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卡铂联合紫杉醇作为初治晚期卵巢癌的一线化疗方案。德国AGO卵巢癌研究组。妇科肿瘤协作组

Carboplatin plus paclitaxel as first-line chemotherapy in previously untreated advanced ovarian cancer. German AGO Study Group Ovarian Cancer. Arbeitsgemeinschaft Gynäkologische Onkologie.

作者信息

du Bois A, Lück H J, Meier W, Möbus V, Costa S, Richter B, Bauknecht T, Warm M, Schroeder W, Olbricht S, Nitz U, Jackisch C

机构信息

Department of Gynecology and Obstetrics, St Vincentius-Krankenhäuser, Karlsruhe, Germany.

出版信息

Semin Oncol. 1997 Aug;24(4 Suppl 11):S11-28-S11-33.

PMID:9314296
Abstract

Since publication of the results of the Gynecologic Oncology Group (GOG) III study, the combination of cisplatin and paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) has been adopted widely as the new standard for treating advanced ovarian cancer. Further attempts to optimize first-line chemotherapy with platinum and taxanes include substituting carboplatin for cisplatin, individualizing the carboplatin dose by calculating it according to the area under the concentration-time curve, and reducing the length of the paclitaxel infusion. Attempts to optimize platinum/paclitaxel combinations have led to the initiation of several small phase I/II trials evaluating the carboplatin/paclitaxel combination. The promising results of these studies have prompted the initiation of three phase III trials comparing carboplatin/paclitaxel with the standard combination of cisplatin/paclitaxel. An interim analysis after 1 year's accrual to the prospectively randomized German Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) study is presented. Treatment consists of paclitaxel 185 mg/m2 infused over 3 hours on day 1 followed directly by either cisplatin 75 mg/m2 (arm B) or carboplatin dosed to an area under the curve of 6 (arm A). Treatment is repeated every 3 weeks for six courses. Eligibility criteria are epithelial ovarian cancer International Federation of Gynecology and Obstetrics stage IIB through IV, age of consent, written informed consent, Eastern Cooperative Oncology Group performance status < or =2, life expectancy of more than 12 weeks, adequate bone marrow function defined as neutrophil count 1.5 x 10(9)/L and platelet count > or =100 x 10(9)/L, adequate renal function defined as glomerular filtration rate (GFR) > or =60 mL/min, and adequate liver function defined as serum bilirubin levels within 1.25 x upper limit of normal. From October 1995 to December 1996, 442 of 660 planned patients were recruited to the AGO study. The interim analysis is based on data from 353 patients who were enrolled within the first study year. These preliminary data indicate that hematologic toxicity occurred more frequently in arm A (carboplatin/paclitaxel), while nonhematologic toxicity occurred slightly more frequently in arm B. Dose-intensity analysis did not reveal cumulative dose reductions or increasing use of colony-stimulating factors over subsequent courses in either arm. In all, 44 patients with measurable disease following surgery completed chemotherapy and were evaluable for response. The data remain blinded at this time, and results are reported for the group as a whole. So far, there have been 18 (41%) complete responses and 15 (34%) partial responses, for an overall response rate of 75%. Retrospective comparison with the GOG results reveals no significant difference in response rates between patients in the cisplatin/paclitaxel arm of GOG III and those in the AGO study: the GOG study reported a 73% response rate, compared with a preliminary 75% response rate in the AGO study, resulting in a relative risk of 1.03 (95% confidence interval, 0.83 to 1.27). Overall, this interim analysis did not reveal any reason to terminate this study early. Accrual is ongoing and is expected to be completed in 1997.

摘要

自妇科肿瘤学组(GOG)III期研究结果公布以来,顺铂与紫杉醇(泰素;百时美施贵宝公司,新泽西州普林斯顿)联合用药已被广泛采用,成为治疗晚期卵巢癌的新标准。进一步优化铂类和紫杉类一线化疗的尝试包括用卡铂替代顺铂、根据浓度 - 时间曲线下面积计算个体化卡铂剂量以及缩短紫杉醇输注时间。优化铂类/紫杉醇联合用药的尝试促使开展了多项小型I/II期试验,评估卡铂/紫杉醇联合用药。这些研究的 promising 结果促使启动了三项III期试验,比较卡铂/紫杉醇与顺铂/紫杉醇标准联合用药。本文介绍了前瞻性随机德国妇科肿瘤协作组(AGO)研究入组1年后的中期分析。治疗方案为第1天静脉输注紫杉醇185mg/m²,持续3小时,随后直接给予顺铂75mg/m²(B组)或卡铂,使曲线下面积达到6(A组)。每3周重复治疗一次,共六个疗程。入选标准为国际妇产科联盟(FIGO)IIB期至IV期上皮性卵巢癌、达到同意年龄、签署书面知情同意书、东部肿瘤协作组(ECOG)体能状态≤2、预期寿命超过12周、骨髓功能良好,定义为中性粒细胞计数≥1.5×10⁹/L且血小板计数≥100×10⁹/L、肾功能良好,定义为肾小球滤过率(GFR)≥60mL/min、肝功能良好,定义为血清胆红素水平在正常上限的1.25倍以内。从1995年10月至1996年12月,AGO研究计划招募660例患者,其中442例入组。中期分析基于在研究第一年入组的353例患者的数据。这些初步数据表明,血液学毒性在A组(卡铂/紫杉醇)中更频繁发生,而非血液学毒性在B组中略更频繁发生。剂量强度分析未显示在后续疗程中两组有累积剂量减少或集落刺激因子使用增加的情况。共有44例术后有可测量病灶的患者完成化疗并可评估疗效。目前数据仍处于盲态,结果报告为整个组的情况。到目前为止,有18例(41%)完全缓解和15例(34%)部分缓解,总缓解率为75%。与GOG结果进行回顾性比较发现,GOG III期研究顺铂/紫杉醇组患者与AGO研究患者的缓解率无显著差异:GOG研究报告的缓解率为73%,而AGO研究初步缓解率为75%,相对危险度为1.03(95%置信区间,0.83至1.27)。总体而言,本次中期分析未发现提前终止该研究的任何理由。入组仍在进行中,预计1997年完成。

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