Predictors of reduced relative dose intensity and its relationship to mortality in women receiving multi-agent chemotherapy for epithelial ovarian cancer

Hanna, Rabbie K.; Poniewierski, Marek S.; Laskey, Robin; Lopez, Molly; Shafer, Aaron; Le, Linda Van; Crawford, Jeffrey; Dale, David C.; Gehrig, Paola A.; Secord, Angeles Alvarez; Havrilesky, Laura J.; Lyman, Gary H.

doi:10.1016/j.ygyno.2012.12.017

Cited by 74 publications

(46 citation statements)

References 33 publications

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“…Many fewer studies (5 total) directly evaluated the association of RDI with survival by using a preplanned threshold for RDI or dose intensity (lung cancer, n = 2; breast cancer, n = 2; ovarian cancer, n = 1). Three of the five studies observed improved survival in patients receiving treatment at a higher RDI [18,20,22], two of which were the two largest studies identified in the review [20,22]. Findings from these two studies -one in breast cancer and the other in ovarian cancer -support the emerging perception that maintaining RDI ≥ 85% may have a favorable impact on survival [20,22].…”

Section: Discussionmentioning

confidence: 77%

“…2) [22]. No significant association between RDI < 85% and progression-free survival was found (P = 0.650) [22].…”

Section: Ovarian Cancermentioning

confidence: 91%

“…A multivariate regression analysis showed that delivered RDI < 85% was significantly associated with shorter overall survival (hazard ratio = 1.71; P = 0.003; Fig. 2) [22]. No significant association between RDI < 85% and progression-free survival was found (P = 0.650) [22].…”

Section: Ovarian Cancermentioning

confidence: 96%

“…Four studies reported RDI and overall survival in metastatic ovarian cancer (Table 4) [21][22][23][24]. Of these four studies, one evaluated overall survival with a preplanned RDI threshold (Table 4) [22].…”

Section: Ovarian Cancermentioning

confidence: 99%

“…Of these four studies, one evaluated overall survival with a preplanned RDI threshold (Table 4) [22]. In this study, Hanna et al evaluated the prognostic significance of RDI in a retrospective analysis of 325 patients with epithelial ovarian carcinoma who received multiagent chemotherapy [22]. A multivariate regression analysis showed that delivered RDI < 85% was significantly associated with shorter overall survival (hazard ratio = 1.71; P = 0.003; Fig.…”

Section: Ovarian Cancermentioning

confidence: 99%

See 4 more Smart Citations

A review of relative dose intensity and survival in patients with metastatic solid tumors

Havrilesky

Reiner

Morrow

et al. 2015

Critical Reviews in Oncology/Hematology

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102

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Section: Discussionmentioning

confidence: 77%

“…2) [22]. No significant association between RDI < 85% and progression-free survival was found (P = 0.650) [22].…”

Section: Ovarian Cancermentioning

confidence: 91%

Section: Ovarian Cancermentioning

confidence: 96%

Section: Ovarian Cancermentioning

confidence: 99%

Section: Ovarian Cancermentioning

confidence: 99%

See 3 more Smart Citations

A review of relative dose intensity and survival in patients with metastatic solid tumors

Havrilesky

Reiner

Morrow

et al. 2015

Critical Reviews in Oncology/Hematology

Self Cite

102

View full text Add to dashboard Cite

Effect of Exercise on Chemotherapy-Induced Peripheral Neuropathy Among Patients Treated for Ovarian Cancer

