatin or carboplatin combined with paclitaxel. Although this regimen is initially effective in a high percentage of cases, unfortunately, after few months of initial treatment, tumor relapse occurs due to platinum-resistance. DOXIL (liposomal preparation of doxorubicin) is a choice of drug for recurrent ovarian cancer. However, its response rate is very low and is accompanied by myocardial toxicity. Resistance to chemotherapy and recurrence of cancer is primarily attributed to the presence of cancer stem cells (CSCs), a small population of cells present in cancer. Effect of DOXIL and withaferin A (WFA), both alone and in combination, was investigated on cell proliferation of ovarian cancer cell line A2780 and tumor growth in SCID mice bearing i.p. ovarian tumors. ALDH1 cells were isolated from A2780 using cell sorter, and effect of DOXIL and WFA both alone and in combination on tumorigenic function of ALDH1 was studied using spheroids formation assays in vitro. Western blots were performed to examine the expression of ALDH1 and Notch 1 genes. In our studies, we showed, for the first time, that DOXIL when combined with withaferin A (WFA) elicits synergistic effect on inhibition of cell proliferation of ovarian cancer cells and inhibits the expression of ALDH1 protein, a marker for ALDH1 positive cancer stem cells (CSCs), and Notch1, a signaling pathway gene required for self-renewal of CSCs. Inhibition of expression of both ALDH1 and Notch1 genes by WFA was found to be dose dependent, whereas DOXIL (200 nM) was found to be ineffective. SCID mice, bearing i.p. ovarian tumors, were treated with a small dose of DOXIL (2 mg/kg) in combination with a sub-optimal dose of WFA (2 mg/kg) which resulted in a highly significant (60% to 70%) reduction in tumor growth, and complete inhibition of metastasis compared to control. In contrast, WFA treatment showed a significant reduction in tumor growth but no change in metastasis compared to control. DOXIL showed non-significant reduction in tumor growth and no change in metastasis compared to control. Isolated ALDH1 positive CSCs treated with the combination of DOXIL and WFA resulted in a significant reduction in spheroids formation (tumorigenic function of CSCs) and expression of ALDH1 protein. WFA when used alone at a concentration of 1.5 μM was found to be highly effective in suppression of ALDH1 expression, whereas DOXIL at a concentration of 200 nM was found to be ineffective. DOXIL in combination with WFA elicits synergistic effects, targets cancer stem cells, and has potential to minimize induction of drug resistance and reoccurrence of cancer. Based on our studies, we conclude that the combination of DOXIL with WFA has the potential to be an effective therapy for ovarian cancer and may ameliorate DOXIL related side effects as well as recurrence of ovarian cancer leading to increase in patients' survival rate.
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Selle F, Emile G, Pautier P, Asmane I, Soares DG, Khalil A, Alexandre J, Lhommé C, Ray-Coquard I, Lotz JP, Goldwasser F, Tazi Y, Heudel P, Pujade-Lauraine E, Gouy S, Tredan O, Barbaza MO, Ady-Vago N, Dubot C. Safety of bevacizumab in clinical practice for recurrent ovarian cancer: A retrospective cohort study. Oncol Lett 2016; 11:1859-1865. [PMID: 26998090 DOI: 10.3892/ol.2016.4146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 11/05/2015] [Indexed: 12/21/2022] Open
Abstract
The poor outcome of patients with recurrent ovarian cancer constitutes a continuous challenge for decision-making in clinical practice. In this setting, molecular targets have recently been identified, and novel compounds are now available. Bevacizumab has been introduced for the treatment of patients with ovarian cancer and is, to date, the most extensively investigated targeted therapy in this setting. However, potential toxicities are associated with the use of this monoclonal antibody. These toxicities have been reported in clinical trials, and can also be observed outside of trials. As limited data is currently available regarding the safety of bevacizumab treatment in daily clinical practice, the current retrospective study was designed to evaluate this. Data from 156 patients with recurrent ovarian cancer who had received bevacizumab treatment between January 2006 and June 2009 were retrospectively identified from the institutional records of five French centers. In contrast to clinical trials, the patients in the present study were not selected and had a heterogeneous profile according to their prior medical history, lines of treatment prior to bevacizumab introduction and number of relapses. The results first confirm the effect of heavy pretreatment on the occurrence of serious and fatal adverse events in clinical practice, as previously reported for clinical trials and for other retrospective cohort studies. Importantly, the data also demonstrates, for the first time, that medical history of hypertension is an independent predictive risk factor for the development of high-grade hypertension during bevacizumab treatment. These results thus suggest that treating physicians must consider all risk factors for managing bevacizumab toxicity prior to its introduction. Such risk factors include the time of bevacizumab introduction, a patient's history of hypertension and a low incidence of pre-existing obstructive disease.
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Affiliation(s)
- Frédéric Selle
- Department of Medical Oncology, Alliance For Cancer Research (APREC), Tenon Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris 75020, France; Department of Clinical Oncology, Sorbonne University, Pierre-and-Marie-Curie University (University of Paris VI), Paris 75014, France
| | - George Emile
- Department of Medical Oncology, Cochin Hospital/Hotel Dieu, AP-HP, Paris Descartes University (University of Paris V), Paris 75014, France
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy, Villejuif 94805, France
| | - Irène Asmane
- Oncology Department, Centre Léon Bérard, Lyon 69008, France
| | - Daniele G Soares
- Department of Medical Oncology, Alliance For Cancer Research (APREC), Tenon Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris 75020, France
| | - Ahmed Khalil
- Department of Medical Oncology, Alliance For Cancer Research (APREC), Tenon Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris 75020, France
| | - Jerome Alexandre
- Department of Medical Oncology, Cochin Hospital/Hotel Dieu, AP-HP, Paris Descartes University (University of Paris V), Paris 75014, France
| | - Catherine Lhommé
- Department of Medical Oncology, Gustave Roussy, Villejuif 94805, France
| | | | - Jean-Pierre Lotz
- Department of Medical Oncology, Alliance For Cancer Research (APREC), Tenon Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris 75020, France; Department of Clinical Oncology, Sorbonne University, Pierre-and-Marie-Curie University (University of Paris VI), Paris 75014, France
| | - François Goldwasser
- Department of Medical Oncology, Cochin Hospital/Hotel Dieu, AP-HP, Paris Descartes University (University of Paris V), Paris 75014, France
| | - Youssef Tazi
- Department of Medical Oncology, Gustave Roussy, Villejuif 94805, France
| | - Pierre Heudel
- Oncology Department, Centre Léon Bérard, Lyon 69008, France
| | - Eric Pujade-Lauraine
- Department of Medical Oncology, Cochin Hospital/Hotel Dieu, AP-HP, Paris Descartes University (University of Paris V), Paris 75014, France
| | - Sébastien Gouy
- Department of Medical Oncology, Gustave Roussy, Villejuif 94805, France
| | - Olivier Tredan
- Oncology Department, Centre Léon Bérard, Lyon 69008, France
| | - Marie O Barbaza
- Department of Statistics, Auxesia, Decines-Charpieu 69150, France
| | | | - Coraline Dubot
- Department of Medical Oncology, Alliance For Cancer Research (APREC), Tenon Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris 75020, France
