title: Improved outcomes with dose-dense paclitaxel-based neoadjuvant chemotherapy in advanced epithelial ovarian carcinoma.
abstract: We compared tolerability, toxicity, response, and interval debulking surgery (IDS) outcomes between patients who received weekly dose-dense paclitaxel (DDP) and every three-week platinum to standard every three-week taxane plus platinum neoadjuvant chemotherapy (NACT) for advanced epithelial ovarian cancer (EOC).
  
  
  
  We conducted a retrospective study of patients receiving NACT at our center between June 1, 2012 and July 31, 2015. Patients with stage III/IV EOC who received at least one cycle of DDP (weekly paclitaxel plus every three-week carboplatin) or standard taxane (every three-week paclitaxel or docetaxel plus carboplatin) therapy were included. Abstracted data included demographics, tolerability, grade 3/4 toxicity, response, and IDS outcomes. Fisher's exact and student t-test were used for statistical significance.
  
  
  
  Twenty-one patients received DDP and 40 received standard taxane. Tolerability was comparable. More patients receiving DDP experienced grade 3 or 4 toxicity when considered in aggregate (86% vs. 40%; p=0.001). Pathologic complete response (pCR) was achieved in 14% of DDP patients versus 3% of standard (p=0.11). 48% of patients in the DDP group were debulked to no residual disease (NRD) versus 28% in the standard group (p=0.16).
  
  
  
  While associated with an increase in severe toxicity compared to standard three-week taxane, DDP appears to facilitate higher rates of pCR and NRD for patients receiving NACT in this preliminary study. These results warrant further investigation of DDP for patients with advanced EOC and assessment of impact on long-term survival outcomes.
authors.affiliation: Division of Gynecologic Oncology, University of Alabama at Birmingham, United States.
authors.forename: David A
authors.initials: DA
authors.lastname: Becker
authors.affiliation: Division of Gynecologic Oncology, University of Alabama at Birmingham, United States.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Thomas
authors.affiliation: Division of Gynecologic Oncology, University of Alabama at Birmingham, United States.
authors.forename: Allison L
authors.initials: AL
authors.lastname: Gilbert
authors.affiliation: Division of Gynecologic Oncology, University of Alabama at Birmingham, United States.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Boone
authors.affiliation: Division of Gynecologic Oncology, University of Alabama at Birmingham, United States.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Straughn
authors.affiliation: Division of Gynecologic Oncology, University of Alabama at Birmingham, United States.
authors.forename: Warner K
authors.initials: WK
authors.lastname: Huh
authors.affiliation: Division of Gynecologic Oncology, University of Alabama at Birmingham, United States.
authors.forename: Kerri S
authors.initials: KS
authors.lastname: Bevis
authors.affiliation: Division of Gynecologic Oncology, University of Alabama at Birmingham, United States.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Leath
authors.affiliation: Division of Gynecologic Oncology, University of Alabama at Birmingham, United States. Electronic address: ralvarez@uabmc.edu.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Alvarez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D000077143:Docetaxel; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D016190:Carboplatin; D017239:Paclitaxel
keywords: Dose-dense paclitaxel; Neoadjuvant chemotherapy; Ovarian cancer