Treatment of primary advanced and recurrent endometrial carcinoma with a combination of carboplatin and paclitaxel

Abstract

5110 Background: Primary advanced endometrial carcinomas constitute approximately 10% of all diagnosed cases. Of all treated tumors 15–20% will recur, mainly within 3 years, with locoregional or distant metastases. Chemotherapy is a treatment option for these cases. A platinum and an anthracycline have been a standard regimen at many centers. A response rate of 40–50% and short survival time are frequently reported. To improve the results a combination of carboplatin and paclitaxel was used in a consecutive series of endometrial carcinomas. Methods: A non-randomized, prospective, phase II trial was conducted at 5 Swedish departments for gynecological oncology during the period 2000–2003. Sixty-six consecutive primary advanced (n = 18) or recurrent (n = 48) carcinomas were treated with a combination of carboplatin (AUC = 5) and paclitaxel (175 mg/m2, 3h infusion) given every 3 weeks for at least 6 courses. A combination of CT scans, chest X-rays, ultrasound and clinical examinations were used during the follow-up. No patients were lost to follow-up. Results: In the complete series 19 complete responses (29%) and 25 partial responses (38%) were recorded. The overall response rate was 67% (95% CI: 55–78%). For the primary advanced carcinomas the response rate was 83% and for the recurrent tumors 60%. For primary advanced endometrioid carcinomas the overall response rate was 86% (95% CI: 67–100%). The overall 2 year survival rate was 57% (95% CI: 44–69%) and the 3 year survival rate 29% (95% CI: 17–42%) in the complete series. The median overall survival time was 26.4 months. Grades 2–3 neutropenia was recorded in 12% after 6 courses. Thrombocytopenia was infrequent and only grade 1 reactions occurred. Neurosensory symptoms were more frequent (grade 1: 42%, grade 2: 26% and grade 3: 8%) and the most serious toxicity recorded. Grades 2–3 motor neurotoxicity occurred in 7 out of 53 evaluable patients (13%). Conclusions: The carboplatin-paclitaxel combination seems to be more effective than prior used regimes in treatment of primary advanced endometrial carcinoma. However, the majority of the patients were not cured from their disease and the neurotoxicity was a significant problem in this series of patients. No significant financial relationships to disclose.