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Pautier P, Motte-Rouge TDL, Lécuru F, Classe JM, Ferron G, Floquet A, Kurtz JE, Freyer G, Hardy-Bessard AC. Prise en charge médicale de la récidive du cancer épithélial de l'ovaire: Medical management of recurrent epithelial ovarian cancer. Bull Cancer 2021; 108:S22-S32. [PMID: 34955159 DOI: 10.1016/s0007-4551(21)00584-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The panel of therapeutic options available for medical treatment of relapsed ovarian cancer increased over the last years. In late, platinum-sensitive relapse, standard treatment remains platinum-based polychemotherapy. The choice between bevacizumab added to chemotherapy followed by maintenance and inhibitors of poly-(ADP-riboses) polymerases (PARPi) after response to platinum-based therapy should be discussed, taking into account prior treatment, contraindications, and disease characteristics (biology, symptoms…). The addition of bevacizumab at first platinum-sensitive relapse can be considered if it has not been administered in first line, and it is optional (rechallenge) if previously administered (but without Marketing Authorization in this setting). PARPi are indicated for maintenance therapy after response to platinum-based chemotherapy (whatever the treatment line), regardless of BRCA mutational status, in case of no prior administration. Early relapses are associated with poor prognosis and therapeutic options are more limited. They are treated by monochemotherapy without platinum agents, associated with bevacizumab if not administered previously. Beyond first early relapse, there is no standard and inclusion in a clinical trial should be proposed if possible. Several clinical studies assessing associations of immunotherapy and chemotherapy and/or antiangiogenic drugs and/or targeted therapies (such as PARPi) are ongoing in early or late relapse.
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Affiliation(s)
- Patricia Pautier
- Département d'oncologie médicale, institut Gustave-Roussy, Villejuif, France.
| | | | - Fabrice Lécuru
- Service de chirurgie sénologique, gynécologique et reconstructrice, institut Curie, 26 rue d'Ulm, Paris, France ; Faculté de médecine, Université de Paris, Paris, France
| | - Jean-Marc Classe
- Service de chirurgie oncologique, institut de cancérologie de l'Ouest, France ; Faculté de médecine, université de Nantes, Nantes, France
| | - Gwenaël Ferron
- Département de chirurgie oncologique, institut Claudius-Regaud - IUCT Toulouse, France ; INSERM CRCT 19 (Oncogenèse des sarcomes), centre de recherches en cancérologie de Toulouse, 2, avenue Hubert-Curien, Toulouse, France
| | - Anne Floquet
- Département d'oncologie médicale, Institut Bergonié, 229 cours Agonne, Bordeaux, France
| | - J E Kurtz
- Pôle d'oncologie médico-chirurgicale et d'hématologie, ICANS-Europe, Strasbourg, France
| | - Gilles Freyer
- Service d'oncologie médicale, institut de cancérologie des HCL ; Université Lyon 1, Lyon, France
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Berek JS, Renz M, Kehoe S, Kumar L, Friedlander M. Cancer of the ovary, fallopian tube, and peritoneum: 2021 update. Int J Gynaecol Obstet 2021; 155 Suppl 1:61-85. [PMID: 34669199 PMCID: PMC9298325 DOI: 10.1002/ijgo.13878] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In 2014, FIGO's Committee for Gynecologic Oncology revised the staging of ovarian cancer, incorporating ovarian, fallopian tube, and peritoneal cancer into the same system. Most of these malignancies are high-grade serous carcinomas (HGSC). Stage IC is now divided into three categories: IC1 (surgical spill); IC2 (capsule ruptured before surgery or tumor on ovarian or fallopian tube surface); and IC3 (malignant cells in the ascites or peritoneal washings). The updated staging includes a revision of Stage IIIC based on spread to the retroperitoneal lymph nodes alone without intraperitoneal dissemination. This category is now subdivided into IIIA1(i) (metastasis ≤10 mm in greatest dimension), and IIIA1(ii) (metastasis >10 mm in greatest dimension). Stage IIIA2 is now "microscopic extrapelvic peritoneal involvement with or without positive retroperitoneal lymph node" metastasis. This review summarizes the genetics, surgical management, chemotherapy, and targeted therapies for epithelial cancers, and the treatment of ovarian germ cell and stromal malignancies.