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Nakanishi T, Aoki D, Watanabe Y, Ando Y, Tomotsugu N, Sato Y, Saito T. A Phase II clinical trial of pegylated liposomal doxorubicin and carboplatin in Japanese patients with platinum-sensitive recurrent ovarian, fallopian tube or primary peritoneal cancer. Jpn J Clin Oncol 2015; 45:422-6. [DOI: 10.1093/jjco/hyv016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/18/2015] [Indexed: 11/13/2022] Open
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Mahner S, Meier W, du Bois A, Brown C, Lorusso D, Dell’Anna T, Cretin J, Havsteen H, Bessette P, Zeimet AG, Vergote I, Vasey P, Pujade-Lauraine E, Gladieff L, Ferrero A. Carboplatin and pegylated liposomal doxorubicin versus carboplatin and paclitaxel in very platinum-sensitive ovarian cancer patients: Results from a subset analysis of the CALYPSO phase III trial. Eur J Cancer 2015; 51:352-8. [DOI: 10.1016/j.ejca.2014.11.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/17/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
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15
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Impact of secondary cytoreductive surgery on survival in patients with platinum sensitive recurrent ovarian cancer: Analysis of the CALYPSO trial. Gynecol Oncol 2015; 136:18-24. [DOI: 10.1016/j.ygyno.2014.09.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 09/23/2014] [Accepted: 09/25/2014] [Indexed: 11/19/2022]
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16
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Staropoli N, Ciliberto D, Botta C, Fiorillo L, Grimaldi A, Lama S, Caraglia M, Salvino A, Tassone P, Tagliaferri P. Pegylated liposomal doxorubicin in the management of ovarian cancer: a systematic review and metaanalysis of randomized trials. Cancer Biol Ther 2014; 15:707-20. [PMID: 24658024 PMCID: PMC4049787 DOI: 10.4161/cbt.28557] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/09/2014] [Accepted: 03/16/2014] [Indexed: 02/06/2023] Open
Abstract
Ovarian cancer is the leading cause of death among gynecological tumors. Carboplatin/paclitaxel represents the cornerstone of front-line treatment. Instead, there is no consensus for management of recurrent/progressive disease, in which pegylated liposomal doxorubicin (PLD) ± carboplatin is widely used. We performed a systematic review and metaanalysis to evaluate impact of PLD-based compared with no-PLD-based regimens in the ovarian cancer treatment. Data were extracted from randomized trials comparing PLD-based treatment to any other regimens in the January 2000-January 2013 time-frame. Study end-points were overall survival (OS), progression free survival (PFS), response rate (RR), CA125 response, and toxicity. Hazard ratios (HRs) of OS and PFS, with 95% CI, odds ratios (ORs) of RR and risk ratios of CA125 response and grade 3-4 toxicity, were extracted. Data were pooled using fixed and random effect models for selected endpoints. Fourteen randomized trials for a total of 5760 patients were selected and included for the final analysis, which showed no OS differences for PLD-based compared with other regimens (pooled HR: 0.94; 95% CI: 0.88-1.02; P = 0.132) and a significant PFS benefit of PLD-based schedule (HR: 0.91; 95% CI: 0.86-0.96; P = 0.001), particularly in second-line (HR: 0.85; 95% CI: 0.75-0.91) and in platinum-sensitive (HR: 0.83; 95% CI: 0.74-0.94) subgroups. This work confirmed the peculiar tolerability profile of this drug, moreover no difference was observed for common hematological toxicities and for RR, CA125 response. PLD-containing regimens do not improve OS when compared with any other schedule in all phases of disease. A marginal PFS advantage is observed only in platinum-sensitive setting and second-line treatment.
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Affiliation(s)
- Nicoletta Staropoli
- Medical Oncology Unit; Department of Experimental and Clinical Medicine; Magna Græcia University and T. Campanella Cancer Center; Catanzaro, Italy
| | - Domenico Ciliberto
- Medical Oncology Unit; Department of Experimental and Clinical Medicine; Magna Græcia University and T. Campanella Cancer Center; Catanzaro, Italy
| | - Cirino Botta
- Medical Oncology Unit; Department of Experimental and Clinical Medicine; Magna Græcia University and T. Campanella Cancer Center; Catanzaro, Italy
| | - Lucia Fiorillo
- Medical Oncology Unit; Department of Experimental and Clinical Medicine; Magna Græcia University and T. Campanella Cancer Center; Catanzaro, Italy
| | - Anna Grimaldi
- Department of Biochemistry; Biophysics and General Pathology; Second University of Naples; Naples, Italy
| | - Stefania Lama
- Department of Biochemistry; Biophysics and General Pathology; Second University of Naples; Naples, Italy
| | - Michele Caraglia
- Department of Biochemistry; Biophysics and General Pathology; Second University of Naples; Naples, Italy
| | - Angela Salvino
- Medical Oncology Unit; Department of Experimental and Clinical Medicine; Magna Græcia University and T. Campanella Cancer Center; Catanzaro, Italy
| | - Pierfrancesco Tassone
- Medical Oncology Unit; Department of Experimental and Clinical Medicine; Magna Græcia University and T. Campanella Cancer Center; Catanzaro, Italy
| | - Pierosandro Tagliaferri
- Medical Oncology Unit; Department of Experimental and Clinical Medicine; Magna Græcia University and T. Campanella Cancer Center; Catanzaro, Italy
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Matthaiou EI, Barar J, Sandaltzopoulos R, Li C, Coukos G, Omidi Y. Shikonin-loaded antibody-armed nanoparticles for targeted therapy of ovarian cancer. Int J Nanomedicine 2014; 9:1855-70. [PMID: 24790428 PMCID: PMC3998853 DOI: 10.2147/ijn.s51880] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Conventional chemotherapy of ovarian cancer often fails because of initiation of drug resistance and/or side effects and trace of untouched remaining cancerous cells. This highlights an urgent need for advanced targeted therapies for effective remediation of the disease using a cytotoxic agent with immunomodulatory effects, such as shikonin (SHK). Based on preliminary experiments, we found SHK to be profoundly toxic in ovarian epithelial cancer cells (OVCAR-5 and ID8 cells) as well as in normal ovarian IOSE-398 cells, endothelial MS1 cells, and lymphocytes. To limit its cytotoxic impact solely to tumor cells within the tumor microenvironment (TME), we aimed to engineer SHK as polymeric nanoparticles (NPs) with targeting moiety toward tumor microvasculature. To this end, using single/double emulsion solvent evaporation/diffusion technique with sonication, we formulated biodegradable NPs of poly(lactic-co-glycolic acid) (PLGA) loaded with SHK. The surface of NPs was further decorated with solubilizing agent polyethylene glycol (PEG) and tumor endothelial marker 1 (TEM1)/endosialin-targeting antibody (Ab) through carbodiimide/N-hydroxysuccinimide chemistry. Having characterized the physicochemical and morphological properties of NPs, we studied their drug-release profiles using various kinetic models. The biological impact of NPs was also evaluated in tumor-associated endothelial MS1 cells, primary lymphocytes, and epithelial ovarian cancer OVCAR-5 cells. Based on particle size analysis and electron microscopy, the engineered NPs showed a smooth spherical shape with size range of 120 to 250 nm and zeta potential value of -30 to -40 mV. Drug entrapment efficiency was ~80%-90%, which was reduced to ~50%-60% upon surface decoration with PEG and Ab. The liberation of SHK from NPs showed a sustained-release profile that was best fitted with Wagner log-probability model. Fluorescence microscopy and flow cytometry analysis showed active interaction of Ab-armed NPs with TEM1-positive MS1 cells, but not with TEM1-negative MS1 cells. While exposure of the PEGylated NPs for 2 hours was not toxic to lymphocytes, long-term exposure of the Ab-armed and PEGylated NPs was significantly toxic to TEM1-positive MS1 cells and OVCAR-5 cells. Based on these findings, we propose SHK-loaded Ab-armed PEGylated PLGA NPs as a novel nanomedicine for targeted therapy of solid tumors.
