Carboplatin with cyclophosphamide in patients with advanced ovarian cancer: an efficacy and quality-adjusted survival analysis.
The efficacy and toxicity of a combination of carboplatin and cyclophosphamide (CC) were studied in a group of 76 patients with advanced ovarian cancer. Progression-free (PFS) and overall survival were compared with a historical group of 65 patients treated with CAP-5 (cyclophosphamide, adriamycin, cisplatin). Subjective toxicity was compared by the measurement of TWiST, the Time Without Symptoms of Disease or Treatment. Of 75 evaluable patients treated with CC, 18 (24%) had a pathologically complete remission (pCR), and 31 (41%) a partial remission (PR). CC led to leukopenia grade III in 38% and grade IV in 3% of 421 treatment cycles. Thrombocytopenia grade III was seen after 7% and grade IV after 2% of cycles. Treatment delay occurred in 11.5% and dose reduction in 21% of cycles. Nephro- or neurotoxicity did not occur. After a median follow-up of 18 months, the median PFS was 24 months and the overall survival was 25 months. Median duration of TWiST was 22 versus 10 months after CAP-5 (P < 0.01). Compared with historical controls, treatment with CC is equivalent to CAP-5. It is free of nephro- and neurotoxicity, but is more myelosuppressive. Quality of life, measured by TWiST, is significantly better during CC. As a consequence of its equivalent efficacy, but lower subjective toxicity, carboplatin should replace cisplatin in treating patients with advanced ovarian cancer.
Willemse
P.H.B.
PH
Departments of Medical Oncology and Gynecologic Oncology, University of Groningen, Ny Smellinghe Hospital Drachten, Scheper Hospital Emmen, The Netherlands.
De Vries
E.G.E.
EG
Kloppenburg
M.
M
Fontein
D.L.
DL
Aalders
J.G.
JG
Boonstra
H.
H
Mulder
N.H.
NH
Sleijfer
D.Th.
DT