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Feasibility of dose-dense paclitaxel/carboplatin therapy in elderly patients with ovarian, fallopian tube, or peritoneal cancer

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Abstract

Purpose

Weekly dose-dense paclitaxel (PTX) in combination with carboplatin (CBDCA) every 3 weeks (ddTC therapy) is a standard treatment for patients with advanced ovarian cancer. However, there is no detailed analysis of the feasibility of ddTC therapy in elderly patients with ovarian cancer.

Methods

We identified patients diagnosed with ovarian, fallopian tube, or peritoneal cancer who received ddTC therapy at the National Cancer Center Hospital from April 2003 to April 2013. We assessed the feasibility of ddTC therapy in elderly patients aged 70 years or older (elderly group), comparing relative dose intensity (RDI) for PTX, CBDCA, and ddTC; adverse events; and rate of chemotherapy discontinuation to those in patients below 70 years of age (younger group).

Results

A total of 143 patients (elderly group, 22; younger group, 121) was analyzed. A comparison of RDI between these two groups showed no significant differences for PTX, CBDCA, and ddTC. Nonhematological and hematological toxicity profiles of the elderly and younger groups were similar, except that severe peripheral neuropathy (Grade 2 or higher) was more common in the elderly group. There was no significant difference in the rate of chemotherapy discontinuation (elderly group, 13.6 % vs. younger group, 7.4 %, p = 0.397).

Conclusions

Our study showed that ddTC therapy was feasible for elderly patients. However, to prevent severe neuropathy, PTX dose reduction deserves consideration.

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References

  1. Bouchardy C, Rapiti E, Blagojevic S, Vlastos AT, Vlastos G (2007) Older female cancer patients: importance, causes, and consequences of undertreatment. J Clin Oncol Off J Am Soc Clin Oncol 25(14):1858–1869. doi:10.1200/JCO.2006.10.4208

    Article  Google Scholar 

  2. Efstathiou E, Dimopoulos MA, Bozas G, Kastritis E, Moulopoulos LA, Rodolakis A, Vlahos G, Gika D, Papadimitriou C, Bamias A (2007) Advanced epithelial ovarian cancer in the elderly: chemotherapy tolerance and outcome. Anticancer Res 27(1b):611–617

    PubMed  Google Scholar 

  3. Fairfield KM, Murray K, Lucas FL, Wierman HR, Earle CC, Trimble EL, Small L, Warren JL (2011) Completion of adjuvant chemotherapy and use of health services for older women with epithelial ovarian cancer. J Clin Oncol Off J Am Soc Clin Oncol 29(29):3921–3926. doi:10.1200/JCO.2010.34.1552

    Article  Google Scholar 

  4. Tew WP, Fleming GF (2015) Treatment of ovarian cancer in the older woman. Gynecol Oncol 136(1):136–142. doi:10.1016/j.ygyno.2014.10.028

    Article  PubMed  Google Scholar 

  5. Tew WP, Lichtman SM (2008) Ovarian cancer in older women. Semin Oncol 35(6):582–589. doi:10.1053/j.seminoncol.2008.08.007

    Article  CAS  PubMed  Google Scholar 

  6. Katsumata N, Yasuda M, Takahashi F, Isonishi S, Jobo T, Aoki D, Tsuda H, Sugiyama T, Kodama S, Kimura E, Ochiai K, Noda K (2009) Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial. Lancet 374(9698):1331–1338. doi:10.1016/s0140-6736(09)61157-0

    Article  CAS  PubMed  Google Scholar 

  7. Katsumata N, Yasuda M, Isonishi S, Takahashi F, Michimae H, Kimura E, Aoki D, Jobo T, Kodama S, Terauchi F, Sugiyama T, Ochiai K (2013) Long-term results of dose-dense paclitaxel and carboplatin versus conventional paclitaxel and carboplatin for treatment of advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer (JGOG 3016): a randomised, controlled, open-label trial. Lancet Oncol 14(10):1020–1026. doi:10.1016/s1470-2045(13)70363-2

