Skip to main content
Top
Published in: Cancer Chemotherapy and Pharmacology 2/2008

01-02-2008 | Original Article

Weekly paclitaxel and carboplatin (PC-W) for patients with primary advanced ovarian cancer: results of a multicenter phase-II study of the NOGGO

Authors: Jalid Sehouli, Dirk Stengel, Alexander Mustea, Oumar Camara, Elke Keil, Dirk Elling, Peter Ledwon, Bernd Christiansen, Peter Klare, Gerhard Gebauer, Marina Schwarz, Werner Lichtenegger, on behalf of the Ovarian Cancer Study Group of the Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie (NOGGO)

Published in: Cancer Chemotherapy and Pharmacology | Issue 2/2008

Login to get access

Abstract

Objectives

To study the toxicity and efficacy of weekly paclitaxel and carboplatin (PC-W) in women with primary ovarian cancer

Methods

This investigation extended a phase-I dose finding study and was approved by the institutional review boards of all participating institutions. Between 1999 and 2003, women with radically resected ovarian cancer of FIGO stages II B to IV were enrolled at 17 German centres. Patients received weekly paclitaxel at a dose of 100 mg/m2, followed by carboplatin AUC 2. After a first treatment block consisting of six cycles of chemotherapy, patients had a treatment-free interval of 14 days, followed by a second block of six cycles. Treatment was completed by a 28-days break and a final block of six cycles.

Results

Altogether, 129 women with a mean age of 59 ± standard deviation 11 years entered the study. Most patients (82.9%) had serous papillary carcinoma of FIGO stage III (72.9%) and IV (20.9%). Participants received 1,851 cycles of chemotherapy; averaging 14.3 ± 4.3 cycles each patient. PC-W produced low rates of peripheral neuropathy (grade 3: 2.3%, 95% confidence interval [CI] 0.5–6.6%), with rapid recovery after 3 months. However, 72 patients had grade III/IV anaemia (55.8%, 95% CI 46.8–64.5%). There were 36 events of grade III/IV leukopenia (27.9%, 95% CI 20.4–36.5%). One patient sustained neutropenic fever. CA-125- and objective response was noted in 73.9% (95% CI 64.7–81.8%) and 55.6% (95% CI 41.4–69.1%) of patients. Median progression free and overall survival was 21 and 43 months, respectively.