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Affiliation(s)
- Jonathan S. Berek
- Stanford Women’s Cancer CenterStanford Cancer InstituteStanford University School of MedicineStanfordCaliforniaUSA
| | - Malte Renz
- Stanford Women’s Cancer CenterStanford Cancer InstituteStanford University School of MedicineStanfordCaliforniaUSA
| | - Sean Kehoe
- Oxford Gynecological Cancer CenterChurchill HospitalOxfordUK
- St Peter’s CollegeOxfordUK
| | - Lalit Kumar
- Department of Medical OncologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Michael Friedlander
- Royal Hospital for WomenSydneyAustralia
- Prince of Wales Clinical SchoolUniversity of New South WalesSydneyAustralia
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Bi J, Newtson AM, Zhang Y, Devor EJ, Samuelson MI, Thiel KW, Leslie KK. Successful Patient-Derived Organoid Culture of Gynecologic Cancers for Disease Modeling and Drug Sensitivity Testing. Cancers (Basel) 2021; 13:cancers13122901. [PMID: 34200645 PMCID: PMC8229222 DOI: 10.3390/cancers13122901] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/26/2021] [Accepted: 06/06/2021] [Indexed: 12/12/2022] Open
Abstract
Developing reliable experimental models that can predict clinical response before treating the patient is a high priority in gynecologic cancer research, especially in advanced or recurrent endometrial and ovarian cancers. Patient-derived organoids (PDOs) represent such an opportunity. Herein, we describe our successful creation of 43 tumor organoid cultures and nine adjacent normal tissue organoid cultures derived from patients with endometrial or ovarian cancer. From an initial set of 45 tumor tissues and seven ascites fluid samples harvested at surgery, 83% grew as organoids. Drug sensitivity testing and organoid cell viability assays were performed in 19 PDOs, a process that was accomplished within seven days of obtaining the initial surgical tumor sample. Sufficient numbers of cells were obtained to facilitate testing of the most commonly used agents for ovarian and endometrial cancer. The models reflected a range of sensitivity to platinum-containing chemotherapy as well as other relevant agents. One PDO from a patient treated prior to surgery with neoadjuvant trastuzumab successfully predicted the patient's postoperative chemotherapy and trastuzumab resistance. In addition, the PDO drug sensitivity assay identified alternative treatment options that are currently used in the second-line setting. Our findings suggest that PDOs could be used as a preclinical platform for personalized cancer therapy for gynecologic cancer patients.
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Affiliation(s)
- Jianling Bi
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, USA; (J.B.); (A.M.N.); (Y.Z.); (E.J.D.); (K.W.T.)
| | - Andreea M. Newtson
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, USA; (J.B.); (A.M.N.); (Y.Z.); (E.J.D.); (K.W.T.)
| | - Yuping Zhang
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, USA; (J.B.); (A.M.N.); (Y.Z.); (E.J.D.); (K.W.T.)
| | - Eric J. Devor
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, USA; (J.B.); (A.M.N.); (Y.Z.); (E.J.D.); (K.W.T.)
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
| | | | - Kristina W. Thiel
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, USA; (J.B.); (A.M.N.); (Y.Z.); (E.J.D.); (K.W.T.)
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
| | - Kimberly K. Leslie
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, USA; (J.B.); (A.M.N.); (Y.Z.); (E.J.D.); (K.W.T.)
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
- Correspondence:
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Ruan JL, Browning RJ, Yildiz YO, Bau L, Kamila S, Gray MD, Folkes L, Hampson A, McHale AP, Callan JF, Vojnovic B, Kiltie AE, Stride E. Evaluation of Loading Strategies to Improve Tumor Uptake of Gemcitabine in a Murine Orthotopic Bladder Cancer Model Using Ultrasound and Microbubbles. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1596-1615. [PMID: 33707089 DOI: 10.1016/j.ultrasmedbio.2021.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
In this study we compared three different microbubble-based approaches to the delivery of a widely used chemotherapy drug, gemcitabine: (i) co-administration of gemcitabine and microbubbles (Gem+MB); (ii) conjugates of microbubbles and gemcitabine-loaded liposomes (GemlipoMB); and (iii) microbubbles with gemcitabine directly bound to their surfaces (GembioMB). Both in vitro and in vivo investigations were carried out, respectively, in the RT112 bladder cancer cell line and in a murine orthotopic muscle-invasive bladder cancer model. The in vitro (in vivo) ultrasound exposure conditions were a 1 (1.1) MHz centre frequency, 0.07 (1.0) MPa peak negative pressure, 3000 (20,000) cycles and 100 (0.5) Hz pulse repetition frequency. Ultrasound exposure produced no significant increase in drug uptake either in vitro or in vivo compared with the drug-only control for co-administered gemcitabine and microbubbles. In vivo, GemlipoMB prolonged the plasma circulation time of gemcitabine, but only GembioMB produced a statistically significant increase in cleaved caspase 3 expression in the tumor, indicative of gemcitabine-induced apoptosis.