Cao

Cartmel

et al. 2023

JAMA Netw Open

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ImportanceChemotherapy-induced peripheral neuropathy (CIPN), one of the most common and severe adverse effects of chemotherapy, is associated with worse quality of life among survivors of ovarian cancer. Currently, there is no effective treatment for CIPN.ObjectiveTo evaluate the effect of a 6-month aerobic exercise intervention vs attention-control on CIPN among women treated for ovarian cancer in the Women’s Activity and Lifestyle Study in Connecticut (WALC) to provide evidence to inform the guidelines and recommendations for prevention or treatment of CIPN.Design, Setting, and ParticipantsThis prespecified secondary analysis evaluated the Women’s Activity and Lifestyle Study in Connecticut (WALC), a multicentered, open-label, population-based, phase 3 randomized clinical trial of an aerobic exercise intervention vs attention control for CIPN in patients who were diagnosed with ovarian cancer. Only WALC participants who received chemotherapy were included in this analysis. Participants were randomized 1:1 to either a 6-month aerobic exercise intervention or to attention control. All analyses were conducted between September 2022 and January 2023.InterventionsThe exercise intervention consisted of home-based moderate-intensity aerobic exercise facilitated by weekly telephone counseling from an American College of Sports Medicine/American Cancer Society–certified cancer exercise trainer. Attention control involved weekly health education telephone calls from a WALC staff member.Main Outcomes and MeasureChange in CIPN was the primary outcome in this secondary analysis. This outcome was represented by CIPN severity, which was self-measured by participants at baseline and 6 months using the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group–Neurotoxicity scale, with a score range of 0 to 44. A mixed-effects model was used to assess the 6-month change in CIPN between the exercise intervention and attention control arms.ResultsOf the 134 participants (all females; mean [SD] age, 57.5 [8.3] years) included in the analysis, 69 were in the exercise intervention arm and 65 were in the attention control arm. The mean (SD) time since diagnosis was 1.7 (1.0) years. The mean (SD) baseline CIPN scores were 8.1 (5.6) in the exercise intervention arm and 8.8 (7.9) in the attention control arm (P = .56). At 6 months, the self-reported CIPN score was reduced by 1.3 (95% CI, −2.3 to −0.2) points in the exercise intervention arm compared with an increase of 0.4 (95% CI, −0.8 to 1.5) points in the attention control arm. The between-group difference was −1.6 (95% CI, −3.1 to −0.2) points. The point estimate was larger among the 127 patients with CIPN symptoms at enrollment (−2.0; 95% CI, −3.6 to −0.5 points).Conclusions and RelevanceFindings of this secondary analysis of the WALC trial indicate that a 6-month aerobic exercise intervention vs attention control significantly improved self-reported CIPN among patients who were treated for ovarian cancer. While replication of the findings in other studies is warranted, incorporating referrals to exercise programs into standard oncology care could reduce CIPN symptoms and increase quality of life in patients with ovarian cancer.Trial RegistrationClinicalTrials.gov Identifier: NCT02107066

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Impact of Chemotherapy Dosing on Ovarian Cancer Survival According to Body Mass Index

Bandera

Lee

Rodrı́guez-Rodrı́guez

et al. 2015

JAMA Oncol

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IMPORTANCE Optimal chemotherapy dosing in obese patients remains uncertain, with variation in practice. Dose reduction strategies are often used to avoid chemotoxicity, but recent American Society of Clinical Oncology guidelines recommend full dose. OBJECTIVE To evaluate the impact of body mass index (BMI) on chemotherapy dosing and of dose reduction on ovarian cancer survival. DESIGN, SETTING, AND PARTICIPANTS Cohort study in Kaiser Permanente Northern California (KPNC) health care setting of patients with primary invasive epithelial ovarian cancers diagnosed from January 2000 through March 2013. Analyses focused on 806 patients receiving adjuvant first-line therapy of carboplatin and paclitaxel with curative intent. MAIN OUTCOMES AND MEASURES Overall and ovarian cancer–specific mortality. Deaths were identified through the KPNC Mortality Linkage System, with median follow-up of 52.5 months. Hazard ratios (HRs) and 95% CIs were estimated from proportional hazards regression, accounting for prognostic variables including age at diagnosis, race, stage, grade, histologic type, chemotoxic effects, comorbidities, cancer antigen 125 levels, and BMI at diagnosis. RESULTS The strongest predictor of dose reduction was a high BMI. Compared with normal-weight women, obese class III women received 38% and 45% lower doses in milligrams per kilogram of body weight of paclitaxel and carboplatin, respectively (P < .001 for each agent). They also received lower relative dose intensity (RDI) for each agent and the combined regimen, calculated as average RDI (ARDI). Mean ARDI was 73.7% for obese class III women and 88.2% for normal-weight women (P < .001). Lower ARDI (<70%) was associated with worse overall (HR, 1.62 [95% CI, 1.10–2.37]) and ovarian cancer–specific survival (HR, 1.69 [95% CI, 1.12–2.55]). Women who were obese at diagnosis appeared to have better survival. In multivariable-adjusted analyses considering joint effects by BMI and ARDI, compared with women with normal weight and no dose reduction, normal-weight women with dose reduction (ARDI < 85%) experienced worse survival (HR, 1.50 [95% CI, 1.02–2.21]). For each BMI category, those with ARDI less than 85% had worse survival than those without dose reduction. The improved survival among obese women was no longer apparent with dose reduction. CONCLUSIONS AND RELEVANCE Lower RDI was an independent predictor of ovarian cancer mortality. This finding was strongest among normal-weight women but seen at all levels of BMI. Our results suggest that body size should not be a major factor influencing dose reduction decisions in women with ovarian cancer.

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Predictors of reduced relative dose intensity and its relationship to mortality in women receiving multi-agent chemotherapy for epithelial ovarian cancer

Cited by 74 publications

References 33 publications

A review of relative dose intensity and survival in patients with metastatic solid tumors

A review of relative dose intensity and survival in patients with metastatic solid tumors

Effect of Exercise on Chemotherapy-Induced Peripheral Neuropathy Among Patients Treated for Ovarian Cancer

Impact of Chemotherapy Dosing on Ovarian Cancer Survival According to Body Mass Index

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