    Article  CAS  PubMed  Google Scholar 

  8. Isonishi S, Yasuda M, Takahashi F, Katsumata N, Kimura E, Aoki D, Jobo T, Terauchi F, Tsuda H, Sugiyama T (2008) Randomized phase III trial of conventional paclitaxel and carboplatin (c-TC) versus dose dense weekly paclitaxel and carboplatin (dd-TC) in women with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer: Japanese Gynecologic Oncology. In: ASCO Annual Meeting; Chicago, IL, USA, 30 May–3 June 2008. Abstract 5506

  9. Falandry C, Weber B, Savoye AM, Tinquaut F, Tredan O, Sevin E, Stefani L, Savinelli F, Atlassi M, Salvat J, Pujade-Lauraine E, Freyer G (2013) Development of a geriatric vulnerability score in elderly patients with advanced ovarian cancer treated with first-line carboplatin: a GINECO prospective trial. Ann Oncol Off J Eur Soc Med Oncol ESMO 24(11):2808–2813. doi:10.1093/annonc/mdt360

    Article  CAS  Google Scholar 

  10. Pignata S, Breda E, Scambia G, Pisano C, Zagonel V, Lorusso D, Greggi S, De VR, Ferrandina G, Gallo C, Perrone F (2008) A phase II study of weekly carboplatin and paclitaxel as first-line treatment of elderly patients with advanced ovarian cancer. A Multicentre Italian Trial in Ovarian cancer (MITO-5) study. Crit Rev Oncol Hematol 66(3):229–236. doi:10.1016/j.critrevonc.2007.12.005

    Article  PubMed  Google Scholar 

  11. Pignata S, Scambia G, Katsaros D, Gallo C, Pujade-Lauraine E, De Placido S, Bologna A, Weber B, Raspagliesi F, Panici PB, Cormio G, Sorio R, Cavazzini MG, Ferrandina G, Breda E, Murgia V, Sacco C, Cinieri S, Salutari V, Ricci C, Pisano C, Greggi S, Lauria R, Lorusso D, Marchetti C, Selvaggi L, Signoriello S, Piccirillo MC, Di Maio M, Perrone F (2014) Carboplatin plus paclitaxel once a week versus every 3 weeks in patients with advanced ovarian cancer (MITO-7): a randomised, multicentre, open-label, phase 3 trial. Lancet Oncol 15(4):396–405. doi:10.1016/s1470-2045(14)70049-x

    Article  CAS  PubMed  Google Scholar 

  12. (2004) Japanese translation of common terminology criteria for adverse events (CTCAE), and instructions and guidelines. Int J Clin Oncol 9(Suppl 3):1–82. http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf

  13. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transp 48(3):452–458. doi:10.1038/bmt.2012.244

    Article  CAS  Google Scholar 

  14. Akerley W, Herndon JE, Egorin MJ, Lyss AP, Kindler HL, Savarese DM, Sherman CA, Rosen DM, Hollis D, Ratain MJ, Green MR (2003) Weekly, high-dose paclitaxel in advanced lung carcinoma: a phase II study with pharmacokinetics by the Cancer and Leukemia Group B. Cancer 97(10):2480–2486. doi:10.1002/cncr.11375

    Article  CAS  PubMed  Google Scholar 

  15. Lichtman SM, Hurria A, Cirrincione CT, Seidman AD, Winer E, Hudis C, Cohen HJ, Muss HB (2012) Paclitaxel efficacy and toxicity in older women with metastatic breast cancer: combined analysis of CALGB 9342 and 9840. Ann Oncol Off J Eur Soc Med Oncol ESMO 23(3):632–638. doi:10.1093/annonc/mdr297

    Article  CAS  Google Scholar 

  16. Tanabe Y, Hashimoto K, Shimizu C, Hirakawa A, Harano K, Yunokawa M, Yonemori K, Katsumata N, Tamura K, Ando M, Kinoshita T, Fujiwara Y (2013) Paclitaxel-induced peripheral neuropathy in patients receiving adjuvant chemotherapy for breast cancer. Int J Clin Oncol 18(1):132–138. doi:10.1007/s10147-011-0352-x

