title: Decreased dose density of standard chemotherapy does not compromise survival for ovarian cancer patients.
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.
authors.affiliation: Department of Oncology and Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Molckovsky
authors.forename: S M
authors.initials: SM
authors.lastname: Vijay
authors.forename: W M
authors.initials: WM
authors.lastname: Hopman
authors.forename: P
authors.initials: P
authors.lastname: Bryson
authors.forename: J F
authors.initials: JF
authors.lastname: Jeffrey
authors.forename: J J
authors.initials: JJ
authors.lastname: Biagi
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000188:drug therapy / Q000401:mortality; D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy / Q000401:mortality; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016190:Carboplatin / Q000008:administration & dosage; D018269:Carcinoma, Endometrioid / Q000188:drug therapy / Q000401:mortality; D002291:Carcinoma, Papillary / Q000188:drug therapy / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D017239:Paclitaxel / Q000008:administration & dosage; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin