Improved outcomes following the use of dose-dense paclitaxel-based neoadjuvant chemotherapy in advanced epithelial ovarian carcinoma

Abstract

Objectives: Prior trials have demonstrated improved survival when dose-dense paclitaxel (DDP) is given in combination with carboplatin every 3 weeks as adjuvant therapy after primary debulking in epithelial ovarian carcinoma (EOC). The use of a DDP-based regimen has not been well studied in the neoadjuvant chemotherapy (NACT) setting. The purpose of this study is to compare outcomes of advanced EOC patients receiving NACT with DDP to those receiving taxane every 3 weeks before interval debulking surgery (IDS). Methods: This was a retrospective review of all patients who received NACT for advanced EOC between June 2012 and July 2015 at our institution. Patient demographics, chemotherapy-related toxicity, and IDS outcomes were compared between the patients who received DDP and those who received taxane. All patients received carboplatin every 3 weeks. The Fisher exact test was used to determine statistical significance. Results: Seventy-five EOC patients were treated with NACT. Of these, 27 (36%) were treated with DDP and 48 (64%) were treated with standard taxane. Patient demographics of the 2 groups were similar. Median number of NACT cycles was similar between the cohorts (2.9 DDP vs 4.1 taxane). Five DDP patients (19%) were unable to complete chemotherapy and were switched to standard taxane. Toxicity, predominantly hematologic and gastrointestinal (GI), was greater in the DDP group. However, there were no episodes of febrile neutropenia in either group, and the percentage of patients requiring blood transfusion was similar—26% DDP vs 15% taxane (P = .24). GI symptoms were manageable. After IDS, 11 patients (41%) in the DDP group had no residual disease compared with 11 patients (23%) in the taxane group (P = .12). Three patients (11%) in the DDP group had a pathologic complete response compared with 1 (2%) in the taxane group (P = .13). Conclusions: Although associated with an increase in toxicity, DDP appears in this preliminary study to facilitate higher rates of no residual disease and pathologic complete response than taxane at the time of IDS. These results warrant further investigation of DDP for patients with advanced EOC undergoing NACT and assessment of its impact on long-term outcomes.Table 1Demographics and Outcomes.