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Affiliation(s)
- Jia-Ling Ruan
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Richard J Browning
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Yesna O Yildiz
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Luca Bau
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Sukanta Kamila
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, United Kingdom
| | - Michael D Gray
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Lisa Folkes
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Alix Hampson
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Anthony P McHale
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, United Kingdom
| | - John F Callan
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, United Kingdom
| | - Borivoj Vojnovic
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Anne E Kiltie
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Eleanor Stride
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom.
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Berek JS, Kehoe ST, Kumar L, Friedlander M. Cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet 2018; 143 Suppl 2:59-78. [PMID: 30306591 DOI: 10.1002/ijgo.12614] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Gynecologic Oncology Committee of FIGO in 2014 revised the staging of ovarian cancer, incorporating ovarian, fallopian tube, and peritoneal cancer into the same system. Most of these malignancies are high-grade serous carcinomas (HGSC). Stage IC is now divided into three categories: IC1 (surgical spill); IC2 (capsule ruptured before surgery or tumor on ovarian or fallopian tube surface); and IC3 (malignant cells in the ascites or peritoneal washings). The updated staging includes a revision of Stage IIIC based on spread to the retroperitoneal lymph nodes alone without intraperitoneal dissemination. This category is now subdivided into IIIA1(i) (metastasis ≤10 mm in greatest dimension), and IIIA1(ii) (metastasis >10 mm in greatest dimension). Stage IIIA2 is now "microscopic extrapelvic peritoneal involvement with or without positive retroperitoneal lymph node" metastasis. This review summarizes the genetics, surgical management, chemotherapy, and targeted therapies for epithelial cancers, and the treatment of ovarian germ cell and stromal malignancies.
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Affiliation(s)
- Jonathan S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Sean T Kehoe
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Michael Friedlander
- Royal Hospital for Women, Randwick, Sydney, NSW, Australia.,University of New South Wales Clinical School, Sydney, NSW, Australia
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Retrospective study of combination chemotherapy with etoposide and ifosfamide in patients with heavily pretreated recurrent or persistent epithelial ovarian cancer. Obstet Gynecol Sci 2018; 61:352-358. [PMID: 29780777 PMCID: PMC5956118 DOI: 10.5468/ogs.2018.61.3.352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/28/2017] [Accepted: 10/10/2017] [Indexed: 11/25/2022] Open
Abstract
Objective This retrospective study is to evaluate the efficacy and toxicity of combination chemotherapy with etoposide and ifosfamide (ETI) in the management of pretreated recurrent or persistent epithelial ovarian cancer (EOC). Methods Patients with recurrent or persistent EOC who had measurable disease and at least one chemotherapy regimen were to receive etoposide at a dose of 100 mg/m2/day intravenous (IV) on days 1 to 3 in combination with ifosfamide 1 g/m2/day IV on days 1 to 5, every 21 days. Results From August 2008 to August 2016, 66 patients were treated with ETI regimen. Most patients were heavily pretreated prior to ETI: 53 (80.3%) patients had received 3 or more chemotherapy regimens. The response rate (RR) of ETI chemotherapy was 18.2% and median duration of response was 6.8 months (range, 0–30). Median survival of all patients was 5 months at a median follow up of 7.2 months. Platinum-free interval (PFI) more than 6 months prior to ETI has statistically significant correlation with overall survival (OS; 9.2 vs. 5.6 months; P=0.029) and RR (34.5% vs. 5.4%; P<0.010). However, treatment free interval before ETI, number of prior chemotherapy regimen, and optimality of primary surgery did not show significant difference for RR or OS. Grade 3 or 4 hematologic toxicities were observed in 7 cases (3%) of the 232 cycles of ETI. Conclusion The ETI combination regimen shows comparatively low toxicity and modest activity in heavily pretreated recurrent or persistent EOC patients with more than 6 months of PFI after last platinum treatment.
