taxane and Carcinoma--Endometrioid

A 78-year-old patient had abdominal bloating since October 2002, and visited a GP, who noticed ascites, and referred the patient to our hospital. An exploratory laparotomy was performed and stage IIIc ovarian cancer was diagnosed. Six courses of docetaxel-carboplatin (DJ) chemotherapy were administered; however, the lesion was assessed as progressive disease (PD), and 24 courses of weekly paclitaxel were then administered. During the follow-up as an outpatient, a tumor marker increased again. Weekly paclitaxel was not effective this time, and the lesion was assessed as PD. The patient therefore received treatment with irinotecan and cisplatin (CPT-11+CDDP). These drugs have different mechanisms of action. The CA 125 level returned to normal following four courses of CPT-11+CDDP. The patient received a total of six courses, and thus far, no obvious recurrent lesion has been observed. These results suggest that CPT-11+CDDP may be effective against recurrent ovarian cancer, which is difficult to treat due to its resistance to platinum drugs and taxane drugs.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Bridged-Ring Compounds; CA-125 Antigen; Camptothecin; Carcinoma, Endometrioid; Cisplatin; Drug Administration Routes; Drug Resistance, Neoplasm; Female; Humans; Irinotecan; Laparotomy; Ovarian Neoplasms; Paclitaxel; Remission Induction; Taxoids

The objective of the present study was to compare recurrence-free survival (RFS) in early stages (FIGO stages I-II) of epithelial ovarian cancer after adjuvant chemotherapy with carboplatin and a taxane (113 patients) and with carboplatin alone (27 patients). The distribution of clinical and pathological prognostic factors as well as type of primary surgery were comparable in the two groups. Recurrence rate was 21% and RFS was 79% in the series of patients treated with taxane-based chemotherapy and 19% and 81%, respectively, in the series of patients who received single drug carboplatin. Thus, no significant differences were recorded. The major toxicities in the present study were myelosuppression (46%) and neuro-toxicity (26%). Neuro-toxicity was more frequently (P=0.007) recorded and of higher grade (P=0.011) for patients in the carboplatin-taxane series compared with patients in the carboplatin series. RFS for patients in FIGO-stage I was 85% and for patients in FIGO-stage II only 47%. In a multivariate logistic regression analysis of predictive factors for tumor recurrence in the complete series (n=140) the FIGO stage was the only independent and significant (P=0.0006) predictive factor with an odds ratio of 6.4 (95% CI: 2.2-18.9) for stage II versus IA-C. Age, tumor grade and type of adjuvant chemotherapy (+/- taxane) were not significant predictive factors. In the present study, although based on a limited number of patients, we could not find any improvement in recurrence rate or recurrence-free survival for patients treated with a carboplatin-taxane combination regimen compared with patients treated with carboplatin monotherapy. The spectrum of side effects was also in favor of the monotherapy regimen. Further, larger randomized studies are needed to give a final and fully conclusive answer to this question.

Topics: Adenocarcinoma, Clear Cell; Adenocarcinoma, Mucinous; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Bridged-Ring Compounds; Carboplatin; Carcinoma, Endometrioid; Chemotherapy, Adjuvant; Cystadenocarcinoma, Serous; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasms, Glandular and Epithelial; Ovarian Neoplasms; Prognosis; Survival Rate; Taxoids