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一项评价依立替康钠和每周紫杉醇治疗复发性或持续性铂耐药卵巢癌、输卵管癌或原发性腹膜癌的 II 期临床试验:NRG 肿瘤学/妇科肿瘤学组研究。

A phase II evaluation of elesclomol sodium and weekly paclitaxel in the treatment of recurrent or persistent platinum-resistant ovarian, fallopian tube or primary peritoneal cancer: An NRG oncology/gynecologic oncology group study.

机构信息

Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine at St. Joseph Hospital, Phoenix, AZ, USA.

NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park, Buffalo, NY, USA.

出版信息

Gynecol Oncol. 2018 Dec;151(3):422-427. doi: 10.1016/j.ygyno.2018.10.001. Epub 2018 Oct 8.

Abstract

OBJECTIVE

Preclinical data suggest elesclomol increases oxidative stress and enhances sensitivity to cytotoxic agents. The objective of this prospective multicenter phase 2 trial was to estimate the activity of IV elesclomol plus weekly paclitaxel in patients with platinum-resistant recurrent ovarian, tubal or peritoneal cancer through the frequency of objective tumor responses (ORR).

METHODS

Patients with measurable disease, acceptable organ function, performance status ≤ 2, and one prior platinum containing regimen were eligible. A two-stage design was utilized with a target sample size of 22 and 30 subjects, respectively. Prior Gynecologic Oncology Group studies within the same population involving single agent taxanes showed an ORR of approximately (20%) and served as a historical control for direct comparison. The present study was designed to determine if the regimen had an ORR of ≥40% with 90% power.

RESULTS

Fifty-eight patients were enrolled, of whom 2 received no study treatment and were inevaluable. The median number of cycles was 3 (268 total cycles, range 1-18). The number of patients responding was 11 (19.6%; 90% CI 11.4% to 30.4%) with one complete response. The median progression-free survival and overall survival was 3.6 months and 13.3 months, respectively. The median ORR duration was 9.2 months. Percentages of subjects with grade 3 toxicity included: Neutropenia 9%; anemia 5%; metabolic 5%; nausea 4%; infection 4%; neurologic (mostly neuropathy) 4%; and vascular (mostly thromboembolism) 4%. There were no grade 4 toxicities reported.

CONCLUSIONS

This combination was well tolerated but is unworthy of further investigation based on the proportion responding [ClinicalTrials.gov Identifier: NCT00888615].

摘要

目的

临床前数据表明依立洛莫尔增加氧化应激并增强对细胞毒性药物的敏感性。本前瞻性多中心 2 期试验的目的是通过客观肿瘤反应(ORR)的频率来评估 IV 依立洛莫尔联合每周紫杉醇在铂耐药复发性卵巢、输卵管或腹膜癌患者中的活性。

方法

符合条件的患者为有可测量疾病、可接受的器官功能、表现状态≤2 和接受过一种含铂方案的患者。采用两阶段设计,目标样本量分别为 22 和 30 例。同一人群中以前的妇科肿瘤学组研究涉及单药紫杉烷,其 ORR 约为(20%),作为直接比较的历史对照。本研究旨在确定该方案是否具有≥40%的 ORR 和 90%的功效。

结果

共纳入 58 例患者,其中 2 例未接受研究治疗且不可评估。中位数治疗周期为 3 个周期(268 个总周期,范围 1-18)。有 11 例患者(19.6%;90%CI11.4%至 30.4%)有反应,包括 1 例完全缓解。中位无进展生存期和总生存期分别为 3.6 个月和 13.3 个月。中位 ORR 持续时间为 9.2 个月。出现 3 级毒性的患者比例包括:中性粒细胞减少 9%;贫血 5%;代谢异常 5%;恶心 4%;感染 4%;神经病变(主要为神经病变)4%;血管(主要为血栓栓塞)4%。无 4 级毒性反应报告。

结论

该联合方案耐受性良好,但鉴于应答比例,不值得进一步研究[临床试验.gov 标识符:NCT00888615]。

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