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Ferrari S, Severi L, Pozzi C, Quotadamo A, Ponterini G, Losi L, Marverti G, Costi MP. Human Thymidylate Synthase Inhibitors Halting Ovarian Cancer Growth. VITAMINS AND HORMONES 2018; 107:473-513. [PMID: 29544641 DOI: 10.1016/bs.vh.2017.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Human thymidylate synthase (hTS) has an important role in DNA biosynthesis, thus it is essential for cell survival. TS is involved in the folate pathways, specifically in the de novo pyrimidine biosynthesis. Structure and functions are intimately correlated, account for cellular activity and, in a broader view, with in vivo mechanisms. hTS is a target for anticancer agents, some of which are clinical drugs. The understanding of the detailed mechanism of TS inhibition by currently used drugs and of the interaction with the mechanism of action of other anticancer agents can suggest new perspective of TS inhibition able to improve the anticancer effect and to overcome drug resistance. TS-targeting drugs in therapy today are inhibitors that bind at the active site and that mostly resemble the substrates. Nonsubstrate analogs offer an opportunity for allosteric binding and novel mode of inhibition in the cancer cells. This chapter illustrates the relationship among the large number of hTS actions at molecular and clinical levels, its role as a target for ovarian cancer therapy, in particular in cases of overexpression of hTS and other folate proteins such as those induced by platinum drug treatments, and address the potential combination of TS inhibitors with other suitable anticancer agents.
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Affiliation(s)
| | - Leda Severi
- University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Lorena Losi
- University of Modena and Reggio Emilia, Modena, Italy
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Hardwick NR, Frankel P, Ruel C, Kilpatrick J, Tsai W, Kos F, Kaltcheva T, Leong L, Morgan R, Chung V, Tinsley R, Eng M, Wilczynski S, Ellenhorn JDI, Diamond DJ, Cristea M. p53-Reactive T Cells Are Associated with Clinical Benefit in Patients with Platinum-Resistant Epithelial Ovarian Cancer After Treatment with a p53 Vaccine and Gemcitabine Chemotherapy. Clin Cancer Res 2018; 24:1315-1325. [PMID: 29301826 DOI: 10.1158/1078-0432.ccr-17-2709] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/27/2017] [Accepted: 12/19/2017] [Indexed: 01/05/2023]
Abstract
Purpose: To conduct a phase I trial of a Modified Vaccinia Ankara vaccine delivering wild-type human p53 (p53MVA) in combination with gemcitabine chemotherapy in patients with platinum-resistant ovarian cancer.Experimental Design: Patients received gemcitabine on days 1 and 8 and p53MVA vaccine on day 15, during the first 3 cycles of chemotherapy. Toxicity was classified using the NCI Common Toxicity Criteria and clinical response assessed by CT scan. Peripheral blood samples were collected for immunophenotyping and monitoring of anti-p53 immune responses.Results: Eleven patients were evaluated for p53MVA/gemcitabine toxicity, clinical outcome, and immunologic response. TOXICITY there were no DLTs, but 3 of 11 patients came off study early due to gemcitabine-attributed adverse events (AE). Minimal AEs were attributed to p53MVA vaccination. Immunologic and clinical response: enhanced in vitro recognition of p53 peptides was detectable after immunization in both the CD4+ and CD8+ T-cell compartments in 5 of 11 and 6 of 11 patients, respectively. Changes in peripheral T regulatory cells (Tregs) and myeloid-derived suppressor cells (MDSC) did not correlate significantly with vaccine response or progression-free survival (PFS). Patients with the greatest expansion of p53-reactive T cells had significantly longer PFS than patients with lower p53-reactivity after therapy. Tumor shrinkage or disease stabilization occurred in 4 patients.Conclusions: p53MVA was well tolerated, but gemcitabine without steroid pretreatment was intolerable in some patients. However, elevated p53-reactive CD4+ and CD8+ T-cell responses after therapy correlated with longer PFS. Therefore, if responses to p53MVA can be enhanced with alternative agents, superior clinical responses may be achievable. Clin Cancer Res; 24(6); 1315-25. ©2018 AACR.
