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Decreased dose density of standard chemotherapy does not compromise survival for ovarian cancer patients
  1. A. Molckovsky*,
  2. S. M. Vijay*,
  3. W. M. Hopman*,
  4. P. Bryson,
  5. J. F. Jeffrey and
  6. J. J. Biagi*
  1. *Department of Oncology; and
  2. Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
  1. Address correspondence and reprint requests to: Dr. James J. Biagi, MD, FRCP(C), Cancer Centre of Southeastern Ontario, 25 King St. W., Kingston, ON K7L 5P9 Canada. Email: jim.biagi{at}krcc.on.ca

Abstract

For women diagnosed with ovarian cancer, the standard practice of surgery followed by adjuvant platinum–taxane combination chemotherapy, with cycles administered every 3 weeks, is based on randomized control trials. However, a substantial number of patients require delays or reductions on this schedule. The Cancer Centre of Southeastern Ontario (CCSEO) has historically administered chemotherapy every 4 weeks. We analyzed survival outcomes of our cohort. All ovarian cancer patients treated with chemotherapy at the CCSEO from 1995 to end-2002 were included in this study. Overall survival and progression-free survival were calculated from initiation of chemotherapy using the Kaplan–Meier technique and log-rank tests. Cox regression analysis was used to adjust for age and disease stage. A total of 171 patients were treated with chemotherapy (cisplatin–paclitaxel or carboplatin–paclitaxel), of which 144 received chemotherapy every 4 weeks and 27 every 3 weeks. Median progression-free survival was 19.2 months for the group treated every 4 weeks vs 13.2 months for the 3-weekly group. Median overall survival was 36.5 months compared to 27.1 months, respectively. Trends favored treatment every 4 weeks. In early-stage disease, 5-year overall survival was 74% and 5-year progression-free survival was 68%. Administration of platinum–paclitaxel chemotherapy every 4 weeks did not reduce survival of ovarian cancer patients. Importantly, median survival is favorable compared to results from landmark trials where patients were treated every 3 weeks. These results suggest that decreasing the frequency of chemotherapy cycles does not decrease survival. Prospective trials would be required to compare quality of life and cost-effectiveness.

  • carboplatin
  • chemotherapy
  • dose density
  • ovarian neoplasm
  • paclitaxel

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