Markman M, Reichman B, Hakes T, Rubin S, Lewis J L, Jones W, Barakat R, Curtin J, Almadrones L, Hoskins W
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Gynecol Oncol. 1993 Jul;50(1):100-4. doi: 10.1006/gyno.1993.1171.
To examine the relative efficacy of cisplatin-based intraperitoneal (IP) therapy versus carboplatin-based IP therapy as salvage treatment of small-volume residual ovarian cancer.
We retrospectively examined the surgically defined response rates of patients with ovarian cancer treated at the Memorial Sloan-Kettering Cancer Center on four organoplatinum-based salvage IP trials (cisplatin/etoposide, cisplatin/cytarabine, carboplatin/etoposide, carboplatin/etoposide + recombinant human erythropoietin). Additional criteria for inclusion in this analysis were: (a) small-volume residual disease (microscopic disease only or largest residual tumor mass < or = 0.5 cm) when IP therapy was initiated; (b) prior response to organoplatinum-based systemic therapy; (c) laparotomy evaluation for response to the IP salvage program.
The surgically documented complete response rate for patients with microscopic disease treated with cisplatin-based or carboplatin-based therapy was 46% (6/13) versus 38% (6/16), respectively (P > 0.25). In contrast, the surgically documented overall and complete response rates for patients with small-volume macroscopic disease treated with cisplatin or carboplatin were 71% (12/17) versus 32% (6/19) (P < 0.05, chi 2 test with Yates' correction), and 41% (6/17) versus 11% (2/19) (p < 0.1), respectively.
In agreement with experimental data demonstrating that the concentration of platinum within tumor is higher following equimolar doses of cisplatin, compared to carboplatin, we have observed, in this retrospective analysis, a higher surgically documented response rate for patients with small-volume residual macroscopic ovarian cancer receiving salvage cisplatin-based IP therapy. While a randomized trial will be required to definitively address the question of the relative effectiveness of the two commercially available organoplatinum agents for IP treatment of ovarian cancer, our data suggest that cisplatin is the superior agent for regional therapy in this disease.
探讨以顺铂为基础的腹腔内（IP）治疗与以卡铂为基础的IP治疗作为小体积残留卵巢癌挽救治疗的相对疗效。
我们回顾性分析了纪念斯隆凯特琳癌症中心在四项基于铂类的挽救性IP试验（顺铂/依托泊苷、顺铂/阿糖胞苷、卡铂/依托泊苷、卡铂/依托泊苷+重组人促红细胞生成素）中治疗的卵巢癌患者经手术确定的缓解率。纳入本分析的其他标准为：（a）开始IP治疗时为小体积残留病灶（仅微小病灶或最大残留肿瘤块<或=0.5 cm）；（b）先前对基于铂类的全身治疗有反应；（c）通过剖腹手术评估对IP挽救方案的反应。
接受以顺铂为基础或卡铂为基础治疗的微小病灶患者经手术记录的完全缓解率分别为46%（6/13）和38%（6/16）（P>0.25）。相比之下，接受顺铂或卡铂治疗的小体积肉眼可见病灶患者经手术记录的总体缓解率和完全缓解率分别为71%（12/17）和32%（6/19）（P<0.05，采用Yates校正的卡方检验），以及41%（6/17）和11%（2/19）（P<0.1）。
与实验数据一致，即等摩尔剂量的顺铂后肿瘤内铂浓度高于卡铂，在这项回顾性分析中，我们观察到接受以顺铂为基础的挽救性IP治疗的小体积残留肉眼可见卵巢癌患者经手术记录的缓解率更高。虽然需要进行随机试验来明确解决两种市售铂类药物对卵巢癌IP治疗的相对有效性问题，但我们的数据表明顺铂是该疾病区域治疗的更优药物。
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