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Affiliation(s)
- Efthymia-Iliana Matthaiou
- Ovarian Cancer Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA ; Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Jaleh Barar
- Ovarian Cancer Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA ; Research Center for Pharmaceutical Nanotechnology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Raphael Sandaltzopoulos
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Chunsheng Li
- Ovarian Cancer Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - George Coukos
- Ovarian Cancer Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA ; Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Yadollah Omidi
- Ovarian Cancer Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA ; Research Center for Pharmaceutical Nanotechnology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
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Clinical features of long-term survivors of recurrent epithelial ovarian cancer. Int J Clin Oncol 2014; 20:143-9. [PMID: 24664306 DOI: 10.1007/s10147-014-0687-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/12/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND Although recurrent epithelial ovarian cancer (EOC) is generally regarded as an incurable disease, some patients survive more than 5 years after the first recurrence. The aim of this study was to evaluate the clinical features of patients with recurrent EOC who achieve long-term survival. METHODS We retrospectively reviewed the medical records of 164 patients with recurrent EOC and analyzed the clinical stage, histologic subtype, primary treatment, disease-free interval (DFI), recurrence site, secondary treatment, and overall survival from the time of the first recurrence (R-OS), using the Kaplan-Meier method and the log-rank test. RESULTS The median R-OS for all 164 patients was 25 months and the 5-year R-OS rate was 25.4 %. There were no significant differences in R-OS according to the disease stage. The median R-OS was significantly shorter in the 6-12-month DFI group (23 months) than in the ≥12-month DFI group (61 months) (p = 0.0002), while there was no significant difference between the 6-12 and 3-6-month DFI groups (20 months) (p = 0.161). Of the 164 patients, only 14 survived >5 years after the first recurrence. Most of them underwent surgery and/or radiotherapy in combination with chemotherapy and underwent >18 cycles of platinum-based chemotherapy throughout their treatments (median 22 cycles; range 4-44). CONCLUSIONS If high sensitivity to platinum is maintained, patients with recurrent EOC may have prolonged survival following repeated platinum-based chemotherapy cycles. Moreover, their prognosis improves when chemotherapy is combined with secondary cytoreductive surgery and/or irradiation.
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Rakowski JA, Ahmad S, Holloway RW. Use of pegylated liposomal doxorubicin in the management of platinum-sensitive recurrent ovarian cancer: current concepts. Expert Rev Anticancer Ther 2014; 12:31-40. [DOI: 10.1586/era.11.187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Del Campo JM, Muñoz-Couselo E, Diaz de Corcuera I, Oaknin A. Trabectedin combined with liposomal doxorubicin in women with relapsed ovarian cancer. Expert Rev Anticancer Ther 2014; 10:795-805. [DOI: 10.1586/era.10.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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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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Khemapech N, Oranratanaphan S, Termrungruanglert W, Lertkhachonsuk R, Vasurattana A. Salvage Chemotherapy in Recurrent Platinum-Resistant or Refractory Epithelial Ovarian Cancer with Carboplatin and Distearoylphosphatidylcholine Pegylated Liposomal Doxorubicin (Lipo-Dox®). Asian Pac J Cancer Prev 2013; 14:2131-5. [DOI: 10.7314/apjcp.2013.14.3.2131] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Clinical trials with pegylated liposomal Doxorubicin in the treatment of ovarian cancer. JOURNAL OF DRUG DELIVERY 2013; 2013:898146. [PMID: 23577259 PMCID: PMC3612436 DOI: 10.1155/2013/898146] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 01/29/2013] [Accepted: 01/29/2013] [Indexed: 11/17/2022]
Abstract
Among the pharmaceutical options available for treatment of ovarian cancer, increasing attention has been progressively focused on pegylated liposomal doxorubicin (PLD), whose unique formulation prolongs the persistence of the drug in the circulation and potentiates intratumor accumulation. Pegylated liposomal doxorubicin (PLD) has become a major component in the routine management of epithelial ovarian cancer. In 1999 it was first approved for platinum-refractory ovarian cancer and then received full approval for platinum-sensitive recurrent disease in 2005. PLD remains an important therapeutic tool in the management of recurrent ovarian cancer in 2012. Recent interest in PLD/carboplatin combination therapy has been the object of phase III trials in platinum-sensitive and chemonaïve ovarian cancer patients reporting response rates, progressive-free survival, and overall survival similar to other platinum-based combinations, but with a more favorable toxicity profile and convenient dosing schedule. This paper summarizes data clarifying the role of pegylated liposomal doxorubicin (PLD) in ovarian cancer, as well as researches focusing on adding novel targeted drugs to this cytotoxic agent.
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Grenader T, Rosengarten O, Isacson R, Plotkin Y, Gabizon A. Pegylated liposomal doxorubicin/carboplatin combination in ovarian cancer, progressing on single-agent pegylated liposomal doxorubicin. World J Clin Oncol 2012; 3:137-141. [PMID: 23198277 PMCID: PMC3509111 DOI: 10.5306/wjco.v3.i10.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the efficacy and safety of the combination of pegylated liposomal doxorubicin (PLD) and carboplatin in patients with recurrent epithelial ovarian carcinoma (ROC), following disease progression on single agent PLD.
METHODS: An analysis of the medical records of 10 patients with ROC, treated in our institution with a combination of PLD and carboplatin following progression on single-agent PLD therapy was performed. The median age was 59.1 years (range, 45 to 77 years). All diagnoses were histological-proven. Eight of the 10 patients were platinum-resistant. Following disease progression on single-agent PLD treatment, carboplatin area under the curve (AUC)-5 was added to PLD in all 10 patients. In order to assess disease status, Ca-125 was assessed before each PLD/carboplatin treatment. Relative changes in Ca-125 values were calculated, and response defined as a greater than 50% reduction in Ca-125 from baseline. Radiographic studies were re-evaluated and responses to therapy based on computer tomography (CT) scans carried out on a regular basis every 2-3 mo in each patient. Statistical analysis was performed using SPSS (V19).
RESULTS: A median of 10 cycles (range, 2-26) of the carboplatin-PLD combination was given. Of the 10 treated patients, 6 had > 50% reduction in Ca-125 levels from baseline, 4 of these had a partial response according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria, and the other 2 patients had no measurable disease. In a further 2 patients with a best response of disease stabilization and < 50% reduction of Ca-125 levels, one had progression of disease after 26 cycles, and the second progressed with brain metastases following 12 cycles. Seven of the eight patients who were platinum-resistant showed evidence of clinical benefit on carboplatin-PLD combination therapy; 5 of these had > 50% reduction in Ca-125 level, 4 also showed a partial response on CT scan. The treatment was generally well-tolerated by the patients.
CONCLUSION: Addition of carboplatin to PLD, after disease progression on single-agent PLD therapy, is both effective and safe in patients with ROC, even in those with Platinum-resistant disease.
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Affiliation(s)
- Tal Grenader
- Tal Grenader, Ora Rosengarten, Rut Isacson, Yevgeni Plotkin, Alberto Gabizon, Department of Oncology, Sha'are Zedek Medical Center, Jerusalem 91031, Israel
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del Carmen MG, Micha J, Small L, Street DG, Londhe A, McGowan T. A phase II clinical trial of pegylated liposomal doxorubicin and carboplatin plus bevacizumab in patients with platinum-sensitive recurrent ovarian, fallopian tube, or primary peritoneal cancer. Gynecol Oncol 2012; 126:369-74. [DOI: 10.1016/j.ygyno.2012.05.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/17/2012] [Accepted: 05/22/2012] [Indexed: 11/26/2022]
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26
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Chuang YT, Chang CL. Extending platinum-free interval in partially platinum-sensitive recurrent ovarian cancer by a non-platinum regimen: Its possible clinical significance. Taiwan J Obstet Gynecol 2012; 51:336-41. [DOI: 10.1016/j.tjog.2012.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2012] [Indexed: 10/27/2022] Open
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Final overall survival results of phase III GCIG CALYPSO trial of pegylated liposomal doxorubicin and carboplatin vs paclitaxel and carboplatin in platinum-sensitive ovarian cancer patients. Br J Cancer 2012; 107:588-91. [PMID: 22836511 PMCID: PMC3419956 DOI: 10.1038/bjc.2012.307] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: The CALYPSO phase III trial compared CD (carboplatin-pegylated liposomal doxorubicin (PLD)) with CP (carboplatin-paclitaxel) in patients with platinum-sensitive recurrent ovarian cancer (ROC). Overall survival (OS) data are now mature. Methods: Women with ROC relapsing >6 months after first- or second-line therapy were randomised to CD or CP for six cycles in this international, open-label, non-inferiority trial. The primary endpoint was progression-free survival. The OS analysis is presented here. Results: A total of 976 patients were randomised (467 to CD and 509 to CP). With a median follow-up of 49 months, no statistically significant difference was observed between arms in OS (hazard ratio=0.99 (95% confidence interval 0.85, 1.16); log-rank P=0.94). Median survival times were 30.7 months (CD) and 33.0 months (CP). No statistically significant difference in OS was observed between arms in predetermined subgroups according to age, body mass index, treatment-free interval, measurable disease, number of lines of prior chemotherapy, or performance status. Post-study cross-over was imbalanced between arms, with a greater proportion of patients randomised to CP receiving post-study PLD (68%) than patients randomised to CD receiving post-study paclitaxel (43% P<0.001). Conclusion: Carboplatin-PLD led to delayed progression and similar OS compared with carboplatin-paclitaxel in platinum-sensitive ROC.