    Article  CAS  PubMed  Google Scholar 

  17. Chase DM, Huang H, Foss CD, Wenzel LB, Monk BJ, Burger RA (2015) Neurotoxicity in ovarian cancer patients on Gynecologic Oncology Group (GOG) protocol 218: characteristics associated with toxicity and the effect of substitution with docetaxel: an NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 136(2):323–327. doi:10.1016/j.ygyno.2014.12.021

    Article  PubMed  Google Scholar 

  18. Lee JJ, Swain SM (2006) Peripheral neuropathy induced by microtubule-stabilizing agents. J Clin Oncol Off J Am Soc Clin Oncol 24(10):1633–1642. doi:10.1200/jco.2005.04.0543

    Article  CAS  Google Scholar 

  19. Errico A (2014) Gynaecological cancer: MITO-7-a weekly regimen associated with a better quality of life for patients with advanced ovarian cancer. Nat Rev Clin Oncol 11(4):177. doi:10.1038/nrclinonc.2014.45

    Article  PubMed  Google Scholar 

  20. Kanesvaran R, Li H, Koo KN, Poon D (2011) Analysis of prognostic factors of comprehensive geriatric assessment and development of a clinical scoring system in elderly Asian patients with cancer. J Clin Oncol Off J Am Soc Clin Oncol 29(27):3620–3627. doi:10.1200/jco.2010.32.0796

    Article  Google Scholar 

  21. Joseph N, Clark RM, Dizon DS, Lee MS, Goodman A, Boruta D Jr, Schorge JO, Del Carmen MG, Growdon WB (2015) Delay in chemotherapy administration impacts survival in elderly patients with epithelial ovarian cancer. Gynecol Oncol. doi:10.1016/j.ygyno.2015.03.052

    PubMed  Google Scholar 

  22. Maas HA, Kruitwagen RF, Lemmens VE, Goey SH, Janssen-Heijnen ML (2005) The influence of age and co-morbidity on treatment and prognosis of ovarian cancer: a population-based study. Gynecol Oncol 97(1):104–109. doi:10.1016/j.ygyno.2004.12.026

    Article  CAS  PubMed  Google Scholar 

  23. Freyer G, Geay JF, Touzet S, Provencal J, Weber B, Jacquin JP, Ganem G, Tubiana-Mathieu N, Gisserot O, Pujade-Lauraine E (2005) Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Ann Oncol Off J Eur Soc Med Oncol ESMO 16(11):1795–1800. doi:10.1093/annonc/mdi368

    Article  CAS  Google Scholar 

  24. Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM, Gajra A, Bhatia S, Katheria V, Klapper S, Hansen K, Ramani R, Lachs M, Wong FL, Tew WP (2011) Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol Off J Am Soc Clin Oncol 29(25):3457–3465. doi:10.1200/JCO.2011.34.7625

    Article  CAS  Google Scholar 

  25. Tredan O, Geay JF, Touzet S, Delva R, Weber B, Cretin J, Provencal J, Martin J, Stefani L, Pujade-Lauraine E, Freyer G, Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens (2007) Carboplatin/cyclophosphamide or carboplatin/paclitaxel in elderly patients with advanced ovarian cancer? Analysis of two consecutive trials from the Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens. Ann Oncol Off J Eur Soc Med Oncol ESMO 18(2):256–262. doi:10.1093/annonc/mdl400

    Article  CAS  Google Scholar 

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Acknowledgments

This research was partially supported by the Practical Research for Innovative Cancer Control from the Japan Agency for Medical Research and Development (AMED, No.: 15ck0106075h0002).

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Correspondence to Mayu Yunokawa.

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Bun, S., Yunokawa, M., Ebata, T. et al. Feasibility of dose-dense paclitaxel/carboplatin therapy in elderly patients with ovarian, fallopian tube, or peritoneal cancer. Cancer Chemother Pharmacol 78, 745–752 (2016). https://doi.org/10.1007/s00280-016-3100-0

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  • DOI: https://doi.org/10.1007/s00280-016-3100-0

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