Conclusions

PC-W is feasible; a randomized study is warranted to compare this new regimen with conventional 3-weekly treatment.
Literature
1.
go back to reference Bookman MA for the Gynecologic Cancer InterGroup (GCIG) through the Gynecologic Oncology Group (GOG) (2006) GOG0182-ICON5: 5-arm phase III randomized trial of paclitaxel and carboplatin vs combinations with gemcitabine, PEG-lipososomal doxorubicin, or topotecan in patients with advanced-stage epithelial ovarian or primary peritoneal carcinoma (Abstract 5002). J Clin Oncol 24 (Suppl 18):256s Bookman MA for the Gynecologic Cancer InterGroup (GCIG) through the Gynecologic Oncology Group (GOG) (2006) GOG0182-ICON5: 5-arm phase III randomized trial of paclitaxel and carboplatin vs combinations with gemcitabine, PEG-lipososomal doxorubicin, or topotecan in patients with advanced-stage epithelial ovarian or primary peritoneal carcinoma (Abstract 5002). J Clin Oncol 24 (Suppl 18):256s
2.
go back to reference Advanced Ovarian Cancer Trialists Group. Chemotherapy for advanced ovarian cancer (1999) Cochrane Database of Systematic Reviews 1999, Issue 1. Art. No.: CD001418. doi:10.1002/14651858.CD001418 Advanced Ovarian Cancer Trialists Group. Chemotherapy for advanced ovarian cancer (1999) Cochrane Database of Systematic Reviews 1999, Issue 1. Art. No.: CD001418. doi:10.​1002/​14651858.​CD001418
3.
go back to reference Rosenberg P, Andersson H, Boman K, Ridderheim M, Sorbe B, Puistola U, Paro G (2002) Randomized trial of single agent paclitaxel given weekly versus every three weeks and with peroral versus intravenous steroid premedication to patients with ovarian cancer previously treated with platinum. Acta Oncol 41:418–424PubMedCrossRef Rosenberg P, Andersson H, Boman K, Ridderheim M, Sorbe B, Puistola U, Paro G (2002) Randomized trial of single agent paclitaxel given weekly versus every three weeks and with peroral versus intravenous steroid premedication to patients with ovarian cancer previously treated with platinum. Acta Oncol 41:418–424PubMedCrossRef
4.
go back to reference Berek JS, Bertelsen K, du Bois A et al (1999) Advanced epithelial ovarian cancer: 1998 consensus statement. Ann Oncol 10(Suppl 1):87–92PubMedCrossRef Berek JS, Bertelsen K, du Bois A et al (1999) Advanced epithelial ovarian cancer: 1998 consensus statement. Ann Oncol 10(Suppl 1):87–92PubMedCrossRef
7.
go back to reference McGuire WP, Hoskins WJ, Brady MF et al (1996) Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N Engl J Med 334:1–6PubMedCrossRef McGuire WP, Hoskins WJ, Brady MF et al (1996) Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N Engl J Med 334:1–6PubMedCrossRef
8.
go back to reference Piccart MJ, Bertelsen K, James K et al (2000) Randomized intergroup trial of cisplatin-paclitaxel versus cisplatin-cyclophosphamide in women with advanced epithelial ovarian cancer: three-year results. J Natl Cancer Inst 92:699–708PubMedCrossRef Piccart MJ, Bertelsen K, James K et al (2000) Randomized intergroup trial of cisplatin-paclitaxel versus cisplatin-cyclophosphamide in women with advanced epithelial ovarian cancer: three-year results. J Natl Cancer Inst 92:699–708PubMedCrossRef
9.
go back to reference Ozols RF, Bundy BN, Greer BE, Fowler JM, Clarke-Pearson D, Burger RA, Mannel RS, DeGeest K, Hartenbach EM, Baergen R (2003) Phase III trial of carboplatin and paclitaxel compared with cisplatin and pacltitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 21:3194–3200PubMedCrossRef Ozols RF, Bundy BN, Greer BE, Fowler JM, Clarke-Pearson D, Burger RA, Mannel RS, DeGeest K, Hartenbach EM, Baergen R (2003) Phase III trial of carboplatin and paclitaxel compared with cisplatin and pacltitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 21:3194–3200PubMedCrossRef
10.