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Affiliation(s)
- Nicola R Hardwick
- Department of Experimental Therapeutics, Beckman Research Institute, Duarte, California
| | - Paul Frankel
- Division of Biostatistics, Beckman Research Institute, Duarte, California
| | - Christopher Ruel
- Division of Biostatistics, Beckman Research Institute, Duarte, California
| | - Julie Kilpatrick
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Weimin Tsai
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Ferdynand Kos
- Department of Experimental Therapeutics, Beckman Research Institute, Duarte, California
| | - Teodora Kaltcheva
- Department of Experimental Therapeutics, Beckman Research Institute, Duarte, California
| | - Lucille Leong
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Robert Morgan
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Vincent Chung
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Raechelle Tinsley
- Clinical Trials Office, City of Hope National Medical Center, Duarte, California
| | - Melissa Eng
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Sharon Wilczynski
- Department of Pathology, City of Hope National Medical Center, Duarte, California
| | | | - Don J Diamond
- Department of Experimental Therapeutics, Beckman Research Institute, Duarte, California.
| | - Mihaela Cristea
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
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Kuguacin J isolated from bitter melon leaves modulates paclitaxel sensitivity in drug-resistant human ovarian cancer cells. J Nat Med 2017. [PMID: 28639112 DOI: 10.1007/s11418-017-1099-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We previously reported the multidrug resistance-reversing ability of kuguacin J (KJ) in cervical cancer cells via the inhibition of P-glycoprotein (P-gp) function. This study investigated whether KJ could promote cisplatin- and paclitaxel (PTX)-induced cancer cell death in drug-resistance human ovarian cancer cells (SKOV3). Cytotoxicity testing showed that SKOV3 was more resistant to cisplatin and PTX compared to drug-sensitive human ovarian cancer cells (A2780). The cytotoxicity of PTX was significantly increased in SKOV3 cells when co-treated with KJ. We found that enhancement of PTX toxicity in the cells was not related to P-gp inhibition. To elucidate the mechanism by which KJ increases PTX sensitivity, the expression of cell death involving proteins was analyzed by Western blot analysis. The results showed that PTX treatment increased the level of an anti-apoptotic protein, survivin, which may be involved in drug resistance in SKOV3. The co-treatment with PTX and KJ dramatically decreased the level of survivin and markedly induced cleavage of PARP and caspase-3, which are apoptotic-induced molecules. These findings may support the use of KJ as an effective chemosensitizer in combination with conventional chemotherapy to promote PTX sensitization in ovarian cancer patients.
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Dinkic C, Eichbaum M, Schmidt M, Grischke EM, Gebauer G, Fricke HC, Lenz F, Wallwiener M, Marme F, Schneeweiss A, Sohn C, Rom J. Pazopanib (GW786034) and cyclophosphamide in patients with platinum-resistant, recurrent, pre-treated ovarian cancer - Results of the PACOVAR-trial. Gynecol Oncol 2017; 146:279-284. [PMID: 28528917 DOI: 10.1016/j.ygyno.2017.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/02/2017] [Accepted: 05/09/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The prognosis is poor for patients with recurrent, platinum-resistant epithelial ovarian cancer (EOC). Evidence suggests that antiangiogenic treatment modalities could play a major role in EOC. A combined therapy consisting of the investigational oral antiangiogenic agent pazopanib and metronomic oral cyclophosphamide may offer a well-tolerable treatment option to patients with recurrent, previously treated EOC. PATIENTS AND METHODS This study was designed as a multicenter phase I trial evaluating the optimal dose as well as activity and tolerability of pazopanib with metronomic cyclophosphamide in the treatment of patients with recurrent, platinum-resistant, previously treated ovarian, peritoneal, or fallopian tube cancer. Here, 50mg cyclophosphamide were combined with 400 to 800mg pazopanib daily. RESULTS Sixteen patients were treated; mean age was 66years. At dose levels (DL) I and II, one instance of dose-limiting toxicity (DLT) was seen in one of 6 patients. At DL III, two of four patients showed a DLT, leading to a maximum tolerated dose (MTD) of 600mg pazopanib daily. Median number of administered cycles was 6 (2-13), with three patients being treated for at least 13months. Median progression-free survival (PFS) and overall survival (OS) were 8.35months and 24.95months, respectively. 155 adverse events (AE) occurred, most frequently elevation of liver enzymes, leukopenia, diarrhea and fatigue. Altogether, five serious adverse events (SAE) developed in four patients. CONCLUSION Pazopanib 600mg daily p.o. and metronomic cyclophosphamide 50mg daily p.o. is a feasible regimen for patients with recurrent platinum-resistant EOC and showed promising activity in this previously treated patient population. TRIAL REGISTRATION Clin.trial.gov registry no.: NCT01238770.