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Gladieff L, Ferrero A, De Rauglaudre G, Brown C, Vasey P, Reinthaller A, Pujade-Lauraine E, Reed N, Lorusso D, Siena S, Helland H, Elit L, Mahner S. Carboplatin and pegylated liposomal doxorubicin versus carboplatin and paclitaxel in partially platinum-sensitive ovarian cancer patients: results from a subset analysis of the CALYPSO phase III trial. Ann Oncol 2012; 23:1185-1189. [PMID: 21976386 DOI: 10.1093/annonc/mdr441] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND To perform a subset analysis of patients with partially platinum-sensitive recurrent ovarian cancer (ROC) who received either CD [carboplatin-pegylated liposomal doxorubicin (PLD)] or CP (carboplatin-paclitaxel) in the CALYPSO trial. PATIENTS AND METHODS CALYPSO, an international phase III, non-inferiority trial, enrolled women with ROC that relapsed >6 months following first- or second-line therapy. Patients were randomized to CD or CP. Patients with a treatment-free interval of >6 and ≤ 12 months were evaluated for progression-free survival (PFS), the primary end point of CALYPSO trial, and safety. RESULTS A total of 344 partially platinum-sensitive patients were included (N = 161, CD and N = 183, CP). The hazard ratio for PFS was 0.73 (95% confidence interval: 0.58-0.90; P = 0.004 for superiority) in favor of CD. Median PFS times were 9.4 months (CD) and 8.8 months (CP). Toxicities more common with CP versus CD included grade 3/4 neutropenia (50% versus 39%; P = 0.015), grade 2 alopecia (86% versus 9%; P < 0.001), neuropathy and hypersensitivity reactions. Hand-foot syndrome was more common with CD; however, grade 3/4 reactions were low (one patient in each arm). CONCLUSION Carboplatin-PLD has a more favorable risk-benefit profile than CP in patients with partially platinum-sensitive ROC and should be considered an effective treatment option for these patients.
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Affiliation(s)
- L Gladieff
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France.
| | - A Ferrero
- Academic Division of Gynecologic Oncology, Mauriziano Hospital, Torino, Italy
| | - G De Rauglaudre
- Department of clinical Oncology, Institut Sainte-Catherine, Avignon, France
| | - C Brown
- NHMRC Clinical Trials Centre, Sydney, Australia
| | - P Vasey
- University of Queensland, Brisbane, Australia
| | - A Reinthaller
- Department of Gynecology and Gynecologic Oncology, Medical University of Vienna - General Hospital of Vienna, Vienna, Austria
| | - E Pujade-Lauraine
- Department of Medical Oncology, Medicale Hopital Hotel-Dieu and Universite Paris Descartes, Paris, France
| | - N Reed
- Gartnavel General Hospital, Beatson Oncology Centre, Glasgow, UK
| | - D Lorusso
- Department of Obstetrics and Gynecology, University of Sacred Heart, Roma, Italy
| | - S Siena
- Department of Oncology, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - H Helland
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - L Elit
- Department of Gynecologic Oncology, Juravinski Cancer Centre, Hamilton, Canada
| | - S Mahner
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Collea RP, Kruter FW, Cantrell JE, George TK, Kruger S, Favret AM, Lindquist DL, Melnyk AM, Pluenneke RE, Shao SH, Crockett MW, Asmar L, O'Shaughnessy J. Pegylated liposomal doxorubicin plus carboplatin in patients with metastatic breast cancer: a phase II study. Ann Oncol 2012; 23:2599-2605. [PMID: 22431702 DOI: 10.1093/annonc/mds052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We determined the objective response rates produced by pegylated liposomal doxorubicin (PLD) plus carboplatin with/without trastuzumab (Herceptin). PATIENTS AND METHODS Patients with measurable disease were stratified by taxane treatment history and human epidermal growth factor receptor-2 status. TREATMENT PLD 30 mg/m(2) followed by carboplatin, day 1 of each 28-day cycle; human epidermal growth factor receptor-2 (HER2)-positive patients also received trastuzumab. RESULTS Arm 1 received PLD plus carboplatin (N = 41 arm 1a, taxane naive; N = 42 arm 1b, taxane pretreated); Arm 2 patients received PLD plus carboplatin + Herceptin (N = 46). Overall response rates: 31%, 31%, and 56%, respectively. Median overall survival durations were not reached in arm 1a and were 13 and 33 months for arms 1b and 2. Median progression-free survival: 8, 5, 10 months, respectively. Grades 3-4 treatment-related toxic effects for arms 1a, 1b, 2, respectively, were neutropenia 22%, 31%, 35%; thrombocytopenia 34%, 26%, 17%; and fatigue 2%, 14%, 13%. CONCLUSIONS PLD plus carboplatin has moderate antitumor activity and excellent tolerability. Herceptin and PLD plus carboplatin in HER2-positive patients have antitumor activity without significant cardiac toxicity. Toxicity results suggest that PLD can be combined with Herceptin with minimal cardiac toxicity.
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Affiliation(s)
- R P Collea
- US Oncology Research, McKesson Specialty Health, The Woodlands; New York Oncology Hematology Center, Albany.
