Intraperitoneal paclitaxel and cisplatin compared with dose-dense paclitaxel and carboplatin for patients with stage III ovarian cancer

Abstract

Introduction Patients diagnosed with stage III ovarian cancer are at high risk of recurrence and optimal adjuvant therapy is often debated. There is limited literature that directly compares intraperitoneal paclitaxel and cisplatin with dose-dense paclitaxel and carboplatin. Objectives The primary objective was to compare progression-free survival, overall survival, and tolerability of adjuvant intraperitoneal paclitaxel and cisplatin to dose-dense paclitaxel and carboplatin in stage III ovarian cancer patients. Methods A retrospective, IRB-approved, single center chart review was conducted reviewing adult patients with stage III ovarian cancer undergoing adjuvant intraperitoneal therapy or dose-dense therapy between 2010 and 2018. Results Eighty-two patients were included in the final analysis; 44 in the intraperitoneal group and 38 in the dose-dense group. Intraperitoneal therapy was not associated with a longer progression-free survival (35.4 vs. 31.1 months; P = 0.97). The duration of overall survival did not differ between intraperitoneal and dose-dense (56.3 vs. 54.5 months; P = 0.55). Dose reductions were less frequent with intraperitoneal than dose-dense (11.36% vs. 31.58%; P = 0.02). No difference in treatment delays (45.5% vs. 65.8%; P = 0.07), dose cancellations (59.1% vs. 57.9%; P = 0.91), supportive care additions (95.5% vs. 84.2%; P = 0.09), or therapy discontinuation (59.1% vs. 39.5%; P = 0.07) between groups was noted. Conclusions Intraperitoneal therapy with paclitaxel and cisplatin, as compared with dose-dense paclitaxel and carboplatin, did not prolong progression-free or overall survival in the adjuvant setting among stage III ovarian cancer patients. A trend towards decreased tolerability was noted with intraperitoneal therapy.

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

“…Dose-dense weekly chemotherapy is based on the concept of shortening the timing of recycling by Goldie-Coldman's hypothesis and the Norton-Simon model [96][97][98], providing the rationale, such as a reducing interval between treatment, an increasing duration of chemotherapy exposure, and an increasing dose-intensity or dose-density of cytotoxic agents, and offering a chance that tumor regrowth could be decreased by this approach [99][100][101][102]. In addition, dose-dense chemotherapy can not only preserve the immune system but also promote the treatment-mediated tumor-specific immunity, especially the antitumor kill cluster of differentiation 8+ (CD8+) T-cell response [103].…”

Quimioterapia adyuvante en cáncer epitelial de ovario en estadios avanzados

“…11 Además un ensayo entre grupos europeos-canadienses (OV-10), informaron una tasa de respuesta clínica superior en el tratado con paclitaxel (59% versus 45%), con una reducción de 25% en la tasa de mortalidad 12 , lo que confirmaba los hallazgos previos. Después la investigación GOG 158 realizó un estudio de no inferioridad donde compara el carboplatino en reemplazo del cisplatino, encontrando que el riesgo de progresión era equivalente en los dos grupos (RR=0,88; IC 0-1-03) y la toxicidad mayor con paclitaxel y cisplatino 13 , resultado confirmado por el grupo para cáncer de ovario de Arbeitsgemeninschaft Gynäkologische Onkologie (AGO) que obtuvieron resultados clínicos similares. 14 La combinación de paclitaxel y carboplatino se convirtió en la quimioterapia combinada de referencia para la primera línea del tratamiento del carcinoma epitelial de ovario (en National Comprehensive Cancer Network (NCCN) guía clínica de Cáncer de ovario/Cáncer de trompas de Falopio/ Cáncer perineal primario versión 2021.1).…”