一项多中心回顾性研究,旨在评估在体弱的老年上皮性卵巢癌患者中使用卡铂-紫杉醇一线疗法与卡铂单药疗法的可行性、安全性和有效性。

IF 4.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Eve Merry, Ronas Taner Kesmez, Tamara Yu, Michael Flynn, Jonathan Ledermann, Michelle Lockley, Nicola Macdonald, Mary McCormack, Shibani Nicum, Shanthini Crusz, Rowan Miller
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引用次数: 0

摘要

目的:老年卵巢癌患者在临床试验中的代表性不足,导致该群体的最佳一线化疗方案不明确。老年卵巢癌妇女(EWOC)-1 试验表明,与标准的 3 周卡铂-紫杉醇(3wCP)相比,3 周卡铂(3wC)对体弱的老年卵巢癌患者的生存率和可行性更差。我们的回顾性研究比较了体弱卵巢癌队列中一线 3wCP 和 3wC 的可行性、安全性和疗效:我们回顾性分析了伦敦两家癌症中心两年内新诊断的国际妇产科联盟(FIGO)III/IV期、≥70岁上皮性卵巢癌患者的临床数据,这些患者由临床医生选择接受3wC或3wCP治疗。查尔森合并症指数(CCI)和东部合作肿瘤学组(ECOG)表现状态提供了体弱的替代指标。不良事件通用术语标准 v5.0 对毒性进行了分级:共有107名患者接受了3wC(30人)和3wCP(77人)治疗。两组患者的年龄、表现状态和 CCI 有显著差异,3wC 患者年龄更大(84 岁对 75 岁,P0.05)。两种方案的总体≥3级血液学毒性率相似(33% 3wC vs 44% 3wCP,p=0.37),≥3级中性粒细胞减少症(p=0.019)和≥3级血小板减少症(p=0.006)分别在3wCP和3wC中更为常见。没有发生与治疗相关的死亡:我们的数据表明,对于体弱的老年卵巢癌患者来说,标准的 3wCP 是一种耐受性良好、可行的一线治疗方法。如果对已确定的临床预后因素进行校正,3wCP所改善的生存率并不显著。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A multicenter retrospective study to assess feasibility, safety and efficacy of first-line carboplatin-paclitaxel versus carboplatin monotherapy in a frail, elderly epithelial ovarian cancer population.

Objective: Underrepresentation of elderly ovarian cancer patients in clinical trials has led to lack of clarity regarding optimal first-line chemotherapy in this cohort. The Elderly Women with Ovarian Cancer (EWOC)-1 trial demonstrated that 3-weekly carboplatin (3wC) resulted in worse survival and feasibility compared with standard 3-weekly carboplatin-paclitaxel (3wCP) in frail, elderly ovarian cancer patients. Our retrospective study compares feasibility, safety, and efficacy of first-line 3wCP and 3wC in a frail ovarian cancer cohort.

Methods: Clinical data were retrospectively analyzed for newly-diagnosed, International Federation of Gynecology and Obstetrics (FIGO) stage III/IV, ≥70-year-old epithelial ovarian cancer patients, treated by clinician choice with 3wC or 3wCP at two London cancer centers over a 2 year period. Charlson Comorbidity Index (CCI) and Eastern Cooperative Oncology Group (ECOG) performance status provided surrogate markers of frailty. Common Terminology Criteria for Adverse Events v5.0 graded toxicity.

Results: A total of 107 patients were treated with 3wC (n=30) and 3wCP (n=77). Age, performance status, and CCI were significantly different between cohorts, with 3wC patients older (84 vs 75 years, p<0.001), with more comorbidities (median CCI 4 vs 3, p<0.001) and worse performance status (47% vs 17% PS ≥2, p=0.015). Surgical outcomes differed significantly between cohorts, with 20 (67%) 3wC patients not undergoing surgery, compared with 22 (29%) 3wCP patients (p<0.001). Median follow-up was 45.8 months (IQR 38.7-56.3 months). While we observed improved progression-free (HR 0.55, 95% CI 0.33 to 0.90, p=0.017) and overall survival (HR 0.44, 95% CI 0.27 to 0.73, p=0.001, log-rank test) in a univariate cox proportional hazards comparison between 3wCP and 3wC, this was not significant on multivariate analysis. Completion of six planned chemotherapy cycles was achieved by the majority, with similar discontinuation rates between groups (13% 3wC vs 8% 3wCP, p>0.05). Overall grade ≥3 hematological toxicity rates were similar between regimens (33% 3wC vs 44% 3wCP, p=0.37) with grade ≥3 neutropenia (p=0.019) and grade ≥3 thrombocytopenia (p=0.006) more common with 3wCP and 3wC, respectively. No treatment-related deaths occurred.

Conclusion: Our data demonstrates that standard 3wCP is a well-tolerated, feasible first-line treatment for frail, elderly ovarian cancer patients. Improved survival with 3wCP was not significant when corrected for established clinical prognostic factors.

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来源期刊
CiteScore
6.60
自引率
10.40%
发文量
280
审稿时长
3-6 weeks
期刊介绍: The International Journal of Gynecological Cancer, the official journal of the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology, is the primary educational and informational publication for topics relevant to detection, prevention, diagnosis, and treatment of gynecologic malignancies. IJGC emphasizes a multidisciplinary approach, and includes original research, reviews, and video articles. The audience consists of gynecologists, medical oncologists, radiation oncologists, radiologists, pathologists, and research scientists with a special interest in gynecological oncology.
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