| | - F W Kruter
- US Oncology Research, McKesson Specialty Health, The Woodlands; Alliance Hematology-Oncology PA, Westminster
| | - J E Cantrell
- US Oncology Research, McKesson Specialty Health, The Woodlands; Birmingham Hematology-Oncology, Birmingham
| | - T K George
- US Oncology Research, McKesson Specialty Health, The Woodlands; Texas Oncology, Odessa
| | - S Kruger
- US Oncology Research, McKesson Specialty Health, The Woodlands; Virginia Oncology Associates, Hampton
| | - A M Favret
- US Oncology Research, McKesson Specialty Health, The Woodlands; Northern Virginia Hematology-Oncology, Fairfax
| | - D L Lindquist
- US Oncology Research, McKesson Specialty Health, The Woodlands; Arizona Oncology, Sedona
| | - A M Melnyk
- US Oncology Research, McKesson Specialty Health, The Woodlands; Texas Oncology, Abilene
| | - R E Pluenneke
- US Oncology Research, McKesson Specialty Health, The Woodlands; Kansas City Cancer Center, Kansas City
| | - S H Shao
- US Oncology Research, McKesson Specialty Health, The Woodlands; Northwest Cancer Specialists, Portland
| | - M W Crockett
- US Oncology Research, McKesson Specialty Health, The Woodlands
| | - L Asmar
- US Oncology Research, McKesson Specialty Health, The Woodlands
| | - J O'Shaughnessy
- US Oncology Research, McKesson Specialty Health, The Woodlands; Texas Oncology, PA, Baylor-Charles A. Sammons Cancer Center, Dallas, USA
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30
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A Rational Approach to the Management of Recurrent or Persistent Ovarian Carcinoma. Clin Obstet Gynecol 2012; 55:114-30. [DOI: 10.1097/grf.0b013e31824b9bc5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Sehouli J, Alfaro V, González-Martín A. Trabectedin plus pegylated liposomal doxorubicin in the treatment of patients with partially platinum-sensitive ovarian cancer: current evidence and future perspectives. Ann Oncol 2012; 23:556-562. [PMID: 21734221 DOI: 10.1093/annonc/mdr321] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
The effectiveness of platinum re-treatment in relapsed ovarian cancer depends on relapse-free/treatment-free intervals. Platinum agents can be effectively readministered to platinum-sensitive patients (relapsing >12 months after platinum), but efficacy is lower in partially platinum-sensitive (PPS) disease (relapsing 6-12 months after platinum). There is no clear standard treatment challenging PPS patients. Survival data in this subset with chemotherapy combinations such as pegylated liposomal doxorubicin (PLD) plus carboplatin or gemcitabine plus PLD are available from phase II trials ranging from 16 to 21 months. Recent results from OVA-301 phase III randomized trial evaluating trabectedin plus PLD showed the longest median overall survival ever reported in PPS patients (23 months). Subsequent chemotherapy (including platinum-based regimens) was administered later and survival in patients receiving third-line platinum was longer in patients treated with trabectedin plus PLD compared with those treated with PLD alone. These results suggest that prolonging platinum-free interval (PFI) with an effective non-platinum regimen improves outcome with subsequent third-line platinum treatment. An ongoing phase III trial (INOVATYON) aims to demonstrate if the results observed with trabectedin plus PLD in PPS patients are due to PFI extension, and if PFI extension with non-platinum combination prolongs response to subsequent platinum and survival in this population.
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Affiliation(s)
- J Sehouli
- Department of Obstetrics and Gynecology, Charité University Hospital, Berlin, Germany.
| | - V Alfaro
- Clinical R&D, PharmaMar, Colmenar Viejo, Madrid
| | - A González-Martín
- Department of Medical Oncology, Centro Oncológico MD Anderson International, Madrid, Spain
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Kurtz J, Kaminsky M, Floquet A, Veillard A, Kimmig R, Dorum A, Elit L, Buck M, Petru E, Reed N, Scambia G, Varsellona N, Brown C, Pujade-Lauraine E. Ovarian cancer in elderly patients: carboplatin and pegylated liposomal doxorubicin versus carboplatin and paclitaxel in late relapse: a Gynecologic Cancer Intergroup (GCIG) CALYPSO sub-study. Ann Oncol 2011; 22:2417-2423. [DOI: 10.1093/annonc/mdr001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Prognostic nomogram to predict progression-free survival in patients with platinum-sensitive recurrent ovarian cancer. Br J Cancer 2011; 105:1144-50. [PMID: 21915127 PMCID: PMC3208495 DOI: 10.1038/bjc.2011.364] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Patients with platinum-sensitive recurrent ovarian cancer are a heterogeneous group, and it is not possible to accurately predict the progression-free survival (PFS) in these patients. We developed and validated a nomogram to help improve prediction of PFS in patients treated with platinum-based chemotherapy. Methods: The nomogram was developed in a training cohort (n=955) from the CALYPSO trial and validated in the AGO-OVAR 2.5 Study (n=340). The proportional-hazards model (nomogram) was based on pre-treatment characteristics. Results: The nomogram had a concordance index (C-index) of 0.645. Significant predictors were tumour size platinum-chemotherapy-free interval, CA-125, number of organ metastatic sites and white blood count. When the nomogram was applied without CA-125 (CA-125 was not available in validation cohort), the C-indices were 0.624 (training) and 0.594 (validation). When classification was based only on the platinum-chemotherapy-free interval, the indices were 0.571 (training) and 0.560 (validation). The calibration plot in the validation cohort based on four predictors (without CA-125) suggested good agreement between actual and nomogram-predicted 12-month PFS probabilities. Conclusion: This nomogram, using five pre-treatment characteristics, improves prediction of PFS in patients with platinum-sensitive ovarian cancer having platinum-based chemotherapy. It will be useful for the design and stratification of patients in clinical trials and also for counselling patients.
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Pignata S, Scambia G, Ferrandina G, Savarese A, Sorio R, Breda E, Gebbia V, Musso P, Frigerio L, Del Medico P, Lombardi AV, Febbraro A, Scollo P, Ferro A, Tamberi S, Brandes A, Ravaioli A, Valerio MR, Aitini E, Natale D, Scaltriti L, Greggi S, Pisano C, Lorusso D, Salutari V, Legge F, Di Maio M, Morabito A, Gallo C, Perrone F. Carboplatin plus paclitaxel versus carboplatin plus pegylated liposomal doxorubicin as first-line treatment for patients with ovarian cancer: the MITO-2 randomized phase III trial. J Clin Oncol 2011; 29:3628-35. [PMID: 21844495 DOI: 10.1200/jco.2010.33.8566] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Carboplatin/paclitaxel is the standard first-line chemotherapy for patients with advanced ovarian cancer. Multicentre Italian Trials in Ovarian Cancer-2 (MITO-2), an academic multicenter phase III trial, tested whether carboplatin/pegylated liposomal doxorubicin (PLD) was more effective than standard chemotherapy. PATIENTS AND METHODS Chemotherapy-naive patients with stage IC to IV ovarian cancer (age ≤ 75 years; Eastern Cooperative Oncology Group performance status ≤ 2) were randomly assigned to carboplatin area under the curve (AUC) 5 plus paclitaxel 175 mg/m(2) or to carboplatin AUC 5 plus PLD 30 mg/m(2), every 3 weeks for six cycles. Primary end point was progression-free survival (PFS). With 632 events in 820 enrolled patients, the study would have 80% power to detect a 0.80 hazard ratio (HR) of PFS. RESULTS Eight hundred twenty patients were randomly assigned. Disease stages III and IV were prevalent. Occurrence of PFS events substantially slowed before obtaining the planned number. Therefore, in concert with the Independent Data Monitoring Committee, final analysis was performed with 556 events, after a median follow-up of 40 months. Median PFS times were 19.0 and 16.8 months with carboplatin/PLD and carboplatin/paclitaxel, respectively (HR, 0.95; 95% CI, 0.81 to 1.13; P = .58). Median overall survival times were 61.6 and 53.2 months with carboplatin/PLD and carboplatin/paclitaxel, respectively (HR, 0.89; 95% CI, 0.72 to 1.12; P = .32). Carboplatin/PLD produced a similar response rate but different toxicity (less neurotoxicity and alopecia but more hematologic adverse effects). There was no relevant difference in global quality of life after three and six cycles. CONCLUSION Carboplatin/PLD was not superior to carboplatin/paclitaxel, which remains the standard first-line chemotherapy for advanced ovarian cancer. However, given the observed CIs and the different toxicity, carboplatin/PLD could be considered an alternative to standard therapy.
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Affiliation(s)
- Sandro Pignata
- Istituto Nazionale Tumori, via Mariano Semmola, 80131 Napoli, Italy.
