Carboplatin-paclitaxel Combination Research Articles

Effect of the combination of trastuzumab, paclitaxel and carboplatin in the treatment of uterine serous carcinoma: A systematic review and meta-analysis

Purpose: To systematically review the efficacy of paclitaxel-carboplatin versus trastuzumab in combination with paclitaxel/carboplatin for the treatment of uterine serous carcinoma (USC) with high Her2/neu expression, in order to obtain an evidence-based reference for clinical treatment.Methods: Publications were obtained from China Knowledge Network (CNKI), VIP database (VIP), Wanfang database, PubMed, Embase, Cochrane Library, and Web of Science. The retrieval period was from the establishment of database to May 2022, and the efficacy of paclitaxel-carboplatin combination with trastuzumab (study group) versus paclitaxel-carboplatin (control group) for the treatment of Her2/neu high-expressing USC was collected. Two reviewers independently screened, extracted data, and evaluated the quality of evidence of included studies. RevMan 5.3 statistical software was used for meta-analysis. Outcomes included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and adverse events.Results: Meta-analysis showed that the study group had significantly longer OS than control group (p = 0.004), and PFS of study group was significantly longer than that of control group (p < 0.0001). In terms of ORR, there was no difference between the two groups (p = 0.42). However, in terms of total and high-risk adverse events, the number of patients with adverse events in study group was higher than in control group (p = 0.05), (p = 0.0001).Conclusion: Paclitaxel-carboplatin combination with trastuzumab significantly prolongs OS and PFS in USC patients with high Her2/neu expression, but it may increase the incidence of adverse events.

Factors contributing to carboplatin blockade and interruption in its route of administration in paclitaxel-carboplatin therapy.

The interruption of anticancer infusion processes in patients undergoing chemotherapy may affect their quality of life and the efficacy and safety of the therapy. We experienced several interruptions of carboplatin infusion in multiple patients receiving paclitaxel-carboplatin combination therapy. Therefore, we investigated the causes of these interruptions. The filter and catheter surfaces were evaluated by scanning electron microscopy. Moreover, using a texture analyzer, the mechanical strengths of catheter-attached syringes were compared pre- and post-administration. We observed that the syringe pushing force requirement was higher following dripping failure. However, precipitates were not evident on the filter surfaces, regardless of the dripping failure route. In this case, some of the drug adhered to the catheters' surfaces and interrupted the carboplatin titration. Consequently, in patients receiving combination therapy with paclitaxel and carboplatin, and experiencing interruptions in carboplatin infusion, attention should be paid to the catheter.

Serum vascular endothelial growth factor associated with the progression of granulosa cell tumor: a report of two cases

BackgroundGranulosa cell tumors (GCTs) account for approximately 2% of ovarian malignancies and are considered a rare type of ovarian cancer. GCTs are characterized by irregular genital bleeding after menopause due to female hormone production as well as late recurrence around 5–10 years after initial treatment. In this study, we investigated two cases of GCTs to find a biomarker that can be used to evaluate the treatment and predict recurrence.Case presentationCase 1 was a 56-year-old woman who presented to our hospital with abdominal pain and distention. An abdominal tumor was found, and GCTs were diagnosed. Serum vascular endothelial growth factor (VEGF) levels decreased after surgery. Case 2 involved a 51-year-old woman with refractory GCTs. Carboplatin–paclitaxel combination therapy and bevacizumab were administered after the tumor resection. After chemotherapy, a decline in VEGF levels was observed, but serum VEGF levels increased again with disease progression.ConclusionsVEGF expression may be of clinical importance in GCTs as a clinical biomarker for disease progression, which may be used to determine the efficacy of bevacizumab against GCTs.

Evaluation of adverse drug reactions of chemotherapeutic agents used in advanced non-small cell lung cancer - experience from a rural tertiary care institution in North Eastern India.