go back to reference Du Bois A, Lück HJ, Meier W, Adams HP, Mobus V, Costa S, Bauknecht T, Richter B, Warm M, Schröder W, Olbricht S, Nitz U, Jackisch C, Emons G, Wagner U, Kuhn W, Pfisterer J (2003) A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. J Natl Cancer Inst 95:1320–1330PubMed Du Bois A, Lück HJ, Meier W, Adams HP, Mobus V, Costa S, Bauknecht T, Richter B, Warm M, Schröder W, Olbricht S, Nitz U, Jackisch C, Emons G, Wagner U, Kuhn W, Pfisterer J (2003) A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. J Natl Cancer Inst 95:1320–1330PubMed
11.
go back to reference Sugimura M, Sagae S, Ishioka S, Nishioka Y, Tsukada K, Kudo R (2004) Mechanisms of paclitaxel-induced apoptosis in an ovarian cancer cell line and its paclitaxel-resistant clone. Oncology 66:53–61PubMedCrossRef Sugimura M, Sagae S, Ishioka S, Nishioka Y, Tsukada K, Kudo R (2004) Mechanisms of paclitaxel-induced apoptosis in an ovarian cancer cell line and its paclitaxel-resistant clone. Oncology 66:53–61PubMedCrossRef
12.
go back to reference Richardson A, Kaye SB (2005) Drug resistance in ovarian cancer: the emerging importance of gene transcription and spatio-temporal regulation of resistance. Drug Resist Updat 8:311–321PubMedCrossRef Richardson A, Kaye SB (2005) Drug resistance in ovarian cancer: the emerging importance of gene transcription and spatio-temporal regulation of resistance. Drug Resist Updat 8:311–321PubMedCrossRef
13.
go back to reference Lopes NM, Adams EG, Pitts TW, Bhuyan BK (1996) The microtubule-affecting drug paclitaxel has antiangiogenic activity. Clin Cancer Res 2:1843–1849 Lopes NM, Adams EG, Pitts TW, Bhuyan BK (1996) The microtubule-affecting drug paclitaxel has antiangiogenic activity. Clin Cancer Res 2:1843–1849
14.
go back to reference Smith JA, Ngo H, Martin MC, Wolf JK (2005) An evaluation of cytotoxicity of the taxane and platinum agents combination treatment in a panel of human ovarian carcinoma cell lines. Gynecol Oncol 98:141–145PubMedCrossRef Smith JA, Ngo H, Martin MC, Wolf JK (2005) An evaluation of cytotoxicity of the taxane and platinum agents combination treatment in a panel of human ovarian carcinoma cell lines. Gynecol Oncol 98:141–145PubMedCrossRef
15.
go back to reference Lopes NM, Adams EG, Pitts TW, Bhuyan BK (1993) Cell kinetics and cell cycle effects of taxol on human and hamster ovarian cell lines. Cancer Chemother Pharmacol 32:235–242PubMedCrossRef Lopes NM, Adams EG, Pitts TW, Bhuyan BK (1993) Cell kinetics and cell cycle effects of taxol on human and hamster ovarian cell lines. Cancer Chemother Pharmacol 32:235–242PubMedCrossRef
16.
go back to reference Browder T, Butterfield CE, Kraling BM et al (2000) Antiangiogenic scheduling of chemotherapy improves efficacy against experimental drug-resistant cancer. Cancer Res 60:1878–1886PubMed Browder T, Butterfield CE, Kraling BM et al (2000) Antiangiogenic scheduling of chemotherapy improves efficacy against experimental drug-resistant cancer. Cancer Res 60:1878–1886PubMed
17.
go back to reference Pasquier E, Carre M, Pourroy B, Camoin L, Rebai O, Briand C, Braguer D (2004) Antiangiogenic activity of paclitaxel is associated with its cytostatic effect, mediated by the initiation but not completion of a mitochondrial apoptotic signaling pathway. Mol Cancer Ther 3:1301–1310PubMed Pasquier E, Carre M, Pourroy B, Camoin L, Rebai O, Briand C, Braguer D (2004) Antiangiogenic activity of paclitaxel is associated with its cytostatic effect, mediated by the initiation but not completion of a mitochondrial apoptotic signaling pathway. Mol Cancer Ther 3:1301–1310PubMed
18.
go back to reference Liebmann JE, Cook JA, Lipschultz C, Teague D, Fisher J, Mitchell JB (1993) Cytotoxic studies of paclitaxel (taxol) in human tumour cell lines. Br J Cancer 68:1104–1109PubMed Liebmann JE, Cook JA, Lipschultz C, Teague D, Fisher J, Mitchell JB (1993) Cytotoxic studies of paclitaxel (taxol) in human tumour cell lines. Br J Cancer 68:1104–1109PubMed
19.