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Joly F, Ray-Coquard I, Fabbro M, Donoghoe M, Boman K, Sugimoto A, Vaughan M, Reinthaller A, Vergote I, Ferrandina G, Dell'Anna T, Huober J, Pujade-Lauraine E. Decreased hypersensitivity reactions with carboplatin-pegylated liposomal doxorubicin compared to carboplatin-paclitaxel combination: Analysis from the GCIG CALYPSO relapsing ovarian cancer trial. Gynecol Oncol 2011; 122:226-32. [DOI: 10.1016/j.ygyno.2011.04.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 04/14/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
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Morotti M, Valenzano Menada M, Venturini PL, Ferrero S. Pharmacokinetic and toxicity considerations for the use of anthracyclines in ovarian cancer treatment. Expert Opin Drug Metab Toxicol 2011; 7:707-20. [PMID: 21434836 DOI: 10.1517/17425255.2011.570330] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Safe and effective treatments are needed for ovarian cancer. While there are many drugs currently available, there has recently been a renewed novel interest in the use of anthracyclines. AREAS COVERED This review summarizes the available evidence on pharmacokinetic (PK) and toxicology implications of anthracyclines and pegylated liposomal doxorubicin (PLD) in the clinical management of women with epithelial ovarian cancer. This article consists of material obtained via Medline, PubMed and EMBASE literature searches, up to September 2010. EXPERT OPINION PLD is a liposomal formulation of doxorubicin (DXR), with a distinct pharmacokinetic profile, characterized by extended circulation time and a reduced clearance and volume of distribution with respect to the free drug. PLD is effective and well tolerated in relapsed ovarian cancer. The toxicity profile of PLD is characterized by dose-limiting mucosal and cutaneous toxicities, mild myelosuppression and decreased cardiotoxicity compared to free DXR. The good response rate, toxicity profile and pharmacokinetic profile of PLD suggest that PLD could be an option in first-line and second-line treatment in ovarian cancer; especially in those who had experienced taxane-induced toxicity or had a poor performance status.
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Affiliation(s)
- Matteo Morotti
- San Martino Hospital and University of Genoa, Department of Obstetrics and Gynaecology, Genoa, Italy
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Silver DF, Chi DS, Bou-Zgheib N. Clinical Approach to Diagnosis and Management of Ovarian, Fallopian Tube, and Peritoneal Carcinoma. Surg Pathol Clin 2011; 4:261-74. [PMID: 26837295 DOI: 10.1016/j.path.2010.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ovarian, fallopian tube and peritoneal carcinomas make up the deadliest group of malignancies of the female genital tract. Ovarian carcinoma is the second most common malignancy of the female reproductive tract in developed countries and the sixth most common cancer diagnosed in women in the United States. While signs and symptoms of ovarian carcinoma related to the mass-effect of advanced disease are relatively common, no reliable signs or symptoms are seen in patients with early ovarian carcinoma. The diagnosis can only be made by surgical removal and pathologic evaluation of a suspicious mass. The authors present an overview of the disease and discussions of genetic predisposition, prevention, screening, and diagnosis of ovarian, fallopian tube and primary peritoneal carcinomas. Details on staging procedures as well as surgical and chemotherapeutic techniques are outlined for the various stages of disease.
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Affiliation(s)
- David F Silver
- The Women's Institute for Gynecologic Cancer & Special Pelvic Surgery, 755 Memorial Parkway, Phillipsburg, NJ 08865, USA.
| | - Dennis S Chi
- Gynecologic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Nadim Bou-Zgheib
- The Women's Institute for Gynecologic Cancer & Special Pelvic Surgery, 755 Memorial Parkway, Phillipsburg, NJ 08865, USA
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Chua TC, Robertson G, Liauw W, Morris DL. Salvage cytoreduction for chemorefractory ovarian cancer with peritoneal carcinomatosis: a last chance or futile efforts? Aust N Z J Obstet Gynaecol 2011; 50:478-84. [PMID: 21039384 DOI: 10.1111/j.1479-828x.2010.01201.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The role of secondary cytoreductive surgery in recurrent ovarian cancer in the presence of carcinomatosis is increasingly accepted as being an effective management strategy for selected patients. However, in patients with chemorefractory disease, the role of cytoreduction remains controversial. The objective of this study was to evaluate if cytoreduction of peritoneal carcinomatosis in patients with chemorefractory recurrent ovarian cancer as salvage treatment confers any survival benefits. METHODS A retrospective review was performed on patients with chemorefractory ovarian cancer with peritoneal carcinomatosis who underwent cytoreduction as a salvage treatment. Survival was calculated using the Kaplan-Meier method. Univariate analysis was performed to examine potential prognostic factors using the log-rank test. RESULTS A total of 16 patients were identified, of which 15 patients (94%) had FIGO Stage III ovarian cancer at initial diagnosis. The initial surgical effort was optimal in one patient (6%), and 13 patients (62%) had been on at least two lines of chemotherapy. The median progression-free and overall survival was 18 (95% CI 0-42) months and 36 (95% CI 14-58) months, respectively. The 1-, 3-year survival rate was 73% and 23%, respectively. ECOG status zero (P = 0.023) and younger patients (age < 51) (P = 0.066) appeared to be associated with an improved overall survival. CONCLUSIONS Salvage cytoreduction may be considered a last chance effort to prolong survival in this group of patients with chemorefractory ovarian cancer who have a 'poor prognosis' and would otherwise not have been candidates for any proven or effective therapy.
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Affiliation(s)
- Terence C Chua
- UNSW Department of Surgery, Cancer Care Centre, St George Hospital, Kogarah, Sydney, New South Wales, Australia
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Lee SM, O'Halloran TV, Nguyen ST. Polymer-caged nanobins for synergistic cisplatin-doxorubicin combination chemotherapy. J Am Chem Soc 2010; 132:17130-8. [PMID: 21077673 DOI: 10.1021/ja107333g] [Citation(s) in RCA: 177] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Multicomponent chemotherapy has increasingly become a strategy of great importance in clinical cancer treatments. However, this type of chemotherapy has not been demonstrated in nanoscale delivery vehicles where two cytotoxic agents can be packaged together, potentially leading to synergistic drug activities. Herein, we present the codelivery of doxorubicin and cisplatin via a single polymer-caged nanobin (PCN) and show that copackaging can yield strong synergy in the efficacy of these agents. Such a PCN comprises a doxorubicin-encapsulated liposomal core protected by a pH-responsive cisplatin prodrug-loaded polymer shell with tunable drug ratios and surface charge potentials. This dual-agent Pt-PCN(DXR) formulation dramatically enhances the overall cytotoxicity of each drug against cancer cells at reduced doses and exhibits higher synergy than combinations of either the free drugs or separately nano-packaged drugs. These results clearly indicate that the polymer-caged nanobin platform can offer new means for building synergy into combination chemotherapy regimens.
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Affiliation(s)
- Sang-Min Lee
- Department of Chemistry and the Center of Cancer Nanotechnology Excellence, Northwestern University, 2145 Sheridan Road, Evanston, Illinois 60208-3113, USA
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40
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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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Ferrandina G, Corrado G, Licameli A, Lorusso D, Fuoco G, Pisconti S, Scambia G. Pegylated liposomal doxorubicin in the management of ovarian cancer. Ther Clin Risk Manag 2010; 6:463-83. [PMID: 20957139 PMCID: PMC2952486 DOI: 10.2147/tcrm.s3348] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Among the pharmaceutical options available for treatment of ovarian cancer, much attention has been progressively focused on pegylated liposomal doxorubicin (PLD), whose unique formulation, which entraps conventional doxorubicin in a bilayer lipidic sphere surrounded by a polyethylene glycol layer, prolongs the persistence of the drug in the circulation and potentiates intratumor drug accumulation. These properties enable this drug to sustain its very favorable toxicity profile and to be used safely in combination with other drugs. PLD has been already approved for treatment of advanced ovarian cancer patients failing first-line platinum-based treatment. Moreover, phase III trials have been already completed, and results are eagerly awaited, which hopefully will expand the range of PLD clinical application in this neoplasia both in front-line treatment, and in the salvage setting in combination with other drugs. Moreover, attempts are continuing to enable this drug to be combined with novel cytotoxic drugs and target-based agents. This review aims at summarizing the available evidence and the new perspectives for the clinical role of PLD in the management of patients with epithelial ovarian cancer.
