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Dose-dense treatment with paclitaxel, carboplatin improved survival in advanced ovarian cancer

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Women with ovarian cancer had longer survival with a dose-dense therapy of paclitaxel and carboplatin than with conventional therapy of the two drugs.

Researchers conducted a phase-3, randomized trial at 85 centers in Japan. Women with stage II to stage IV epithelial ovarian cancer, fallopian tube cancer or primary peritoneal cancer were assigned to six cycles of either conventional therapy of paclitaxel 180 mg/m² given in a three-hour IV infusion plus carboplatin given on day one of a 21-day cycle (n=319) or dose-dense therapy of paclitaxel 80 mg/m² given in a one-hour IV infusion on days one, eight and 15 plus carboplatin on day one of a 21-day cycle (n=312).

Patients in the dose-dense therapy group had a longer PFS (28.0 months) than patients in the conventional therapy group (17.2 months; HR=0.71; 95% CI, 0.58-0.88). OS at three years was also higher in the dose-dense group (72.1%) vs. the conventional group (65.1%; HR=0.75; 95% CI, 0.57-0.98). The overall response rate was similar between groups (P=.72).

Seventy-three percent of patients in the conventional group received six or more cycles of treatment vs. 62% in the dose-dense group. The most common reason for discontinuation was hematologic toxicity: 60% in the dose-dense therapy group and 43% in the conventional group (P=.03).

Neutropenia was the most common adverse event, according to researchers. The dose-dense therapy group had a higher frequency of grade-3 or grade-4 anemia (69%) compared with the conventional therapy group (44%; P<.0001).

“The use of such dose-dense therapy should be decided upon on an individual basis together with other options for women with advanced-stage ovarian cancer, including intraperitoneal therapy, neoadjuvant treatment or substitution of docetaxel,” Michael A. Bookman, MD, chief of the hematology/oncology at Arizona Cancer Center, in Tucson, Ariz., said in an accompanying editorial.

Katsumata N. Lancet. 2009;doi:10.1016/S0140-6736(09)61157-0.

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