Sufliarsky J, Chovanec J, Svetlovska D, Minarik T, Packan T, Kroslakova D, Lalabova R, Helpianska L, Horvathova D, Sevcik L, Spacek J, Laluha A, Tkacova V, Malec V, Rakicka G, Magdin D, Jancokova I, Dorr A, Stresko M, Habetinek V, Koza I
National Cancer Institute Bratislava, 833 10 Brtaislava, Slovakia, Czech Republic.
Neoplasma. 2009;56(4):291-7. doi: 10.4149/neo_2009_04_291.
Despite progress in primary treatment of patients with advanced ovarian cancer, the majority develop recurrence of the disease. A platinum salt treatment, either as monotherapy or in combination with another cytostatic agent, is indicated for patients who have relapsed 6 or more months after primary treatment and thus have platinum-sensitive relapse. Because repeated use of paclitaxel treatment may lead to substantial neurotoxicity, the combination of gemcitabine with carboplatin represents a suitable treatment option, which is widely used in common clinical practice in the Czech Republic and Slovakia. This non-interventional, prospective study observed the effectiveness and tolerability of second-line treatment with gemcitabine and carboplatin in patients with platinum-sensitive relapse of ovarian cancer in routine clinical practice. The primary endpoint was to evaluate the survival and secondary endpoints were to evaluate time to disease progression, objective tumor response rate, and treatment toxicity. Patients were enrolled to planned second-line treatment with gemcitabine and carboplatin (gemcitabine 1000 mg/m2 and carboplatin AUC 5 on Day 1, and gemcitabine 1000 mg/m2 on Day 8 of a 21-day cycle) for platinum-sensitive relapse of ovarian cancer as a part of routine clinical practice and followed for 12 months. The events (death, tumor progression), tumor response, and maximal grades of toxicity were recorded according to common clinical practice. Survival time (using Kaplan-Meier analysis) and objective tumor response rate were calculated using data forms, and a subgroup analysis was performed using log rank tests for time-to-event endpoints; p-values were also calculated. Response rates were calculated for the whole population; for the subgroups, the Fisher's exact test was performed and only p-values were calculated. Between January 2004 and June 2005, 53 patients were enrolled in the study. The median age was 57 years and 96% of patients had an Eastern Cooperative Oncology Group Performance Status (ECOG-PS) of 0 and 1 at baseline. Approximately 91% of patients were originally diagnosed with stage III or IV; 60% of patients had disease free intervals (DFIs) of 12 or more months from previous therapy, and the additional 40% less than 12 months. The 1-year survival rate was 83%. Median survival time was not determined within the 12-month period following the start of the treatment study due to the limited duration of follow-up. Objective tumour response rate was 67.3%. Most common reasons for discontinuation of therapy were "Planned treatment completed" (53%) and "Tumor progression" (11%). Most common toxicities were leukopenia, anaemia, neutropenia, and thrombocytopenia; grades 3 and 4 of these toxicity types did not exceed 30%. Febrile neutropenia was recorded in two patients. Most common non-haematological toxicities were nausea and vomiting, fatigue, and neuropathy; grades 3 and 4 of these were below 6%. Results on time to disease progression are not published due to inconsistent statistical analysis of reported data. Based on this observation from routine clinical practice, which corresponds with previously published results from controlled clinical trials, the gemcitabine and carboplatin combination seems to be a suitable therapeutic option for patients with platinum-sensitive relapse of ovarian cancer.
尽管晚期卵巢癌患者的初始治疗取得了进展,但大多数患者仍会出现疾病复发。对于初始治疗6个月或更长时间后复发且铂敏感的患者,可采用铂盐单药治疗或与其他细胞毒性药物联合治疗。由于重复使用紫杉醇治疗可能导致严重的神经毒性,吉西他滨与卡铂联合治疗是一种合适的治疗选择,在捷克共和国和斯洛伐克的临床实践中广泛应用。这项非干预性前瞻性研究观察了吉西他滨和卡铂二线治疗铂敏感复发卵巢癌患者在常规临床实践中的有效性和耐受性。主要终点是评估生存率,次要终点是评估疾病进展时间、客观肿瘤缓解率和治疗毒性。患者作为常规临床实践的一部分,接受吉西他滨和卡铂的计划二线治疗(21天周期的第1天给予吉西他滨1000mg/m²和卡铂AUC 5,第8天给予吉西他滨1000mg/m²)用于铂敏感复发的卵巢癌,并随访12个月。根据常规临床实践记录事件(死亡、肿瘤进展)、肿瘤反应和最大毒性等级。使用数据表格计算生存时间(采用Kaplan-Meier分析)和客观肿瘤缓解率,并对事件发生时间终点使用对数秩检验进行亚组分析;同时计算p值。计算总体人群的缓解率;对于亚组,进行Fisher精确检验并仅计算p值。2004年1月至2005年6月,53例患者纳入研究。中位年龄为57岁,96%的患者基线时东部肿瘤协作组体能状态(ECOG-PS)为0和1。约91%的患者最初诊断为III期或IV期;60%的患者自上次治疗后的无病间期(DFI)为12个月或更长,另外40%的患者小于12个月。1年生存率为83%。由于随访时间有限,在治疗研究开始后的12个月内未确定中位生存时间。客观肿瘤缓解率为67.3%。停止治疗的最常见原因是“计划治疗完成”(53%)和“肿瘤进展”(11%)。最常见的毒性反应是白细胞减少、贫血、中性粒细胞减少和血小板减少;这些毒性类型的3级和4级反应不超过30%。两名患者记录有发热性中性粒细胞减少。最常见的非血液学毒性反应是恶心、呕吐、疲劳和神经病变;这些反应的3级和4级低于6%。由于报告数据的统计分析不一致,未公布疾病进展时间的结果。基于常规临床实践的这一观察结果,与先前发表的对照临床试验结果一致,吉西他滨和卡铂联合治疗似乎是铂敏感复发卵巢癌患者的合适治疗选择。