By Michael Casasnovas
TAMPA, Fla -- March 13, 2008 -- Surgery for removal of tumour volume appears to be more relevant than chemotherapy dose intensification in women with epithelial ovarian cancer, researchers reported here at the Society of Gynaecologic Oncologists (SGO) 2008 Annual Meeting on Women's Cancer.
"In our cohort of women with advanced epithelial ovarian cancer, optimal debulking, rather than dose intensification of adjuvant chemotherapy, was the most important factor for improved time to progression," said Aaron Shafer, MD, Clinical Fellow, University of North Carolina, Chapel Hill, North Carolina.
Dr. Shafer conducted a retrospective chart review of women diagnosed with epithelial ovarian cancer at two institutions between 1995 and 2005. Researchers assessed the impact of surgical debulking and chemotherapeutic dose intensity on time to progression to determine which factors had the greatest clinical outcome.
The research team identified 210 eligible patients who had high-grade histology. Subjects received paclitaxel and carboplatin as adjuvant chemotherapy after initial surgical debulking of stage III/IV disease.
Median age of patients was 59 years, median body mass index was 24.8 kg/m2, and median body surface area was 1.70 m2.
Optimal debulking occurred in 55.7% of patients; 55.9% had grade 3 histology; 73.8% received 6 cycles of chemotherapy; 16 patients received fewer than the 6 intended cycles, and 39 patients received more than 6 cycles.
Patients received 175 mg/m2 of paclitaxel over 3 hours in combination with carboplatin cycles. Carboplatin was dosed to reach an area under the curve of either 5 or 6.
The predominant toxicity causing dose modification was neutropenia.
Median time to progression was 17.5 months and median overall survival was 63.6 months, Dr. Shafer reported in his poster presentation on March 10. Median follow-up was 3.2 years.
Multivariate analysis revealed that optimal debulking had the greatest impact on extending time to progression (P = .005). Another favourable factor was the number of cycles of chemotherapy that the patients were able to receive (P = .04).
When researchers considered factors detrimental to improving time to progression, they found that suboptimal debulking surgery increased the risk of progression by 56% (P = .002). Body mass index 30 kg/m2 or greater (P = .02) and increased dose intensity with paclitaxel (P = .018) appeared to be significant in reducing time to disease progression.
"In accordance with recent results from randomised trials of cyclophosphamide, cisplatin, carboplatin, and paclitaxel, we did not find that dose intensity of adjuvant carboplatin or paclitaxel positively impacted on survival, or more specifically, those patients that had lower dose intensities did not have a worse progression-free survival," said Dr. Shafer.
"The most important factor in progression-free survival is the ability to achieve optimal cytoreduction at the time of their initial surgery," he said. "This underlines the importance of prompt referral of patients with suspected ovarian cancer to gynaecologic oncologists for evaluation and treatment in order to maximise the chance of optimal cytoreduction."
[Presentation title: Surgical Cytoreduction and Dose Intensity of Adjuvant Paclitaxel and Carboplatin Chemotherapy in Advanced Epithelial Ovarian Cancer. Abstract 125]
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