Treatment of chemotherapy-induced anemia in patients with ovarian cancer: Does the use of erythropoiesis-stimulating agents worsen survival?

ABSTRACTS / Gynecologic Oncology 120 (2011) S2–S133

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survival for ESA–YES patients (16 months vs 24 months, P < 0.001); however, the two groups had statistically similar overall survival (38 months vs 46 months, P = 0.10). Conclusions: Our data demonstrate a negative impact on survival when using ESAs for chemotherapy-induced anemia. Considering that patients who receive ESAs are more likely to experience recurrence, death and decreased survival, the use of ESAs in patients with ovarian cancer should be restricted. doi:10.1016/j.ygyno.2010.12.034

28 An economic analysis of intravenous carboplatin plus dose-dense weekly paclitaxel versus intravenous carboplatin plus every three-weeks paclitaxel in the upfront treatment of ovarian cancer H. Dalton1, X. Yu2, L. Hu3, B. Monk1, I. Benjamin1, J. Chan3 1 Creighton University School of Medicine at St. Joseph's Hospital and Medical Center, Phoenix, AZ, 2University of Memphis School of Public Health, Memphis, TN, 3UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA

doi:10.1016/j.ygyno.2010.12.033

27 Treatment of chemotherapy-induced anemia in patients with ovarian cancer: Does the use of erythropoiesis-stimulating agents worsen survival? R. Rocconi1, B. Long2, P. Sullivan2, M. Blaize3, J. Brown3, J. Arbuckle3, K. Bevis3, J. Estes3, E. Reed1, M. Finan1 1 University of South Alabama Mitchell Cancer Institute, Mobile, AL, 2 University of South Alabama, Mobile, AL, 3University of Alabama, Birmingham, AL Objective: Emerging data have demonstrated that the use of erythropoiesis-stimulating agents (ESAs) worsens survival in cancer patients. A criticism of these studies is that ESAs are used to achieve "supratherapeutic" hemoglobin levels rather than treat chemotherapy-induced anemia (CIA). Considering the paucity of data specific to ovarian cancer, our objective was to evaluate the effect of ESAs as used for the treatment of CIA on survival in patients with ovarian cancer. A multi-institution retrospective chart review was performed on patients with ovarian cancer. Data collected included patient demographics, surgicopathologic information, chemotherapy treatments, laboratory data, erythropoeisis stimulation data, transfusions, and survival data. Patients who underwent surgery or chemotherapy treatment outside the participating institutions were ineligible. Patients were stratified by ever-use of ESAs and compared using χ2 test, Fisher's exact test, Student's t test, and Kaplan–Meier statistics for analysis. Results: Five hundred eighty-one patients were eligible for analysis; 39% (n = 229) patients had used ESAs at least once (ESA–YES) and 61% (n = 352) had never used ESAs (ESA–NO). Mean age was 60.4, and the majority of patients had stage IIIC (60%) ovarian cancer of papillary serous histology (64%). The majority of patients received optimal cytoreduction (67%) followed by a mean number of 2.4 chemotherapy regimens and median follow-up of 27 months. The ESA–YES and ESA– NO groups were similar with respect to age, body mass index, race, stage, histology and debulking status. Compared with the ESA–NO group, ESA– YES patients were significantly more likely to experience recurrence (56% vs 80%, P < 0.001) and death (46% vs 59%, P = 0.002). Kaplan– Meier curves demonstrated a significant reduction in progression-free

Objective: Recent results from the JGOG showed that dose-dense paclitaxel once a week plus carboplatin every three weeks (ddT) improved progression-free survival (PFS) and overall survival (OS) compared with the standard once every-three-weeks carboplatin plus paclitaxel (q3T) regimen in advanced ovarian cancer. We performed a cost analysis comparing ddT with q3T in the primary treatment of ovarian cancer. Using a Markov decision model, a cost–utility study was performed to compare ddT (80 mg/m2 IV weekly) with q3T (180 mg/m2 IV every three weeks). Cost of drugs, rates of complication and PFS were derived from the published JGOG study (Lancet 2009;374:1331–8). An acceptable incremental cost-effectiveness ratio (ICER) per progression-free life-year saved (LYS) was established. The estimated costs of growth colony-stimulating factors and blood transfusion were also included in the model. Results: Based on Medicare payment for administration of chemotherapy, the estimated cost of ddT is $107 versus $80 per cycle for q3T based on the body weight and surface of an average woman at the age of 63. The estimated total costs of treatment per cycle of combination chemotherapy and administration were $750 for ddT and $483 for q3T. The estimated cost of growth colony-stimulating factors is $1014 for four injections of 300 mg, and that for blood transfusion is $200 for each unit transfused. The median PFS was approximately 28 months with ddT versus 17 months with q3T. This resulted in an ICER of $3940 per LYS for ddT compared with the q3T arm. Using a maximum ICER of $10,000 per LYS as the cost-effective threshold, the ddT arm appears cost-effective. The ICER was sensitive to the median PFS difference between two treatment arms. A four-month difference in PFS resulted in an ICER of $7419 per LYS. The ICER is also sensitive to OS difference, rate of blood transfusion, and hematologic toxicity of treatment. Conclusions: In this economic model, our data suggest that the dosedense paclitaxel regimen is cost-effective. GOG 262 will confirm the efficacy of ddT compared with q3T (with bevacizumab at the discretion of the treating oncologist). doi:10.1016/j.ygyno.2010.12.035

29 Should stage IIIC ovarian cancer be further stratified by intraperitoneal versus retroperitoneal-only disease? A Gynecologic Oncology Group study B. Rungruang1, A. Miller2, S. Richard1, C. Hamilton3, N. Rodriguez4, M. Bookman5, G. Maxwell3, T. Krivak1, N. Horowitz4