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Should neoadjuvant chemotherapy be preferred to an alternative treatment for advanced ovarian cancer: Comparison of neoadjuvant chemotherapy followed by interval debulking surgery and primary debulking surgery in patients with advanced ovarian cancer
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Abstracts / Gynecologic Oncology 137 (2015) 92–179
However, its increased toxicity profile limits uptake, especially in geriatric patients. We evaluated patterns of use and outcomes in elderly women with advanced ovarian cancer treated with IP/IV chemotherapy. Methods: A cohort of patients at least 66 years old with stage III/IV epithelial ovarian cancer diagnosed between 2002 and 2009 was identified in the Surveillance, Epidemiology, and End Results (SEER)Medicare database. All patients received surgery plus combination taxane/platinum chemotherapy. Demographic and clinical factors, including age, stage, histology, grade, year of diagnosis, tumor size, and comorbidity score as well as five additional SEER demographic variables were used to compute the propensity score of the probability for each patient to receive IP/IV chemotherapy using a multiple logistic regression model. Based on the propensity score, a 4:1 match of IV to IP/ IV patients was included in the analysis. Kaplan–Meier analysis was performed to compare the overall survival rates between the IP/IV and IV groups in the matched sample. Cox proportional hazards model was used to determine risk factors for survival. Results: A total of 3651 women with advanced ovarian cancer met the inclusion criteria, including 3527 women treated with IV chemotherapy (96.7%) and 124 (3.3%) women treated with IP/IV. The median age in the IP/IV group was 71 years (range, 66–83 years), whereas the median age was 73 years (range, 66–97 years) in the IV group. Women treated with IP/IV chemotherapy had a decreased risk of death (HR = 0.59, 95% CI 0.44–0.79). The median survival in the matched IP/IV group was 50.5 months compared to 38.2 months in the IV only group (P = 0.006). We did not observe a higher percentage of women using acute care services (emergency department visits, intensive care unit/ hospital admissions) in the IP/IV group than in the IV group. Conclusions: IP chemotherapy may be given to a carefully selected group of elderly patients with ovarian cancer without resulting in an increase in acute care services. A significant survival advantage with IP/ IV chemotherapy over IV chemotherapy may be maintained in a geriatric patient population, although residual confounders may exist.
438 — Poster session Should neoadjuvant chemotherapy be preferred to an alternative treatment for advanced ovarian cancer: Comparison of neoadjuvant chemotherapy followed by interval debulking surgery and primary debulking surgery in patients with advanced ovarian cancer J. Liu. Cancer Center, Sun Yat-Sen University, Guangzhou, China Objectives: The aim of the present study was to evaluate the role of neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) in comparison with primary debulking surgery (PDS) in the treatment of patients with advanced ovarian cancer. Methods: All patients with stages III–IV epithelial ovarian cancer who underwent debulking surgery at our institution between 1994 and 2010 were included. Demographic and clinicopathologic treatment and survival outcome data were collected and analyzed. Results: Among the 391 eligible patients, 176 (45%) underwent NACT-IDS and 215 (55%) had PDS. The majority of patients (81.3%) had stage III diseases. No difference in the distribution of disease stage was observed in the two groups. Mean CA-125 levels at diagnosis were higher in the NACT-IDS group (P b 0.001). A similar proportion of patients presented with CA-125 normalization at completion of the third cycle of postoperative chemotherapy in the two groups. Compared with PDS, NACT-IDS was associated with less intraoperative blood loss (387 mL vs. 557 mL, P b 0.001) and a lower rate of blood transfusion (44.0% vs. 54.2%, P = 0.052). There was no significant difference between NACT-IDS and PDS groups in operation time and postoperative complications. Patients who received NACT-IDS were more likely to have residual disease ≤1 cm than those with PDS (70.5% vs. 56.5%, P = 0.005). No difference in the median overall survival was found between patients treated with NACT-IDS (48.0 months) and patients treated with PDS (51.0 months, P = 0.228). In multivariate analyses, residual disease ≤1 cm (HR = 0.697, P = 0.031) and CA-125 normalization at the completion of the third cycle of postoperative chemotherapy (HR = 0.663, P b 0.001) were confirmed to be independent predictors for improved overall survival. Conclusions: Patients with advanced ovarian cancer undergoing NACTIDS had similar outcomes when compared to those treated with PDS, which implied that NACT-IDS might be superior to PDS because the patients in the NACT-IDS group may have more serious diseases. Moreover, the NACT-IDS group had a greater chance of achieving optimal cytoreduction. Our results are extremely consistent with previous randomized studies. NACT-IDS should be considered as an alternative treatment for advanced ovarian cancer. doi:10.1016/j.ygyno.2015.01.441
439 — Poster session Survival and toxicity of a modified GOG 172 IP chemotherapy regimen in patients with ovarian, fallopian tube or primary peritoneal carcinoma D. Becker, C.L. Walters Haygood, B. Smith, K.S. Bevis. University of Alabama at Birmingham, Birmingham, AL, USA
doi:10.1016/j.ygyno.2015.01.440
Objectives: Despite advantages in survival outcomes, adjuvant intraperitoneal (IP) chemotherapy in the treatment of advancedstage epithelial ovarian, fallopian tube, or primary peritoneal carcinoma carries significant toxicity. We report our experiences using a modified Gynecologic Oncology Group 172 regimen consisting of intravenous (IV) docetaxel + IP cisplatin and paclitaxel with growth colony-stimulating factor (GCSF) support. Methods: We conducted a retrospective review from 6/2006 to 4/2014 evaluating patients treated with a modified outpatient IP chemotherapy regimen consisting of docetaxel 75 mg/m2 IV + cisplatin 75 mg/m2 IP
