Comparing Paclitaxel–Carboplatin with Paclitaxel–Cisplatin as the Front-Line Chemotherapy for Patients with FIGO IIIC Serous-Type Tubo-Ovarian Cancer

Abstract

The use of weekly chemotherapy for the treatment of patients with advanced-stage serous-type epithelial Tubo-ovarian cancer (ETOC), and primary peritoneal serous carcinoma (PPSC) is acceptable as the front-line postoperative chemotherapy after primary cytoreductive surgery (PCS). The main component of dose-dense chemotherapy is weekly paclitaxel (80 mg/m2), but it would be interesting to know what is the difference between combination of triweekly cisplatin (20 mg/m2) or triweekly carboplatin (carboplatin area under the curve 5-7 mg/mL per min [AUC 5-7]) in the dose-dense paclitaxel regimen. Therefore, we compared the outcomes of women with Gynecology and Obstetrics (FIGO) stage IIIC ETOC and PPSC treated with PCS and a subsequent combination of dose-dense weekly paclitaxel and triweekly cisplatin (paclitaxel–cisplatin) or triweekly carboplatin using AUC 5 (paclitaxel–carboplatin). Between January 2010 and December 2016, 40 women with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC EOC, FTC, or PPSC were enrolled, including 18 treated with paclitaxel–cisplatin and the remaining 22 treated with paclitaxel–carboplatin. There were no statistically significant differences in disease characteristics of patients between two groups. Outcomes in paclitaxel–cisplatin group seemed to be little better than those in paclitaxel–carboplatin (median progression-free survival [PFS] 30 versus 25 months as well as median overall survival [OS] 58.5 versus 55.0 months); however, neither reached a statistically significant difference. In terms of adverse events (AEs), patients in paclitaxel–carboplatin group had more AEs, with a higher risk of neutropenia and grade 3/4 neutropenia, and the need for a longer period to complete the front-line chemotherapy, and the latter was associated with worse outcome for patients. We found that a period between the first-time chemotherapy to the last dose (6 cycles) of chemotherapy >21 weeks was associated with a worse prognosis in patients compared to that ≤21 weeks, with hazard ratio (HR) of 81.24 for PFS and 9.57 for OS. As predicted, suboptimal debulking surgery (>1 cm) also contributed to a worse outcome than optimal debulking surgery (≤1 cm) with HR of 14.38 for PFS and 11.83 for OS. Based on the aforementioned findings, both regimens were feasible and effective, but maximal efforts should be made to achieve optimal debulking surgery and following the on-schedule administration of dose-dense weekly paclitaxel plus triweekly platinum compounds. Randomized trials validating the findings are warranted.

Safety and Efficacy of Weekly Paclitaxel and Cisplatin Chemotherapy for Ovarian Cancer Patients with Hypersensitivity to Carboplatin

“…The administration of cisplatin to patients with hypersensitivity reaction to carboplatin was a concern owing to two deaths reported previously [ 20 , 21 ]. However, when combining the results of our study and previous reports [ 14 , 15 , 19 ], the incidence of hypersensitivity reaction to cisplatin was shown to be 31/183 (16.9%), with two deaths [ 16 , 17 ] (1.1%). While desensitization therapy is cumbersome and there are disadvantages in terms of temporal constraints, wTP is simple and easy to administer.…”

“…Since 2011, we have performed weekly administration of paclitaxel and cisplatin (wTP) in consecutive patients who developed carboplatin hypersensitivity reaction. Compared to dose-dense paclitaxel plus triweekly carboplatin, wTP with low-dose cisplatin has been reported to produce less hematologic toxicity, renal dysfunction, and anorexia, although the therapeutic effects of both regimens were similar [ 16 ]. The aim of this observational study was to investigate the safety and efficacy of wTP in patients with carboplatin hypersensitivity reaction.…”

Evaluation of Short-Term Efficacy and Long-Term Oncologi-Cal Outcomes of Different Paclitaxels Plus Platinum Regi-Mens in the Treatment of Serous Ovarian Cancer—A Real World Study

“…Unfortunately, in recent 10 years, almost all of the randomized controlled trials and real-world studies on the progress of ovarian cancer chemotherapy have focused on targeted drugs.There are only a few studies on traditional chemotherapy drugs,and the scope of chemotherapy drugs is too narrow, all of them focus on paclitaxel,carboplatin and cisplatin.Gao [7]evaluated and compared the e cacy of post-operative chemotherapy using paclitaxel plus carboplatin or nedaplatin in patients with ovarian cancer,as well as the effects of different combinational therapies on the survival times of patients,The results showed that chemotherapy had a signi cant effect on the survival time of patients,and carboplatin plus paclitaxel should be the rst choice for the initial treatment of ovarian cancer.A recent randomized controlled trial [17]compared the effects of weekly paclitaxel (80 mg/m 2 ) combined with three weeks of cisplatin (20 mg/m 2 ) or three weeks of carboplatin (AUC 5-7) chemotherapy on the prognosis of epithelial ovarian cancer after primary cytoreductive surgery,The results showed that the median PFS and median OS of paclitaxel carboplatin group were better than those of paclitaxel cisplatin group, but the difference was not statistically signi cant,the incidence of adverse events (such as myelosuppression) of paclitaxel carboplatin group was higher, and the prognosis of patients with chemotherapy cycle > 21 weeks was worse than that of patients with chemotherapy cycle≤21 weeks.…”

The promising oncostatic effects of melatonin against ovarian cancer

“…Some molecular signaling mechanisms like a chronic inflammatory response, oxidative stress (OS), apoptosis, and angiogenesis are associated with the development of OVC [3]. Chemotherapy is the first-line treatment for OVC, co-administration of carboplatin and paclitaxel is mostly applied [18] but recurrence and eventual resistance are common [19]. Recently developed chemotherapies that act as the PARP inhibitors, checkpoint inhibitors, anti-angiogenic agents are blended with conventional chemotherapeutic agents for clinical trials [20].…”