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(Ivanhoe Newswire) -- Ovarian cancer patients who received an intensive 'dose-dense' chemotherapy regimen survived longer and had a higher-rate of progression-free survival, according to a new study by Dr Noriyuki Katsumata, National Cancer Center Hospital, Tokyo, Japan, and colleagues.
Paclitaxel and carboplatin given every three weeks is currently the standard first-line chemotherapy for advanced epithelial ovarian cancer. Paclitaxel and carboplatin have been combined with other drugs, given either concurrently or sequentially, in the hope of prolonging survival, but the results of several trials have been disappointing.
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In this study, the authors compared a conventional three-week regimen of paclitaxel and carboplatin with a dose-dense weekly regimen. Patients with advanced epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer participated in this phase III trial at 85 centers in Japan. Patients were given six cycles of either paclitaxel plus carboplatin, given on day 1 of a 21-day cycle, or dose-dense paclitaxel, given on days 1, 8, and 15, plus carboplatin given on day 1 of a 21-day cycle.
Progression-free survival was longer in the dose-dense treatment group, at 28 months, than in the conventional treatment group, at 17 months. Overall survival at 3 years was 72 percent in the dose-dense regimen group, compared with 65 percent in the conventional treatment group.
Expressed another way, women assigned to the dose-dense regimen had a 29 percent lower risk of disease progression and a 25 percent lower risk of death than those given the conventional regimen.
Although the end results were promising, the side effects of the chemotherapy were severe, especially in the dose-dense group. A total of 165 patients assigned to the dose-dense regimen and 117 assigned to the conventional regimen discontinued treatment early. Withdrawal because of toxicity was higher in the dose-dense regimen group. Most patients in both groups experienced neutropenia (reduced white blood cell count). Severe anemia was higher in the dose-dense treatment group than in the conventional treatment group.
The authors say that the survival rates achieved in the dose-dense group are rare in women with advanced ovarian cancer. They concluded, "Dose-dense weekly paclitaxel plus carboplatin improved survival compared with the conventional regimen and represents a new treatment option in women with advanced epithelial ovarian cancer."
In an accompanying Comment, Dr. Michael A Bookman, Arizona Cancer Center, Tucson, AZ, is quoted as saying that confirmatory trials are now underway regarding dose-dense regimens. He concluded, "The use of such dose-dense therapy should be decided on an individual basis together with other options for women with advanced-stage ovarian cancer."
SOURCE: The Lancet, September 19, 2009
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