Abstracts / Gynecologic Oncology 137 (2015) 92–179
However, its increased toxicity profile limits uptake, especially in geriatric patients. We evaluated patterns of use and outcomes in elderly women with advanced ovarian cancer treated with IP/IV chemotherapy. Methods: A cohort of patients at least 66 years old with stage III/IV epithelial ovarian cancer diagnosed between 2002 and 2009 was identified in the Surveillance, Epidemiology, and End Results (SEER)Medicare database. All patients received surgery plus combination taxane/platinum chemotherapy. Demographic and clinical factors, including age, stage, histology, grade, year of diagnosis, tumor size, and comorbidity score as well as five additional SEER demographic variables were used to compute the propensity score of the probability for each patient to receive IP/IV chemotherapy using a multiple logistic regression model. Based on the propensity score, a 4:1 match of IV to IP/ IV patients was included in the analysis. Kaplan–Meier analysis was performed to compare the overall survival rates between the IP/IV and IV groups in the matched sample. Cox proportional hazards model was used to determine risk factors for survival. Results: A total of 3651 women with advanced ovarian cancer met the inclusion criteria, including 3527 women treated with IV chemotherapy (96.7%) and 124 (3.3%) women treated with IP/IV. The median age in the IP/IV group was 71 years (range, 66–83 years), whereas the median age was 73 years (range, 66–97 years) in the IV group. Women treated with IP/IV chemotherapy had a decreased risk of death (HR = 0.59, 95% CI 0.44–0.79). The median survival in the matched IP/IV group was 50.5 months compared to 38.2 months in the IV only group (P = 0.006). We did not observe a higher percentage of women using acute care services (emergency department visits, intensive care unit/ hospital admissions) in the IP/IV group than in the IV group. Conclusions: IP chemotherapy may be given to a carefully selected group of elderly patients with ovarian cancer without resulting in an increase in acute care services. A significant survival advantage with IP/ IV chemotherapy over IV chemotherapy may be maintained in a geriatric patient population, although residual confounders may exist.
438 — Poster session Should neoadjuvant chemotherapy be preferred to an alternative treatment for advanced ovarian cancer: Comparison of neoadjuvant chemotherapy followed by interval debulking surgery and primary debulking surgery in patients with advanced ovarian cancer J. Liu. Cancer Center, Sun Yat-Sen University, Guangzhou, China Objectives: The aim of the present study was to evaluate the role of neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) in comparison with primary debulking surgery (PDS) in the treatment of patients with advanced ovarian cancer. Methods: All patients with stages III–IV epithelial ovarian cancer who underwent debulking surgery at our institution between 1994 and 2010 were included. Demographic and clinicopathologic treatment and survival outcome data were collected and analyzed. Results: Among the 391 eligible patients, 176 (45%) underwent NACT-IDS and 215 (55%) had PDS. The majority of patients (81.3%) had stage III diseases. No difference in the distribution of disease stage was observed in the two groups. Mean CA-125 levels at diagnosis were higher in the NACT-IDS group (P b 0.001). A similar proportion of patients presented with CA-125 normalization at completion of the third cycle of postoperative chemotherapy in the two groups. Compared with PDS, NACT-IDS was associated with less intraoperative blood loss (387 mL vs. 557 mL, P b 0.001) and a lower rate of blood transfusion (44.0% vs. 54.2%, P = 0.052). There was no significant difference between NACT-IDS and PDS groups in operation time and postoperative complications. Patients who received NACT-IDS were more likely to have residual disease ≤1 cm than those with PDS (70.5% vs. 56.5%, P = 0.005). No difference in the median overall survival was found between patients treated with NACT-IDS (48.0 months) and patients treated with PDS (51.0 months, P = 0.228). In multivariate analyses, residual disease ≤1 cm (HR = 0.697, P = 0.031) and CA-125 normalization at the completion of the third cycle of postoperative chemotherapy (HR = 0.663, P b 0.001) were confirmed to be independent predictors for improved overall survival. Conclusions: Patients with advanced ovarian cancer undergoing NACTIDS had similar outcomes when compared to those treated with PDS, which implied that NACT-IDS might be superior to PDS because the patients in the NACT-IDS group may have more serious diseases. Moreover, the NACT-IDS group had a greater chance of achieving optimal cytoreduction. Our results are extremely consistent with previous randomized studies. NACT-IDS should be considered as an alternative treatment for advanced ovarian cancer. doi:10.1016/j.ygyno.2015.01.441
439 — Poster session Survival and toxicity of a modified GOG 172 IP chemotherapy regimen in patients with ovarian, fallopian tube or primary peritoneal carcinoma D. Becker, C.L. Walters Haygood, B. Smith, K.S. Bevis. University of Alabama at Birmingham, Birmingham, AL, USA
doi:10.1016/j.ygyno.2015.01.440
Objectives: Despite advantages in survival outcomes, adjuvant intraperitoneal (IP) chemotherapy in the treatment of advancedstage epithelial ovarian, fallopian tube, or primary peritoneal carcinoma carries significant toxicity. We report our experiences using a modified Gynecologic Oncology Group 172 regimen consisting of intravenous (IV) docetaxel + IP cisplatin and paclitaxel with growth colony-stimulating factor (GCSF) support. Methods: We conducted a retrospective review from 6/2006 to 4/2014 evaluating patients treated with a modified outpatient IP chemotherapy regimen consisting of docetaxel 75 mg/m2 IV + cisplatin 75 mg/m2 IP