Graziani Silvia R, Vital Carolina G, Morikawa Aleksandra T, Van Eyll Brigitte M, Fernandes Junior Hezio J, Kalil Filho Roberto, Maranhão Raul C
Heart Institute (InCor) of the Medical School Hospital, University of São Paulo, São Paulo, SP, Brazil.
Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, SP, Brazil.
Med Oncol. 2017 Sep;34(9):151. doi: 10.1007/s12032-017-1009-z. Epub 2017 Jul 29.
Ovarian cancer is often diagnosed at advanced stages, when poorly responsive to standard treatment. First-line treatment consists in schemes including cytoreductive surgery followed by adjuvant chemotherapy schemes with platinum and taxane derivatives. Second-line regimens are based on gemcitabine and liposomal doxorubicin. Third line is often not worthwhile because of the high toxicity with poor response to treatment. Previously, we showed that paclitaxel (PTX) carried in non-protein lipid core nanoparticles (LDE) resembling the chemical structure of LDL has remarkably reduced toxicity. Here, the hypothesis was tested whether PTX-LDE could safely benefit patients in third-line treatment setting. Fourteen women unresponsive to second-line chemotherapy for ovarian cancer, aged 61 ± 10 years, clinical stage IV and TqNqM1, were included. PTX-LDE was administered at 175 mg/m, 3/3 week dose. Patients were submitted to clinical examinations before each chemotherapy cycle. Serum biochemistry and imaging examinations to monitor disease progression were performed. In total, 74 cycles of chemotherapy were done and, in all cycles, clinical or laboratorial toxicities were not observed. Median progression-free survival (PFS) was 3.0 months (95% CI 2.0-3.9). In four patients, PFS was >6 months and in 2 > 1 year. The unpreceded, striking absence of toxicity and consistently long PFS, compared to previous results, indicate that at least 4 among 14 patients had tumor arrest by the treatment and clear benefit of PTX-LDE at third-line setting. The absence of observable toxicity allows dose escalating to improve response to treatment, as perspective to be tested in the ensuing studies.
卵巢癌通常在晚期被诊断出来,此时对标准治疗反应不佳。一线治疗包括减瘤手术,随后是铂类和紫杉烷类衍生物的辅助化疗方案。二线治疗方案基于吉西他滨和脂质体阿霉素。由于毒性高且治疗反应差,三线治疗通常不值得。此前,我们表明,载于类似于低密度脂蛋白化学结构的非蛋白质脂质核心纳米颗粒(LDE)中的紫杉醇(PTX)毒性显著降低。在此,我们检验了PTX-LDE在三线治疗环境中能否安全地使患者受益的假设。纳入了14名对卵巢癌二线化疗无反应的女性,年龄61±10岁,临床分期为IV期,TqNqM1。PTX-LDE以175mg/m²、每3周一次的剂量给药。在每个化疗周期前对患者进行临床检查。进行血清生化和影像学检查以监测疾病进展。总共进行了74个化疗周期,在所有周期中均未观察到临床或实验室毒性。中位无进展生存期(PFS)为3.0个月(95%CI 2.0-3.9)。4名患者的PFS>6个月,2名患者的PFS>1年。与先前结果相比,前所未有的明显无毒性和持续较长的PFS表明,14名患者中至少有4名通过治疗实现了肿瘤停滞,且PTX-LDE在三线治疗中明显有益。无明显毒性使得可以提高剂量以改善治疗反应,这是后续研究中有待检验的观点。
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