Lung cancer is one of the major causes of morbidity and mortality both in developed and developing countries. Adverse drug reactions (ADRs) are inevitable, albeit unwanted aspects of cancer chemotherapeutic agents used in lung cancer. To determine common ADRs and the severity of ADRs of different chemotherapeutic agents used in non-small cell lung cancer (NSCLC) patients. The study was conducted among purposively selected 160 patients who had undergone chemotherapy for lung carcinoma. Clinical records of NSCLC patients were reviewed and data related to the socio-demographic and clinic-therapeutic profiles of patients were collected. ADRs were graded according to the Common toxicity criteria (CTC) grading. Data analysis was done using the IBM-SPSS software and presented using the principle of descriptive statistics. Relationships between ADRs and drug regimens were determined using Chi-square tests considering a 95% confidence interval and P value ≤ 0.05 as significant. Among 160 patients, 78.8% were males and 21.3% were females. The mean age was 59.15 ± 10.6 years, illness duration was 7.5 ± 10.6 months, and treatment duration was 4.4 ± 0.91 months. The overall mortality rate and systemic toxicity of the paclitaxel-carboplatin combination were the lowest. Almost an equal proportion of moderate to severe changes in parameters such as myelosuppression, anemia, thrombocytopenia, alopecia, skin changes, allergic reaction, and peripheral neuropathy, were observed with all chemotherapeutic regimens. Gemcitabine-carboplatin regimen was associated with a higher proportion of altered liver enzymes, electrolyte imbalance, diarrhea, pleural effusion, and renal toxicities. There was a high prevalence of ADRs with different chemotherapeutic agents. Early detection of these ADRs may help in minimizing the damage by either modifying the dose or changing the offending agent.

The “Sandwich” Schedule: A Well-Tolerated Adjuvant Treatment Both in Intermediate–High- and High-Risk Endometrial Cancer

(1) Background: In intermediate-high- and high-risk endometrial cancer (EC), radiotherapy (RT) and chemotherapy (CT) play a basic role. However, there is controversy regarding the optimal timing of their combination. The "sandwich" schedule involves adjuvant CT followed by RT and subsequent CT. The aim of this study is to assess the tolerability and efficacy of the "sandwich" schedule. (2) Methods: A retrospective study was conducted in two gynecological oncology units in Torino, Italy, from 1 January 2003 until 31 December 2021. Intermediate-high- and high-risk patients with available clinical data were included. Compliance with treatment, CT and RT toxicities, disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS) were analyzed. (3) Results: A total of 118 patients were selected: 27.1% FIGO I-II stages and 72.9% III-IV. Most of the patients (75.4%) received a carboplatin-paclitaxel combination, and as much as 94.9% of CT cycles were completed. Chemotherapy-related G3-4 toxicities were detected in 5.3% of the patients, almost half of which were hematological. Grade 2 gastrointestinal and genitourinary toxicities were reported in 8.4% and 4.2% of cases, respectively. With a median follow-up of 46 months, DFS was 77.6%, CSS was 70% and 5-year OS was 54%. (4) Conclusions: The "sandwich" schedule for CT and RT combination is an effective adjuvant treatment with low toxicity both in intermediate-high- and high-risk EC.

Benefits of Conventional Chemotherapy in Progressive Disease Patients with Tyrosine-Kinase Inhibitors: A Case Report

