An Outpatient, Dose-Intense, Intravenous Cisplatin and Oral Etoposide Regimen for the Treatment of Advanced, Platinum-Resistant Ovarian Cancer

• Published in: International journal of gynecological cancer Vol. 28; no. 3; pp. 448 - 452
• Main Authors: Morgan, Robert D, Clamp, Andrew R, Hasan, Jurjees, Mitchell, Claire, Saunders, Geoff, Mescallado, Nerissa, Welch, Richard, Jayson, Gordon C
• Format: Journal Article
• Language: English
• Published: England by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology 01.03.2018; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Ambulatory Care - methods; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Chemotherapy; Cisplatin - administration & dosage; Cisplatin - adverse effects; Confidence intervals; Disease Progression; Drug Resistance, Neoplasm; Etoposide - administration & dosage; Etoposide - adverse effects; Female; Humans; Infusions, Intravenous; Metastasis; Middle Aged; Neoplasm Grading; Ovarian cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - pathology; Retrospective Studies
• ISSN: 1048-891X; 1525-1438
• DOI: 10.1097/IGC.0000000000001194

OBJECTIVESAdvanced-stage, platinum-resistant, ovarian cancer can be treated with dose-intense chemotherapy; one such regimen includes intravenous cisplatin and oral etoposide. To minimize the toxicity associated with weekly cisplatin, pretreatment and posttreatment hydration is required, often necessitating inpatient, overnight admission. We report a shorter, within-day regimen for delivering weekly cisplatin. METHODSThis was a retrospective study to assess the use of standard (inpatient; treatment time of 12 hours) versus modified (outpatient; treatment time of 4 hours) regimens. The primary outcome included all-grade and grade 3/4 adverse events. Secondary outcomes included clinical benefit response and, median progression-free survival and overall survival. RESULTSBetween January 2012 and December 2014, 66 women with metastatic ovarian cancer received dose-intense weekly cisplatin and oral etoposide (n = 45 standard, n = 21 modified). The commonest all-grade adverse events were anemia (96% vs 90%, standard and modified, respectively), fatigue (73% vs 67%), neutropenia (71% vs 76%), hypocalcemia (51% vs 43%), and thrombocytopenia (49% vs 57%). There were no statistically significant differences in the incidence or grades of adverse events. The clinical benefit response was 53% in the standard group and 62% in the modified group (P = 0.9). The median progression-free survival was 4.2 and 6.5 months (incidence rate ratio, 1.22; 95% confidence interval, 0.71–2.15; P = 0.29), and median overall survival was 6.6 and 8.4 months (incidence rate ratio, 1.83; 95% confidence interval, 1.04–3.35; P = 0.03), in favor of the modified regimen. CONCLUSIONSOur shorter, within-day regimen for delivering dose-intense weekly cisplatin and oral etoposide to treat platinum-resistant metastatic ovarian cancer is safe and efficacious.