Isonishi Seiji, Hirama Masanori, Saitou Motoaki, Yasuda Makoto, Tanaka Tadao
Department of Obstetrics and Gynecology, Jikei University School of Medicine, 4-11-1 Izumi-honchou, Komae, Tokyo, 201-8601, Japan.
Int J Clin Oncol. 2006 Jun;11(3):236-42. doi: 10.1007/s10147-006-0561-x.
The current treatment of patients with recurrent ovarian cancer who have received initial platinum- or taxane-based chemotherapy depends on the results of the initial chemotherapy. The purpose of this study was to evaluate how to make the selection of second-line agents for patients with recurrent ovarian carcinoma initially diagnosed as stage II to IV.
We conducted a retrospective crossover study in patients who received second-line chemotherapy at Jikei University School of Medicine. We evaluated the responses, progression-free survivals, survivals of second-line chemotherapy, and overall survivals after primary surgery for 51 patients. The treatment cohorts were defined as follows: TC1, patients who were given paclitaxel and carboplatin as first-line chemotherapy and who, upon recurrence, were treated with a platinum-based combination as second-line; and TC2, patients who were given a non-taxane-based platinum combination as first-line chemotherapy, followed, at the time of recurrence, with paclitaxel and carboplatin.
The response rates of the second-line chemotherapy for the TC1 and TC2 groups were 44% and 25% (P=0.09). The median progression-free survivals of TC1 and TC2 were 12.9 and 6.4 months (P=0.018; hazard ratio [HR], 2.42; 95% confidence interval [CI], 1.16-5.04). The median survivals after second-line chemotherapy for the two groups were 16.8 and 10.4 months (P=0.007; HR, 2.78; 95% CI, 1.33-5.84) and overall survivals after primary surgery were 36.6 and 27.9 months (P=0.007; HR, 2.36; 95% CI, 1.07-5.21).
The TC1 group demonstrated a significantly better response and extension of progression-free survival, as well as significantly better survival after crossover and overall survival after primary surgery. As this was a retrospective analysis, this effect should be considered as hypothesis-generating and assessed prospectively in other trials comparing these two chemotherapy schedules.
接受过以铂类或紫杉烷类为基础的初始化疗的复发性卵巢癌患者的当前治疗方案取决于初始化疗的结果。本研究的目的是评估如何为最初诊断为II至IV期的复发性卵巢癌患者选择二线治疗药物。
我们在东京慈惠会医科大学接受二线化疗的患者中进行了一项回顾性交叉研究。我们评估了51例患者二线化疗的反应、无进展生存期、二线化疗后的生存期以及初次手术后的总生存期。治疗队列定义如下：TC1组，一线化疗接受紫杉醇和卡铂治疗，复发后接受铂类联合化疗作为二线治疗的患者；TC2组，一线化疗接受非紫杉烷类铂类联合化疗，复发时接受紫杉醇和卡铂治疗的患者。
TC1组和TC2组二线化疗的有效率分别为44%和25%（P = 0.09）。TC1组和TC2组的中位无进展生存期分别为12.9个月和6.4个月（P = 0.018；风险比[HR]，2.42；95%置信区间[CI]，1.16 - 5.04）。两组二线化疗后的中位生存期分别为16.8个月和10.4个月（P = 0.007；HR，2.78；95% CI，1.33 - 5.84），初次手术后的总生存期分别为36.6个月和27.9个月（P = 0.007；HR，2.36；95% CI，1.07 - 5.21）。
TC1组显示出明显更好的反应和无进展生存期延长，以及交叉后生存期和初次手术后总生存期明显更好。由于这是一项回顾性分析，这种效果应被视为生成假设，并在比较这两种化疗方案的其他试验中进行前瞻性评估。