go back to reference Schiff PB, Horwitz SB (1980) Taxol stabilizes microtubules in mouse fibroblasts. Proc Natl Acad Sci USA 77:1561–1565PubMedCrossRef Schiff PB, Horwitz SB (1980) Taxol stabilizes microtubules in mouse fibroblasts. Proc Natl Acad Sci USA 77:1561–1565PubMedCrossRef
20.
go back to reference Sehouli J, Stengel D, Elling D et al (2002) First-line chemotherapy with weekly paclitaxel and carboplatin for advanced ovarian cancer: a phase I study. Gynecol Oncol 85:321–326PubMedCrossRef Sehouli J, Stengel D, Elling D et al (2002) First-line chemotherapy with weekly paclitaxel and carboplatin for advanced ovarian cancer: a phase I study. Gynecol Oncol 85:321–326PubMedCrossRef
21.
go back to reference Calvert AH, Newell DR, Gumbrell LA et al (1989) Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol 7:1748–1756PubMed Calvert AH, Newell DR, Gumbrell LA et al (1989) Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol 7:1748–1756PubMed
22.
go back to reference Jelliffe RW (1973) Creatinine clearance: bedside estimate. Ann Intern Med 79:604–605PubMed Jelliffe RW (1973) Creatinine clearance: bedside estimate. Ann Intern Med 79:604–605PubMed
23.
go back to reference National Cancer Institute common toxicity criteria (1990) In: Perry MC (eds) The chemotherapy source book. Williams & Wilkins, Baltimore, pp 1133–1140 National Cancer Institute common toxicity criteria (1990) In: Perry MC (eds) The chemotherapy source book. Williams & Wilkins, Baltimore, pp 1133–1140
24.
go back to reference Gronlund B, Hogdall C, Hilden J, Engelholm SA, Hogdall EV, Hansen HH (2004) Should CA-125 response criteria be preferred to response evaluation criteria in solid tumours (RECIST) for prognostication during second-line chemotherapy of ovarian carcinoma? J Clin Oncol 22:4051–4058PubMedCrossRef Gronlund B, Hogdall C, Hilden J, Engelholm SA, Hogdall EV, Hansen HH (2004) Should CA-125 response criteria be preferred to response evaluation criteria in solid tumours (RECIST) for prognostication during second-line chemotherapy of ovarian carcinoma? J Clin Oncol 22:4051–4058PubMedCrossRef
25.
go back to reference Guppy AE, Rustin GJ (2002) CA125 response: can it replace the traditional response criteria in ovarian cancer? Oncologist 7:437–443PubMedCrossRef Guppy AE, Rustin GJ (2002) CA125 response: can it replace the traditional response criteria in ovarian cancer? Oncologist 7:437–443PubMedCrossRef
26.
go back to reference Havrilesky LJ, Alvarez AA, Sayer RA, Lancaster JM, Soper JT, Berchuck A, Clarke-Pearson DL, Rodriguez GC, Carney ME (2003) Weekly low-dose carboplatin and paclitaxel in the treatment of recurrent ovarian and peritoneal cancer. Gynecol Oncol 88:51–57PubMedCrossRef Havrilesky LJ, Alvarez AA, Sayer RA, Lancaster JM, Soper JT, Berchuck A, Clarke-Pearson DL, Rodriguez GC, Carney ME (2003) Weekly low-dose carboplatin and paclitaxel in the treatment of recurrent ovarian and peritoneal cancer. Gynecol Oncol 88:51–57PubMedCrossRef
27.
go back to reference Kaern J, Baekelandt M, Tropé CG (2002) A phase II study of weekly paclitaxel in platinum and paclitaxel-resistant ovarian cancer patients. Eur J Gynaecol Oncol 23:383–389PubMed Kaern J, Baekelandt M, Tropé CG (2002) A phase II study of weekly paclitaxel in platinum and paclitaxel-resistant ovarian cancer patients. Eur J Gynaecol Oncol 23:383–389PubMed
28.
go back to reference Watanabe Y, Nakai H, Ueda H, Nozaki K, Hoshiai H (2005) Evaluation of weekly low-dose paclitaxel and carboplatin treatment for patients with platinum-sensitive relapsed ovarian cancer. Gynecol Oncol 96:323–329PubMedCrossRef Watanabe Y, Nakai H, Ueda H, Nozaki K, Hoshiai H (2005) Evaluation of weekly low-dose paclitaxel and carboplatin treatment for patients with platinum-sensitive relapsed ovarian cancer. Gynecol Oncol 96:323–329PubMedCrossRef
29.
