Do more lines of chemotherapy make you live longer? Treatment for ovarian cancer comparing cohorts of patients 1989–90 with 1995–6 in multivariate analysis of survival

Abstract

5062 Background: Recurrent epithelial ovarian cancer (EOC) has come to be considered a chronic cancer frequently treated with multiple lines of chemotherapy. It remains unclear whether response to sequential treatment improves survival or simply reflects the biology of the disease. Methods: We reviewed 154 patients with EOC presenting in 1989–90 (n=72) and 1995–6 (n=82). The prognostic relevance of disease and treatment characteristics were examined in multivariate survival analysis. Results: Median overall survival (OS) was similar in the early (22.9) and late (22.3 months) cohorts (p=0.29). Median progression free survival (PFS) was apparently longer in the later cohort (9.4 (95%CI 7.1–13.1) vs. 14.9 (95%CI 11.8–20.7)) but did not reach statistical significance (p=0.88) Nearly twice as many patients received >3 lines of chemotherapy (22 vs. 12) for recurrent disease in the later cohort. Univariate and multivariate analysis showed that two parameters were associated with a longer survival time: early stage (p=0.013) and the use of paclitaxel (p=0.032). Patients treated with ≥ 3 lines of chemotherapy for recurrent disease lived for >3x as long as those with 2 or less (15.3 (95% CI 11.6–20.5) vs. 50.1 (95% CI 46.1–59.2) months, p=0.0009). Conclusions: Over the study period there has been little improvement in OS and although more treatment was given to patients in the later cohort, the combination of new agents in first line therapy, rather than the serial use of chemotherapy for recurrent disease, appears to have a greater impact on PFS. The dramatic difference in apparently better survival with multiple lines of therapy may reflect favorable tumor biology, more than the effect of treatment. No significant financial relationships to disclose.