Background. Mutation of the epidermal growth factor receptor (EGFR) in non-small cell lung carcinoma is a favorable predictive factor for targeted EGFR tyrosine kinase inhibitor (TKI) therapy, but patients with EGFR-mutated lung cancer who are given EGFR-TKI will experience disease progression after average 10 to 14 months on average. This study aims to describe a case of progressive lung adenocarcinoma and its chemotherapy treatment.
 Case presentation: A 54 years old woman who came with stage IV left lung adenocarcinoma (exon 21 mutation) who had received EGFR TKI for 17 months progressed, so the treatment was shifted to systemic chemotherapy. Based on these diagnostic results, the patient was diagnosed with progressive disease T3N1M1c left lung adenocarcinoma (pleura, contralateral nodule, ribs, suprarenal) Stage IVb PS ECOG 0. The patient was then treated with conventional doublet-platinum-based chemotherapy with the Carboplatin-Paclitaxel combination.
 Conclusion: Systemic chemotherapy with doublet-platinum is an option in patients with progressive adenocarcinoma with EGFR-TKI who cannot obtain tissue for histopathological examination at rebiopsy or do not have access to advanced molecular biology (e.g., T790M) or follow-up therapy (third-generation TKI, osimertinib).

Natural History of Paclitaxel-associated Acute Pain Syndrome: A Case Report of Rare Side Effect of Paclitaxel

BACKGROUND: One of the harshest side effects following anticancer agent treatments is chemotherapy-induced neuropathic pain. After surgical staging, chemotherapy combination of paclitaxel carboplatin could be a choice of therapy for Stage II or more advanced stage of ovarian cancer. Different side effects may appear after the application of paclitaxel. CASE REPORT: Here, we show an uncommon case of paclitaxel-acute pain syndrome (P-APS), and how we deal with such cases according to our experiences. One uncommon side effect is P-APS, which can be treated effectively with the administration of non-steroidal anti-inflammatory drugs, corticosteroid, and supportive therapy. CONCLUSION: One uncommon side effect of Paclitaxel induced neuropathic can be treated effectively with the administration of non-steroidal anti inflammatory drugs, corticosteroid, and supportive therapy.

Paclitaxel as a possible continuation maintenance therapy in advanced non-small-cell lung cancer

Background: Understanding the molecular basis of lung cancer has led to the development of targeted agents with a significant clinical benefit. This benefit is confined to patients with specific molecular tumor characteristics. However, chemotherapy represents the backbone of treatment in fit patients and is associated with a significant overall survival prolongation and quality of life improvement. Aim: To evaluate the effect of a continuation maintenance therapy with paclitaxel in advanced NSCLC patients with weekly paclitaxel. Patients and Methods: The current study included patients with advanced non-small-cell lung cancer (NSCLC) (stage IIIB or IV) with performance status ≤ 2 who experienced good initial good response, or stable disease after receiving 4 cycles of paclitaxel carboplatin. Patients were randomized into 2 arms, the first arm received weekly paclitaxel (70 mg/m2) as continuation maintenance therapy for 3 weeks of 4 weeks cycle. The treatment was continued until disease progression or unacceptable toxicity (maintenance arm). The second arm was kept under observation (observation arm). Results: There was a better lung cancer symptoms scale in the maintenance arm. Both times to progression and overall survival for the maintenance arm was higher (P value 0.16 and 0.047, respectively). Treatment-related toxicities were significantly higher in the maintenance arm as compared to the observation arm (P value <0.001). Conclusion: Maintenance with paclitaxel can be a reasonable option in patients with NSCLC who experienced a complete or partial response after initial paclitaxel carboplatin combination.

Cost-effectiveness analysis of pembrolizumab compared to standard of care as first line treatment for patients with advanced melanoma in Hong Kong

BackgroundPembrolizumab has been shown to improve overall survival (OS) and progression free survival (PFS) compared to ipilimumab in patients with ipilimumab-naïve advanced melanoma; however, there are no published data on the cost-effectiveness for pembrolizumab compared to standard-of-care treatments currently used in Hong Kong for advanced melanoma.MethodsA partitioned-survival model based on data from a recent randomized phase 3 study (KEYNOTE-006) and meta-analysis was used to derive time in PFS, OS, and post-progression survival for pembrolizumab and chemotherapy, such as dacarbazine (DTIC), temozolomide (TMZ), and the paclitaxel-carboplatin combination (PC). A combination of clinical trial data, published data, results of meta-analysis, and melanoma registry data was used to extrapolate PFS and OS curves. The base-case time horizon for the model was 30 years with costs and health outcomes discounted at a rate of 5% per year. Individual patient level data on utilities and frequencies of adverse events were obtained from the final analysis of KEYNOTE-006 (cut-off date: 3-Dec-15) for pembrolizumab. Cost data included drug acquisition, treatment administration, adverse event management, and clinical management of advanced melanoma. The distribution of patient weight from the Hong Kong population was applied to calculate the drug costs. Analyses were performed from a payer’s perspective. The incremental cost effectiveness ratio (ICER) expressed as cost in US Dollars (USD) per quality-adjusted life years (QALYs) was the main outcome.ResultsIn base-case scenario, the ICER for pembrolizumab as a first-line treatment for advanced melanoma was USD49,232 compared to DTIC, with the ICER values lower than cost-effectiveness threshold in Hong Kong. Results comparing pembrolizumab to TMZ and to PC were similar to that when compared to DTIC. Probability sensitivity analyses showed that 99% of the simulated ICERs were below three times the Gross Domestic Product (GDP) per capita for Hong Kong (currently at $119,274//QALY threshold). In a scenario analysis comparing pembrolizumab with ipilimumab, the estimated ICER was USD8,904.ConclusionsPembrolizumab is cost-effective relative to chemotherapy (DTIC, TMZ and PC), and highly-cost-effective compared to ipilimumab, for the first-line treatment of advanced melanoma in Hong Kong.

A prospective study on treatment of recurrent epithelial ovarian cancer with gemcitabine and pegylated liposomal doxorubicin

Background: Rechallenge of a platinum-based chemotherapy is the most common approach for a recurrent platinumsensitive epithelial carcinoma ovary. However, this carries a substantial risk of cumulative neurotoxicity. Objectives: In the present study, we tried to compare the efficacy and toxicities of gemcitabine pegylated liposomal doxorubicin combination regimen to rechallenge of paclitaxel-carboplatin in this setting. Materials and Methods: A total of 30 patients were included in the study. The patients were randomized into two groups each containing 15 patients. The study group received injection gemcitabine at the dose of 1 g/m2 injection intravenously on day 1 and day 8 and liposomal doxorubicin 30 mg/m2 on day 1 in a 3 weekly cycle up to a total of six cycles in absence of disease progression or unacceptable toxicities. The control group patients were treated with injection paclitaxel at a dose of 175 mg/m2 I/V infusion and injection carboplatin at a dose considering area under the curve 6 in a 3 weekly for six cycles. Results: In the study arm, out of 14 patients, 4 (28.57%) patients had complete response, 6 (42.85%) had partial response, 3 (21.42%) had stable disease, and 1 (7.14%) showed disease progression. In the control arm, 6 (40%) patients out of 15 showed complete response, and 4 (26.66%) partial response. Disease progression was noted in 1 (6.66%) patient. There was less incidence of neurotoxicity compared to the control arm. Conclusion: Chemotherapy with a combination of gemcitabine and pegylated liposomal doxorubicin shows equivalent efficacy in platinum-sensitive recurrent ovarian cancer when compared to rechallenge of platinum-based chemotherapy. The regimen has an acceptable toxicity profile with lesser incidence of neuropathy than rechallenge of paclitaxel-carboplatin combination.

510P - Paclitaxel as continuation maintenance therapy in patients with advanced non-small cell lung cancer

BackgroundMaintenance therapy is one strategy that has been investigated as a way of improving outcomes in patients with non-small cell lung cancer. This study was conducted to evaluate the effect of weekly paclitaxel as a continuation maintenance therapy in advanced NSCLC patients. MethodsThis prospective study included patients with advanced non-small cell lung cancer (NSCLC) patients with stage IIIB (T4 N2 or any T N3 disease) and Stage IV disease (T any N M1) with performance status (P.S) ≤ 2 who presented to Clinical Oncology Department in Menoufia University. All patients received carboplatin – paclitaxel for 4 cycles. the patients with initial good response, or stable disease were randomized into 2 arms, the first arm, received weekly paclitaxel (70 mg/m2) as continuation maintenance therapy for 3 weeks of 4 weeks cycle, and evaluated every 12 weeks, continued till disease progression or unacceptable toxicity (maintenance arm), and the second arm was kept under observation (observation arm). The Primary end-point was time to progression, and the Secondary end-point was toxicity of the drug, and the quality of life of the patients, and overall survival. ResultsTotal 92 patients were included, 46 patients were in the maintenance arm, and 46 patients were in the observation arm. only 14 patients continued maintenance paclitaxel till end of the study (30.4%). Most patients who completed paclitaxel maintenance therapy till the end of follow up period was 0 PS (85.7%), stage IIIB (57.1%), grade II (42.9%), and all of them was adenocarcinoma. Treatment related toxicities were significantly higher in the maintenance arm compared to observation arm p value: (0.017, 0.001 and <0.001) respectively. lung cancer symptoms scale was bettre in maintenance arm. PFS for maintenance arm was 10 months, while 8 months for observation arm (P value =0.16). OS in maintenance arm was 29 months versus 12.5 months for observation arm with significant P value (0.047). Conclusionscontinuation Maintenance with paclitaxel can be a reasonable treatment option in patients with NSCLC with performance status 0, stage IIIB, grade II tumors of adenocarcinoma histology who experienced complete or partial response after initial paclitaxel carboplatin combination. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

A prospective observational study on drug safety monitoring and Pharmacoeconomics in patients with locally advanced unresectable NSCLC in a tertiary care hospital

Background: Lung cancer is the deadliest type of cancer for both men and women. The study was aimed at learning and comparing the toxicities of various chemotherapeutic regimens for the treatment of carcinoma lung, which will help in the implementation of counter measures to avoid development of toxicities, with a constant vigil on the patients during chemotherapeutic cycles. This study also aimed at searching into the added economic burden to the unfortunate patient, who is already suffering from a deadly disease. Study also targeted at evaluating the performance status of the patients receiving the chemotherapy.Methods: The Adverse Drug Reactions (ADR) data was collected from 40 patients receiving chemotherapy for locally advanced unresectable carcinoma lung from the cancer wards of a tertiary care hospital over a period of 2 months. ADRs were graded according to WHO guidelines and their performance statuses were assessed using the Zubrod’s performance scale. Cost analysis of chemotherapeutic regimens was also carried out.Results: On comparison, alopecia and peripheral neuropathy were significantly more common with carboplatin-paclitaxel combination compared to other regimens (p value&lt;0.005). Cost analysis reveals that the most commonly employed carboplatin-paclitaxel combination is more affordable when compared to the newer highly expensive agents but is costlier than cisplatin based chemotherapy. Also, carboplatin-paclitaxel combination offers a reasonably good performance status.Conclusions: Thus, carboplatin-paclitaxel combination is the preferred regimen for palliation in advanced NSCLC, especially in the older patients.

Preoperative Conformal Radiotherapy Concurrently with Paclitaxel/Carboplatin in Gastric Cancer

Background and objectives: Surgery is the primary therapy for localized gastric cancer, but even with the best results only 40% 5-year survival can be achieved with the use of postoperative adjuvant chemoradiotherapy. Preoperative therapy might help increase the R0 resection rate, which is an independent predictor of 5-year OS. Our study hypothesized that the concurrent combination of carboplatin-paclitaxel with radiation therapy would result in a pathological CR rate, which will be in turn associated with OAS and DFS benefits. Patients and methods: prospective phase II study included 32 patients with locally advanced gastric adenocarcinoma including gastroesophageal junction who received a combination of neoadjuvant conformal radiotherapy concurrently with carboplatin-paclitaxel followed by surgery. Results: Pathological CR and R0 resection rates were 18.8% and 75% respectively. With a median follow up of 24 months, 2 years disease-free survival was 28.1% and overall survival was 51.3%. The regimen was tolerated with neither grade 4 toxicities nor deaths. Conclusion: Neoadjuvant radiotherapy concomitant with carboplatin-paclitaxel chemotherapy is a well-tolerated approach for patients with locally advanced gastric adenocarcinoma resulting in significant pathological CR and R0 resection margins as reflected by the good DFS and OS.

THE EFFICACY AND SAFETY OF CARBOPLATIN AND WEEKLY PACLITAXEL COMBINATION THERAPY FOR PREVIOUSLY TREATED SMALL CELL LUNG CANCER PATIENTS WITH INTERSTITIAL LUNG DISEASE

RespirologyVolume 22, Issue S3 p. 75-75 Lung Cancer 3 THE EFFICACY AND SAFETY OF CARBOPLATIN AND WEEKLY PACLITAXEL COMBINATION THERAPY FOR PREVIOUSLY TREATED SMALL CELL LUNG CANCER PATIENTS WITH INTERSTITIAL LUNG DISEASE First published: 23 November 2017 https://doi.org/10.1111/resp.13206_178Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume22, IssueS3Supplement: 22nd Congress of the Asian Pacific Society of Respirology, International Convention Centre, Sydney, Australia, 23–26 November 2017November 2017Pages 75-75 RelatedInformation

Is macrocytosis a potential biomarker of the efficacy of dose-dense paclitaxel-carboplatin combination therapy in patients with epithelial ovarian cancer?

The aims of this study were to investigate a clinical observation that patients with epithelial ovarian cancer treated with first-line platinum-paclitaxel chemotherapy combination (TP) develop macrocytosis and to explore the possible predictive role of macrocytosis in response rate, progression-free survival (PFS), and overall survival. A retrospective analysis of laboratory and clinical data on 184 consecutive ovarian cancer patients treated with first-line TP chemotherapy in a single oncology center from 2004 to 2015 was carried out. Macrocytosis was defined as an increase in mean corpuscular volume of peripheral red blood cells above 97.2 fl during the treatment and/or 30 days after the last chemotherapy cycle. One hundred and forty-one patients were treated with a conventional 3-weekly TP schedule, whereas 43 patients were treated with a dose-dense schedule. Macrocytosis was induced in 35% of patients overall. It was induced significantly more often in patients treated with the dose-dense schedule than in those treated with the 3-weekly schedule (67 vs. 26%, P=1.29×10). Macrocytosis did not correlate with PFS and overall survival in the overall patient population, nor in patients treated with the 3-weekly schedule. It correlated with PFS (hazard ratio=0.42, 95% confidence interval=0.18-0.94, P=0.036) and objective response on therapy in patients treated with the dose-dense schedule (P=0.0285). Dose-dense TP chemotherapy induces macrocytosis significantly more often than does a 3-weekly schedule in ovarian cancer patients. In patients treated with a dose-dense schedule, macrocytosis can potentially be predictive for longer PFS and better response rate. This finding needs further confirmation, preferentially in a prospective study.

Innovations in the treatment of ovarian cancer. Analysis of the therapeutic development: from platinum to immunotherapy.

