Paclitaxel/carboplatin versus single-agent carboplatin in patients with epithelial ovarian cancer and correlation to serum marker VEGF.

Abstract

e15546 Background: The superiority of a platinum and paclitaxel combination regimen over single-agent platinum remains the subject of debate. Overexpression of VEGF by ovarian cancer cells is a major mediator of angiogenesis and serum values may therefore serve as a prognostic tool. The aim of this study is to compare the standard chemotherapy protocol (paclitaxel/carboplatin) to single agent carboplatin as regard the response rate, progression-free survival (PFS) at 2 years; as well as prognostic value of different factors, namely: age, stage, grade, baseline CA-125 and serum VEGF at presentation. Methods: This study is a prospective nonrandomized study including 50 patients with established diagnosis of epithelial ovarian carcinoma attending Clinical Oncology department, Cairo University Hospital in the period from Jan 2006 to Dec 2007. After surgical staging, the patients received either paclitaxel 175 mg/m2 followed by carboplatin AUC 5 (Arm A) or single-agent carboplatin AUC 6 (Arm B) for 6 cycles. Serum sample was collected at baseline and serum VEGF was measured using ELISA technique. Results: At a median follow up period of 16.3 months, the median PFS was 10.8 months. About 60 % of patients showed no disease progression at 2 years. Comparing the two arms, the overall response rate was 88% in arm A versus 82.6% in arm B (p = 0.771). Mean PFS in arm A was 20.51 ± 2.99 compared to 25.14 ± 2.71 in arm B (p = 0.311) with an odds ratio 1.7 (95% CI 0.53-5.60). By analyzing the effect of different factors namely: age, performance status, parity, optimal surgery, stage, grade, baseline CA125, serum VEGF > 100 pg/mL and treatment received using multivariate analysis; it was found that the disease stage as well as optimal surgery showed the most statistically significant relation regarding outcome (p = 0.004 and 0.04 respectively). Neither the baseline CA125, serum VEGF nor treatment arm affected the outcome. Conclusions: Single-agent carboplatin is not inferior to Combination chemotherapy with paclitaxel and carboplatin regarding response rate and PFS at 2 years. Serum vascular endothelial growth factor at baseline seems to have no prognostic value with any correlation to either disease stage or outcome. No significant financial relationships to disclose.