6
|
Hensley ML, Enserro D, Hatcher H, Ottevanger PB, Krarup-Hansen A, Blay JY, Fisher C, Moxley KM, Lele SB, Lea JS, Tewari KS, Thaker PH, Zivanovic O, O’Malley DM, Robison K, Miller DS. Adjuvant Gemcitabine Plus Docetaxel Followed by Doxorubicin Versus Observation for High-Grade Uterine Leiomyosarcoma: A Phase III NRG Oncology/Gynecologic Oncology Group Study. J Clin Oncol 2018; 36:JCO1800454. [PMID: 30289732 PMCID: PMC6241678 DOI: 10.1200/jco.18.00454] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE We conducted a randomized phase III trial to determine whether adjuvant chemotherapy improves survival in women with uterine leiomyosarcoma. METHODS Women with uterus-confined, high-grade leiomyosarcoma who were confirmed disease free by imaging were randomly assigned to four cycles of gemcitabine plus docetaxel, followed by four cycles of doxorubicin, or to observation. All were followed for evidence of recurrence. The primary end point was overall survival (OS). RESULTS With international collaboration, 38 of the targeted accrual of 216 patients were enrolled, after which the study was closed by the National Cancer Institute for accrual futility. Twenty patients were assigned to chemotherapy, 18 to observation. Among the 17 patients treated with at least one cycle of chemotherapy, grade 3 or 4 toxicities were observed in 47%; among the 18 patients assigned to observation, one had grade 3 hypertension. There were six deaths (chemotherapy, n = 5; observation, n = 1), all due to disease. The restricted mean survival time for OS was estimated as 34.3 months (95% CI, 25.3 to 43.3 months) in the chemotherapy arm and as 46.4 months (95% CI, 43.6 to 49.1 months) in the observation arm. There were eight recurrences in each arm. The restricted mean survival time for recurrence-free survival was estimated as 18.1 (95% CI, 14.2 to 22.0) months in the chemotherapy arm and as 14.6 months (95% CI, 10.3 to 19.0 months) in the observation arm. Neither survival outcome comparison was considered statistically robust, due to the small sample size. CONCLUSION Despite international collaboration to test the role of adjuvant chemotherapy in uterine-confined leiomyosarcoma, this study was closed for accrual futility. Although the sample size precludes robust statistical comparison, observed OS and recurrence-free survival data do not show superior outcomes with adjuvant chemotherapy.
Collapse
Affiliation(s)
- Martee L. Hensley
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Danielle Enserro
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Helen Hatcher
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Petronella B. Ottevanger
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Anders Krarup-Hansen
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Jean-Yves Blay
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Cyril Fisher
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Katherine M. Moxley
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Shashikant B. Lele
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Jayanthi S. Lea
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Krishnansu S. Tewari
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Premal H. Thaker
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Oliver Zivanovic
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - David M. O’Malley
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Katina Robison
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - David S. Miller
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| |
Collapse
|