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Affiliation(s)
- Gabriella Ferrandina
- Gynecologic Oncology Unit, Department of Oncology, Catholic University of Campobasso, Campobasso, Italy.
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Pujade-Lauraine E, Wagner U, Aavall-Lundqvist E, Gebski V, Heywood M, Vasey PA, Volgger B, Vergote I, Pignata S, Ferrero A, Sehouli J, Lortholary A, Kristensen G, Jackisch C, Joly F, Brown C, Le Fur N, du Bois A. Pegylated liposomal Doxorubicin and Carboplatin compared with Paclitaxel and Carboplatin for patients with platinum-sensitive ovarian cancer in late relapse. J Clin Oncol 2010; 28:3323-9. [PMID: 20498395 DOI: 10.1200/jco.2009.25.7519] [Citation(s) in RCA: 389] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This randomized, multicenter, phase III noninferiority trial was designed to test the efficacy and safety of the combination of pegylated liposomal doxorubicin (PLD) with carboplatin (CD) compared with standard carboplatin and paclitaxel (CP) in patients with platinum-sensitive relapsed/recurrent ovarian cancer (ROC). PATIENTS AND METHODS Patients with histologically proven ovarian cancer with recurrence more than 6 months after first- or second-line platinum and taxane-based therapies were randomly assigned by stratified blocks to CD (carboplatin area under the curve [AUC] 5 plus PLD 30 mg/m(2)) every 4 weeks or CP (carboplatin AUC 5 plus paclitaxel 175 mg/m(2)) every 3 weeks for at least 6 cycles. Primary end point was progression-free survival (PFS); secondary end points were toxicity, quality of life, and overall survival. RESULTS Overall 976 patients were recruited. With median follow-up of 22 months, PFS for the CD arm was statistically superior to the CP arm (hazard ratio, 0.821; 95% CI, 0.72 to 0.94; P = .005); median PFS was 11.3 versus 9.4 months, respectively. Although overall survival data are immature for final analysis, we report here a total of 334 deaths. Overall severe nonhematologic toxicity (36.8% v 28.4%; P < .01) leading to early discontinuation (15% v 6%; P < .001) occurred more frequently in the CP arm. More frequent grade 2 or greater alopecia (83.6% v 7%), hypersensitivity reactions (18.8% v 5.6%), and sensory neuropathy (26.9% v 4.9%) were observed in the CP arm; more hand-foot syndrome (grade 2 to 3, 12.0% v 2.2%), nausea (35.2% v 24.2%), and mucositis (grade 2-3, 13.9% v 7%) in the CD arm. CONCLUSION To our knowledge, this trial is the largest in recurrent ovarian cancer and has demonstrated superiority in PFS and better therapeutic index of CD over standard CP.
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Affiliation(s)
- Eric Pujade-Lauraine
- University Paris Descartes, Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France.
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Pectasides D, Pectasides E, Papaxoinis G, Psyrri A, Pliarchopoulou K, Koumarianou A, Macheras A, Athanasas G, Xiros N, Economopoulos T. Carboplatin/gemcitabine alternating with carboplatin/pegylated liposomal doxorubicin and carboplatin/cyclophosphamide in platinum-refractory/resistant paclitaxel - pretreated ovarian carcinoma. Gynecol Oncol 2010; 118:52-7. [PMID: 20406710 DOI: 10.1016/j.ygyno.2010.03.003] [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] [Received: 02/10/2010] [Revised: 03/03/2010] [Accepted: 03/06/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In this phase II study the efficacy and toxicity of an alternating chemotherapy regimen was examined in platinum-resistant relapsed epithelial ovarian cancer (EOC) patients. METHODS Forty-five patients with platinum-refractory/resistant relapsed EOC, previously treated with carboplatin+paclitaxel+/-epirubicin were included. The regimen was consisted of gemcitabine 800 mg/m(2) (days 1+8) and carboplatin AUC 5, alternating with pegylated liposomal doxorubicin 30 mg/m(2) and carboplatin AUC 5, alternating with carboplatin AUC 5 and cyclophosphamide 600 mg/m(2), every 3 weeks for a total of 9 cycles. RESULTS Among 38 patients with measurable disease, 39.4% (95% CI: 23.2-55.7) responded (five complete response and 10 partial response), while 30 out of 40 (75%) patients assessable by CA125 criteria had a serological response. Responses were more frequent in patients with platinum-free interval (PFI) 3-6 months than in those with PFI 0-3 months, but this was not statistically-significant. After a median follow-up of 19.5 months (range, 1.0-37+ months) the median progression-free survival was 7.1 months (95% CI: 3.4-10.8) and the median survival (OS) was 18.8 months (95% CI: 15.6-22.0). For patients with PFI 0-3 months PFS was 4.3 (95% CI: 0.8-7.8) months, while for those with PFI 3-6 months PFS was 8.9 (95% CI: 5.3-12.4) months (p=0.062). The regimen was well-tolerated and the main grade 3-4 toxicity was myelosuppression, palmar-plantar erythrodysesthesia, allergy and fatigue. CONCLUSION This alternating regimen, including carboplatin, gemcitabine, liposomal doxorubicin and cyclophosphamide, is an active and well-tolerated treatment in platinum relapsed/refractory EOC patients.
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Affiliation(s)
- D Pectasides
- Second Department of Internal Medicine, Propaedeutic, Oncology Section, University of Athens, University General Hospital Attikon, Rimini 1, Haidari, Athens, Greece.
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Marchetti C, Pisano C, Facchini G, Bruni GS, Magazzino FP, Losito S, Pignata S. First-line treatment of advanced ovarian cancer: current research and perspectives. Expert Rev Anticancer Ther 2010; 10:47-60. [PMID: 20014885 DOI: 10.1586/era.09.167] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Epithelial ovarian cancer is the fourth biggest cause of cancer-related death in women. Over recent decades, improvements have been made in treatment outcome in terms of response rate and survival. To date, intensive surgical staging and cytoreduction, followed by primary chemotherapy with the carboplatin-paclitaxel regimen, are considered the gold standard for the management of this disease. Nevertheless, despite good initial response to systemic therapy after optimal debulking surgery, the long-term survival remains poor, with a high risk of recurrence. Furthermore, medical therapy of ovarian cancer impacts quality of life owing to the common occurrence of chemotherapy side effects, such as alopecia, neurotoxicity and fatigue. In order to improve the efficacy and reduce the toxicity of first-line chemotherapy, more than 10,000 women have been involved in worldwide randomized trials in the last 10 years. Several treatment alternatives have been investigated, such as intraperitoneal chemotherapy, alternative doublets and triplet regimens, in the effort to find an optimal first-line treatment strategy. In this review we discuss the results of these trials, the recent progresses and the most important ongoing studies, including those with emerging target and biological agents.
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Affiliation(s)
- Claudia Marchetti
- Department of Urology and Gynecology, National Cancer Institute of Naples, via Mariano Semmola 80131, Naples, Italy
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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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Sehouli J, Camara O, Mahner S, Bauknecht T, Lichtenegger W, Runnebaum I, Look K, Jaenicke F, Oskay-Oezcelik G. A phase-I trial of pemetrexed plus carboplatin in recurrent ovarian cancer. Cancer Chemother Pharmacol 2010; 66:861-8. [PMID: 20054549 DOI: 10.1007/s00280-009-1230-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 12/23/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND Carboplatin-based combinations are established in platinum-sensitive recurrent ovarian cancer. To improve the therapeutic index, new platinum-based combinations are required. Pemetrexed is a multi-targeted antifolate inhibiting thymidylate synthase. The aim of this study was to determine the maximally tolerated dose (MTD) and dose-limiting toxicity (DLT) and to characterize toxicities of the combination of pemetrexed (Pem) and carboplatin (Cb). DESIGN A standard three-patient cohort dose escalation was performed starting at Cb AUC-5 and Pem 500 mg/m(2). Patients with platinum-sensitive recurrent ovarian cancer were eligible. Two levels of Cb (AUC-5, 6) and five levels of Pem (500, 600, 700, 800, and 900 mg/m(2)) were evaluated. DLTs were based on cycle 1. RESULTS Twenty patients were enrolled. The median age was 57.4 years (37.3-75.3) and the median platinum-free interval was 26.2 months (7.2-124.4). There was one DLT at dose level 3 in cycle one. No serious adverse events related to the study therapy were observed. The 20 patients completed 112 cycles of Cb (104 were planned) and 115 cycles of Pem (112 were planned). The maximum dose level of Cb AUC-6 and Pem 900 mg/m(2) was well tolerated. Response rates in 19 patients were: CR: 63.2%; PR: 21.1%; SD; 5.3%, PD: 10.5%. CONCLUSIONS The combination carboplatin and pemetrexed is safe and well tolerated. A multicenter phase-II trial is currently underway.