go back to reference Katsumata N, Watanabe T, Mukai H et al (2001) A phase II trial of weekly paclitaxel/carboplatin as salvage chemotherapy in patients with relapsed ovarian cancer (Abstract). Proc Am Soc Clin Oncol 19:865 Katsumata N, Watanabe T, Mukai H et al (2001) A phase II trial of weekly paclitaxel/carboplatin as salvage chemotherapy in patients with relapsed ovarian cancer (Abstract). Proc Am Soc Clin Oncol 19:865
30.
go back to reference Omura GA, Brady MF, Look KY, Averette HE, Delmore JE, Long HJ, Wadler S, Spiegel G, Arbuck SG (2003) Phase III trial of paclitaxel at two dose levels, the higher dose accompanied by filgrastim at two dose levels in platinum-pretreated epithelial ovarian cancer: an intergroup study. J Clin Oncol 21(15):2843–2848PubMedCrossRef Omura GA, Brady MF, Look KY, Averette HE, Delmore JE, Long HJ, Wadler S, Spiegel G, Arbuck SG (2003) Phase III trial of paclitaxel at two dose levels, the higher dose accompanied by filgrastim at two dose levels in platinum-pretreated epithelial ovarian cancer: an intergroup study. J Clin Oncol 21(15):2843–2848PubMedCrossRef
31.
go back to reference Safra T, Bernstein Molho R et al (2006) A. phase-II study evaluating safety and efficacy with weekly paclitaxel and carboplatin as a primary treatment for patients with advanced epithelial ovarian cancer (Abstract). J Clin Oncol 24(Suppl 18):274s Safra T, Bernstein Molho R et al (2006) A. phase-II study evaluating safety and efficacy with weekly paclitaxel and carboplatin as a primary treatment for patients with advanced epithelial ovarian cancer (Abstract). J Clin Oncol 24(Suppl 18):274s
32.
go back to reference Markman M, Kennedy A, Webster K, Kulp B, Peterson G, Belinson J (2001) Neurotoxicity associated with a regimen of carboplatin (AUC 5–6) and paclitaxel (175 mg/m2 over 3 h) employed in the treatment of gynecologic malignancies. J Cancer Res Clin Oncol 127:55–58PubMedCrossRef Markman M, Kennedy A, Webster K, Kulp B, Peterson G, Belinson J (2001) Neurotoxicity associated with a regimen of carboplatin (AUC 5–6) and paclitaxel (175 mg/m2 over 3 h) employed in the treatment of gynecologic malignancies. J Cancer Res Clin Oncol 127:55–58PubMedCrossRef
33.
go back to reference Pignata S, De Placido S, Biamonte R et al (2006) Residual neurotoxicity in ovarian cancer patients in clinical remission after first-line chemotherapy with carboplatin and paclitaxel: the Multicenter Italian Trial in Ovarian cancer (MITO-4) retrospective study. BMC Cancer 6:5PubMedCrossRef Pignata S, De Placido S, Biamonte R et al (2006) Residual neurotoxicity in ovarian cancer patients in clinical remission after first-line chemotherapy with carboplatin and paclitaxel: the Multicenter Italian Trial in Ovarian cancer (MITO-4) retrospective study. BMC Cancer 6:5PubMedCrossRef
34.
go back to reference Jakobsen A, Bertelsen K, Andersen JE, Havsteen H, Jakobsen P, Moeller KA, Nielsen K, Sandberg E, Stroeyer I (1997) Dose effect study of carboplatin in ovarian cancer: a Danish Overian Cancer Group study. J Clin Oncol 15:193–198PubMed Jakobsen A, Bertelsen K, Andersen JE, Havsteen H, Jakobsen P, Moeller KA, Nielsen K, Sandberg E, Stroeyer I (1997) Dose effect study of carboplatin in ovarian cancer: a Danish Overian Cancer Group study. J Clin Oncol 15:193–198PubMed
Metadata
Title
Weekly paclitaxel and carboplatin (PC-W) for patients with primary advanced ovarian cancer: results of a multicenter phase-II study of the NOGGO
Authors
Jalid Sehouli
Dirk Stengel
Alexander Mustea
Oumar Camara
Elke Keil
Dirk Elling
Peter Ledwon
Bernd Christiansen
Peter Klare
Gerhard Gebauer
Marina Schwarz
Werner Lichtenegger
on behalf of the Ovarian Cancer Study Group of the Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie (NOGGO)
Publication date
01-02-2008
Publisher
Springer-Verlag
Published in
Cancer Chemotherapy and Pharmacology / Issue 2/2008
Print ISSN: 0344-5704
Electronic ISSN: 1432-0843
DOI
https://doi.org/10.1007/s00280-007-0466-z

Other articles of this Issue 2/2008

Cancer Chemotherapy and Pharmacology 2/2008 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine