Retrospective Evaluation Of Weekly Docetaxel In Recurrent Ovarian Cancer: A Single Center Experience

摘要

Background: The efficacy of weekly taxanes in the treatment of recurrent ovarian cancer is not widely known. We sought to investigate retrospectively the feasibility and efficacy of weekly docetaxel in this setting.Patients and Methods: In our database, we found a total of 8 patients with recurrent ovarian cancer (7 patients with platinum refractory disease, and 1 platinum sensitive patient who could not be re-challenged with platinum) that were treated with weekly administrations of Docetaxel, 36 mg/m2/week, 6 out of 8 weeks (1 cycle).Results: A median of 8 weeks of docetaxel was administered. Partial response was seen in the only platinum sensitive patient, and disease stabilization was encountered in 3 platinum refractory patients. No grade 3 or 4 hematological or non-hematological toxicity was apparent. Median progression free survival was 74 days.Conclusions: Weekly docetaxel in this patient cohort is a non toxic treatment, but with limited evidence of activity. Introduction Recurrent ovarian cancer has poor prognosis with a median survival of 14 months (1). However, chemotherapy with various agents in this setting have been shown to induce tumor regression with no proven superiority of any agent or combination over the others in terms of prolonging survival, except a marginal survival difference demonstrated by intravenous over oral topotecan in the randomized trial by Gore et al (2). Unfortunately, patients with platinum refractory disease appear to derive less benefit from salvage chemotherapy when compared to patients with platinum sensitive disease (3).Taxanes are among the chemotherapeutics used in the treatment of both chemonaive and recurrent ovarian cancer (4,5,6). However, weekly administration of taxanes is a relatively new approach and has not been fully tested in recurrent ovarian cancer. Indeed, so far, there is only one small phase 2 study of weekly docetaxel administration in recurrent ovarian cancer which only showed a modest activity with a response rate of 6.9% at the absence of severe side effects (7). As, it has been known for some time that weekly administration of taxanes may indeed have less toxicity (8,9), with some activity, we decided to collect retrospectively our experience of weekly docetaxel in recurrent ovarian cancer, to see the activity and toxicity of this regimen in our patients treated at the Akdeniz University Hospital. Patients And Methods PatientsIn our oncology database and among the recurrent ovarian cancer patients treated at the clinics of obstetrics and gynaecology, and medical oncology departments of Akdeniz University Medical Faculty, we searched for cases that were treated with weekly docetaxel. At least one type of chemotherapy regimen before recruitment into the study, in the setting of platinum refractory (progression free survival (PFS) < 6 months), or platinum sensitive disease was required. Eastern Cooperative Oncology Group performance status (ECOG) and the status of previous pelvic radiotherapy and prior docetaxel exposure were noted.MethodsTumor response as evaluated by Computerized Tomography scanning and according to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria was noted (10). CA-125 evaluations were also recorded, but not included in the assessment of response because of the absence of complete CA-125 data for the majority of cases.Treatment schedule used in the treatment of our cases of recurrent ovarian cancer was docetaxel 36 mg/m2/week, 6 weekly administrations followed by a 2 weeks' rest period. This schedule was previously described in metastatic breast cancer (8). Also, in a recent study, a recommended dose level of 40 mg/m2/week was put forward, which is very close to the dose level used in this study (11). For the hypersensitivity prophylaxis, methylprednisolone 40 mg. was given orally, 3 times over 2 days, every week of chemotherapy administration (the evening before the day of treatment, the following morning and evening). 5-HT3 a