Ovarian cancer is the seventh most common cancer in women. The therapeutic approach provides for an appropriate integration between surgery and chemotherapy. Surgery is an important step for diagnosis, staging and therapy, aiming at the complete cytoreduction of all macroscopic visible disease. At the moment, adjuvant and first-line chemotherapy has as a standard the carboplatin-paclitaxel combination. Further, the addition of bevacizumab in the advanced stage (IIIB-IV) is strongly recommended. Despite the initial effectiveness, however, 70-80% of patients develop relapsed disease within the first two years and require subsequent treatment lines that have palliative, rather than curative purposes and that seek to reach a chronic state for the disease. Among the causes of recurrences, one of the most studied is related to the stem cells that, due to a quiescent state, are resistant to chemotherapy. The choice of these treatments must consider several factors, including the probability of extending the PFS and OS, the residual toxicity, symptoms control, and the improvement of quality of life, and always remains subject to platinum free interval (PFI). There are not standard therapy. Pegylated liposomal doxorubicin (PLD) as a single agent or in combination with other drugs is one of several treatment modalities that may be considered for relapsed ovaria cancer. In addition, in about 15% to 20% of epithelial tumors, there is a mutation of the BRCA1 and 2 genes. This is fundamental to identify immediately a therapeutic opportunity represented by PARP inhibitors. These drugs, such as olaparib and niraparib, used in maintenance after a previous platinum-response, even partial, have also shown in upfront an activity in BRCA wild type, homologous recombination deficent (HRD) and homologous recombination proficient (HRP). Therefore, after 20 years of chemotherapy alone, new targeted therapies are emerging that will help changing the therapeutic approach, making treatments increasingly personalized.

Postoperative chemotherapy or no further treatment for patients with node-negative stage I-II intermediate or high risk endometrial cancer: The ENGOT-EN2/DGCG trial.

TPS5613 Background: Patients with medium and high-risk stage I and II endometrial cancers (EC) have, despite radical surgery, a high risk for progression. Adjuvant brachytherapy or EBRT is the traditional therapy for many decades although without impacting on survival. Several studies have failed to demonstrate superiority of adjuvant chemotherapy in unselected population with a high number of low-risk patients. It is of utmost importance to demonstrate efficacy of adjuvant combination chemotherapy in a randomized trial comparing to no further treatment in the medium and high-risk node negative stage I and stage II patients. Methods: The primary objective of this trial is to evaluate the effect on overall survival of carboplatin-paclitaxel combination chemotherapy against no further systemic treatment. Key eligibility criteria include: histologically confirmed EC, stage I grade 3 endometrioid adenocarcinoma or stage II endometrioid adenocarcinoma or stage I and II type 2 histology (clear cell, serous, squamous cell carcinoma, carcinosarcoma or undifferentiated carcinoma); prior surgery with pelvic lymphadenectomy or sentinel lymph node biopsy. Patients may receive vaginal brachytherapy in both arms. 240 patients are randomized to receive six courses of adjuvant carboplatin (AUC5) and paclitaxel (175mg/m2) combination on day one every 21 days or no further treatment (1:1 randomization). Primary endpoint is overall survival of endometrioid subgroup. Secondary endpoints include overall survival of whole study population, disease specific survival, progression-free survival, toxicity, compliance, Quality of Life (assessed via EORTC QLQ-C30 and EORTC QLQ-EN24), rate of isolated pelvic or distant relapses, as well as mixed relapses. Trial is enrolling patients. The following cooperative groups are participating: DGCG (DK), NSGO (DK, FIN, SWE), BGOG (BEL), MaNGO (ITA), MITO (ITA), GEICO (SPA), NOGGO (GER), CEEGOG (Czech), ISGO (ISR) &amp; MDACC (USA). Clinical trial information: NCT01244789.

Patient-Derived Xenograft Models of Epithelial Ovarian Cancer for Preclinical Studies.