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Affiliation(s)
- Jalid Sehouli
- Department of Obstetrics and Gynecology, Charité University Hospital, Berlin, Germany.
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Bafaloukos D, Linardou H, Aravantinos G, Papadimitriou C, Bamias A, Fountzilas G, Kalofonos HP, Kosmidis P, Timotheadou E, Makatsoris T, Samantas E, Briasoulis E, Christodoulou C, Papakostas P, Pectasides D, Dimopoulos AM. A randomized phase II study of carboplatin plus pegylated liposomal doxorubicin versus carboplatin plus paclitaxel in platinum sensitive ovarian cancer patients: a Hellenic Cooperative Oncology Group study. BMC Med 2010; 8:3. [PMID: 20055981 PMCID: PMC2823653 DOI: 10.1186/1741-7015-8-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 01/07/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Platinum-based combinations are the standard second-line treatment for platinum-sensitive ovarian cancer (OC). This randomized phase II study was undertaken in order to compare the combination of carboplatin and pegylated liposomal doxorubicin (LD) with carboplatin and paclitaxel (CP) in this setting. METHODS Patients with histologically confirmed recurrent OC, at the time of or more than 6 months after platinum-based chemotherapy, were randomized to six cycles of CP (carboplatin AUC5 + paclitaxel 175 mg/m2, d1q21) or CLD (carboplatin AUC5 + pegylated LD 45 mg/m2, d1q28). RESULTS A total of 189 eligible patients (CP 96, CLD 93), with a median age of 63 years, median Performance Status (PS) 0 and a median platinum free interval (PFI) of 16.5 months, entered the study. Discontinuation due to toxicity was higher in the CP patients (13.5% versus 3%, P = 0.016). The overall response rate was similar: CP 58% versus CLD 51%, P = 0.309 (Complete Response; CR 34% versus 23%) and there was no statistical difference in time-to-progression (TTP) or overall survival (OS; TTP 10.8 months CP versus 11.8 CLD, P = 0.904; OS 29.4 months CP versus 24.7 CLD, P = 0.454). No toxic deaths were recorded. Neutropenia was the most commonly seen severe toxicity (CP 30% versus CLD 35%). More frequent in CLD were severe thrombocytopenia (11% versus 2%, P = 0.016), skin toxicity and Palmar-plantar erythrodysesthesia (PPE) grade 1-2 (38% versus 9%, P< 0.001), while grade 3 neurotoxicity and alopecia were higher in CP (7% versus 0%, P = 0.029, 20% versus 5%, P = 0.003). PS and PFI were independent prognostic factors for TTP and OS. CONCLUSIONS The combination of pegylated LD with carboplatin is effective, showing less neurotoxicity and alopecia than paclitaxel-carboplatin. It thus warrants a further phase III evaluation as an alternative treatment option for platinum-sensitive OC patients. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12609000436279.
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Pegylated liposomal doxorubicin combined with carboplatin: A rational treatment choice for advanced ovarian cancer. Crit Rev Oncol Hematol 2010; 73:23-30. [DOI: 10.1016/j.critrevonc.2009.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 07/31/2009] [Accepted: 08/27/2009] [Indexed: 01/28/2023] Open
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Rapoport BL, Vorobiof DA, Slabber C, Alberts AS, Hlophe HS, Mohammed C. Phase II study of pegylated liposomal doxorubicin and carboplatin in patients with platinum-sensitive and partially platinum-sensitive metastatic ovarian cancer. Int J Gynecol Cancer 2009; 19:1137-41. [PMID: 19820382 DOI: 10.1111/igc.0b013e3181a8b938] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This phase II study assessed the activity and safety of pegylated liposomal doxorubicin (PLD) plus carboplatin in relapsed ovarian cancer (ROC). METHOD Forty women with platinum-sensitive and partially platinum-sensitive ROC were treated with PLD 50 mg/m2 plus carboplatin area under the curve 5 every 28 days in this South African multicenter study. All patients who completed 3 cycles of chemotherapy were evaluated for response. Primary outcome was response in the intent-to-treat population. RESULTS Complete response was 35%, and partial response was 32.5% (overall response, 67.5%). Median time-to-progression was 11.9 months, and median survival was 30.0 months. Overall response was higher in platinum-sensitive (81%) versus partially platinum-sensitive patients (53%), as were median duration of response, median time-to-progression, and median survival. Treatment was well tolerated, with no grade 4 nonhematologic toxicities. Grade 3/4 hematologic toxicities included leukopenia (58%), neutropenia (55%), and thrombocytopenia (43%). CONCLUSION Pegylated liposomal doxorubicin plus carboplatin is well tolerated and active in the treatment of platinum-sensitive and partially platinum-sensitive ROC.
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Affiliation(s)
- B L Rapoport
- The Medical Oncology Centre of Rosebank, Parklands 2121, Johannesburg, South Africa.
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Joly F, Sevin E, Lortholary A, Priou F, Paitel JF, Fabbro M, Henry-Amar M, Hamond K, Bourgeois H. Association of pegylated liposomal doxorubicin and ifosfamide in early recurrent ovarian cancer patients: a multicenter phase II trial. Gynecol Oncol 2009; 116:312-6. [PMID: 19887304 DOI: 10.1016/j.ygyno.2009.09.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 09/23/2009] [Accepted: 09/28/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy of pegylated liposomal doxorubicin (PLD) and continuous infusion ifosfamide (IFO) in ovarian cancer patients who relapse within 1 year after first-line paclitaxel-platinum-based chemotherapy. METHODS Patients were stratified according to treatment-free interval (TFI) (<or >or=6 months). PLD (40 mg/m(2), day 1), IFO (1700 mg/m(2), infusion days 1-3), and mesna were given every 28 days for 6-9 cycles. Primary endpoint was objective response rate (ORR). Secondary endpoints were response duration, progression free survival (PFS), overall survival (OS), and toxicity. RESULTS There were 98 evaluable patients (58%, TFI<6 months). Median number of cycles was 5 (range: 1-9). The frequency of grade 3/4 anemia, thrombocytopenia, and neutropenia was 7%, 3%, and 48%, respectively; febrile neutropenia was 3%. A low rate of grade 3/4 non-hematologic toxicities was reported, including nausea/vomiting (3/4%), hand-foot syndrome (2%), and mucositis (2%). The ORR was 28% (41% and 19% in patients with TFI >or=6, or <6 months, respectively); rate of disease stabilization was 26%; response duration and median OS were 6 (2.4-26) and 14 (1-46) months, respectively. CONCLUSION The combination of PLD and continuous IFO is a feasible and efficient treatment in patients with relapsed ovarian cancer, especially with TFI between 6 and 12 months. This regimen may represent an alternative to platinum reintroduction and should be evaluated in a randomized trial.
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Affiliation(s)
- Florence Joly
- Centre François Baclesse, 3 avenue du Général Harris, Caen cedex 05, France.
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