Dipartimento di Scienze Chirurgiche, Università Milano-Bicocca, Medico Direttore, Unità Ginecologia Oncologica Medica, Divisione di Ginecologia, Via Ripamonti, 435-20141 Milano, Italy.
J Clin Oncol. 2012 Nov 1;30(31):3841-7. doi: 10.1200/JCO.2011.38.8082. Epub 2012 Sep 17.
This study compared the efficacy and safety of patupilone with those of pegylated liposomal doxorubicin (PLD) in patients with platinum-refractory or -resistant epithelial ovarian, primary fallopian tube, or primary peritoneal cancer.
Patients with three or fewer prior regimens were eligible if they had received first-line taxane/platinum-based combination chemotherapy and were platinum refractory or resistant. Patients were randomly assigned to receive patupilone (10 mg/m(2) intravenously every 3 weeks) or PLD (50 mg/m(2) intravenously every 4 weeks).
A total of 829 patients were randomly assigned (patupilone, n = 412; PLD, n = 417). There was no statistically significant difference in overall survival (OS), the primary end point, between the patupilone and PLD arms (P = .195; hazard ratio, 0.93; 95% CI, 0.79 to 1.09), with median OS rates of 13.2 and 12.7 months, respectively. Median progression-free survival was 3.7 months for both arms. The overall response rate (all partial responses) was higher in the patupilone arm than in the PLD arm (15.5% v 7.9%; odds ratio, 2.11; 95% CI, 1.36 to 3.29), although disease control rates were similar (59.5% v 56.3%, respectively). Frequently observed adverse events (AEs) of any grade included diarrhea (85.3%) and peripheral neuropathy (39.3%) in the patupilone arm and mucositis/stomatitis (43%) and hand-foot syndrome (41.8%) in the PLD arm.
Patupilone did not demonstrate significant improvement in OS compared with the active control, PLD. No new or unexpected serious AEs were identified.
本研究比较了紫杉醇结合蛋白类似物(patupilone)与聚乙二醇脂质体阿霉素(PLD)在铂类耐药或铂类难治性上皮性卵巢癌、原发性输卵管癌或原发性腹膜癌患者中的疗效和安全性。
如果患者接受过一线紫杉烷/铂类联合化疗,且对铂类耐药或铂类难治,且有 3 个或更少的既往治疗方案,则有资格入组。患者被随机分配接受 patupilone(10 mg/m²,每 3 周静脉注射 1 次)或 PLD(50 mg/m²,每 4 周静脉注射 1 次)。
共有 829 例患者被随机分配(patupilone 组 412 例,PLD 组 417 例)。patupilone 组和 PLD 组的总生存期(OS)(主要终点)无统计学差异(P=0.195;风险比 0.93;95%CI,0.79 至 1.09),中位 OS 率分别为 13.2 个月和 12.7 个月。两组的中位无进展生存期均为 3.7 个月。patupilone 组的总体缓解率(所有部分缓解)高于 PLD 组(15.5%对 7.9%;优势比 2.11;95%CI,1.36 至 3.29),但疾病控制率相似(分别为 59.5%和 56.3%)。任何级别的常见不良事件(AE)包括 patupilone 组的腹泻(85.3%)和周围神经病(39.3%)以及 PLD 组的黏膜炎/口腔炎(43%)和手足综合征(41.8%)。
与活性对照药物 PLD 相比,patupilone 并未显著改善 OS。未发现新的或意外的严重 AE。