PurposePatient-derived tumor xenografts (PDXs) can provide more reliable information about tumor biology than cell line models. We developed PDXs for epithelial ovarian cancer (EOC) that have histopathologic and genetic similarities to the primary patient tissues and evaluated their potential for use as a platform for translational EOC research.Materials and MethodsWe successfully established PDXs by subrenal capsule implantation of primary EOC tissues into female BALB/C-nude mice. The rate of successful PDX engraftment was 48.8% (22/45 cases). Hematoxylin and eosin staining and short tandem repeat analysis showed histopathological and genetic similarity between the PDX and primary patient tissues.ResultsPatients whose tumors were successfully engrafted in mice had significantly inferior overall survival when compared with those whose tumors failed to engraft (p=0.040). In preclinical tests of this model, we found that paclitaxel-carboplatin combination chemotherapy significantly deceased tumor weight in PDXs compared with the control treatment (p=0.013). Moreover, erlotinib treatment significantly decreased tumor weight in epidermal growth factor receptor–overexpressing PDX with clear cell histology (p=0.023).ConclusionPDXs for EOC with histopathological and genetic stability can be efficiently developed by subrenal capsule implantation and have the potential to provide a promising platform for future translational research and precision medicine for EOC.

Bilateral ovarian serous cystadenocarcinoma in a teenager: a case report

Epithelial ovarian cancers are uncommon among young girls and teenagers compared to germ cell tumors. We report a case of bilateral ovarian serous cystadenocarcinoma in a teenage girl with the attendant challenges of diagnosis, management and follow up. HT, 19 year old had presented at a secondary care level with features suggestive of benign ovarian tumor and had ovariectomy done. However, histology report revealed a malignant epithelial cancer, necessitating a repeat exploration. She was found to have surgical stage 3c disease and subsequently has total abdominal hysterectomy with bilateral salpingectomies, right oophorectomy and omentectomy. She was further managed with paclitaxelcarboplatin combination chemotherapy but defaulted after the 3rd cycle on account of financial constraints. She succumbed to the disease 11 months post diagnosis. Though uncommon, detailed evaluation of teenage patients for malignant ovarian cancer is expedient. The financial burden of cancer care in our environment is also highlighted. Key words : Adolescent, ovarian epithelial cancer, ovariectomy, serous cystadenocarcinoma

The Serum Level of Vascular Endothelial Growth Factor (VEGF) is Declined after Paclitaxel-Carboplatin Combined Chemotherapy Treatment on Epithelial Ovarian Cancer

Objective: To assess the effect of Paclitaxel-Carboplatin combination on epithelial ovarian cancer by studying the changes in VEGF serum levels after receiving 3 series of chemotherapy.&#x0D; &#x0D; Methods: This was a cohort study conducted at several teaching hospitals in Obstetrics and Gynecology Department of the Faculty of Medicine, Hasanuddin University from April 2011 to March 2012. The subjects were patients with ovarian cancer who met the inclusion criteria and had undergone surgery. The clinical staging was determined with 2009 FIGO criteria. They went through histopathology examination to determine the histological type and cell differentiation of the lesion. They also went through combined chemotherapy of Paclitaxel and Carboplatin. The data were analyzed with paired t-test.&#x0D; &#x0D; Results: The study reveals that out of 30 cases of ovarian cancer who received a combination chemotherapy, most were &lt; 45 years of age (53.33%), nulliparous (46.7%), serosum type (53.3%), with moderate differentiation (36.7%), and in advanced stage (73.3%). The VEGF serum level after 3 series of chemotherapy was lower than before (the average value: 294.67 vs 572.77 ng/ml). There was a significant change in VEGF serum level after receiving chemotherapy (p=0.000). The VEGF serum level of advanced-stage and early stage epithelial ovarian cancer after chemotherapy decreases significantly&#x0D; (p=0.000 and p=0.011). The advanced-stage cases showed more responses to chemotherapy than the early-stage did. There was a tendency that adenocarcinoma serosum type was more responsive&#x0D; to the therapy than mucinosum type (p=0.000 vs 0.003).&#x0D; Conclusion: There is no difference in VEGF serum level based on cell differentiation but there is a tendency that well and moderate differentiated cells have a greater change than the poor differentiated cells (p=0.003, p=0.003 vs p=0.019).&#x0D; [Indones J Obstet Gynecol 2012; 36-3: 135-9]&#x0D; &#x0D; Keywords: carboplatin, epithelial ovarian cancer, paclitaxel, VEGF