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Affiliation(s)
- C Dinkic
- University of Heidelberg Medical School, Department of Gynecology and Obstetrics, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany.
| | - M Eichbaum
- HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Department of Gynecology and Gynecologic Oncology, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany
| | - M Schmidt
- University of Mainz Medical School, Department of Gynecology and Obstetrics, Langenbeckstr. 1, 55131 Mainz, Germany
| | - E M Grischke
- University of Tuebingen Medical School, Department of Gynecology and Obstetrics, Calwerstraße 7, 72076 Tuebingen, Germany
| | - G Gebauer
- Klinik für Gynäkologie und gynäkologische Onkologie, Marienkrankenhaus Hamburg, Alfredstraße 9, 22087 Hamburg, Germany
| | - H C Fricke
- Frauenklinik Klinikum Konstanz, Luisenstraße 7, 78464 Konstanz, Germany
| | - F Lenz
- Frauenklinik Sankt-Marienkrankenhaus Ludwigshafen, Salzburger Straße 15, 67067 Ludwigshafen, Germany
| | - M Wallwiener
- University of Heidelberg Medical School, Department of Gynecology and Obstetrics, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - F Marme
- University of Heidelberg Medical School, Department of Gynecology and Obstetrics, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - A Schneeweiss
- University of Heidelberg Medical School, Department of Gynecology and Obstetrics, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - C Sohn
- University of Heidelberg Medical School, Department of Gynecology and Obstetrics, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - J Rom
- University of Heidelberg Medical School, Department of Gynecology and Obstetrics, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
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12
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Wang F, Du X, Li X, Liu N, Yu H, Sheng X. Effects of sequential paclitaxel-carboplatin followed by gemcitabine-based chemotherapy compared with paclitaxel-carboplatin therapy administered to patients with advanced epithelial ovarian cancer: A retrospective, STROBE-compliant study. Medicine (Baltimore) 2016; 95:e5696. [PMID: 28002342 PMCID: PMC5181826 DOI: 10.1097/md.0000000000005696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We aimed to compare the efficacy of paclitaxel and carboplatin followed by gemcitabine-based combination chemotherapy with paclitaxel-carboplatin for treating advanced epithelial ovarian cancer in this retrospective, STROBE-compliant study. Patients' tolerance to treatment was also assessed.We retrospectively analyzed the records of 178 women who underwent initial optimal debulking surgery between January 2003 and December 2011 to treat FIGO stage IIIc epithelial ovarian cancer. Patients in arm 1 (n = 88) received 4 cycles of paclitaxel and carboplatin followed by 2 to 4 cycles of gemcitabine-based combination chemotherapy. Patients in arm 2 (n = 90) received 6 to 8 cycles of paclitaxel and carboplatin. The granulocyte-colony stimulating factor was administered prophylactically to all patients.The median follow-up for both arms was 62 months. Medianprogression-free survival (PFS) between arms 1 and 2 (28 and 19 months [P = 0.003]) as well as 5-year OS (34.1% and 18.9% [P = 0.021]) differed significantly. The neurotoxicity rate was significantly higher in arm 2 than in arm 1 (45.2% vs 27.1%, P = 0.026). There was no significant difference between study arms in hematological toxicity.The sequential regimen significantly improved PFS and 5-year OS with tolerable toxicity compared with the single regimen, and offers an alternative for treating patients with advanced epithelial ovarian cancer.
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Affiliation(s)
- Fei Wang
- School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences
- Department of Gynecologic Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan
| | - Xuelian Du
- Department of Gynecologic Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan
| | - Xiaoxia Li
- Department of Obstetrics and Gynecology, People's Hospital of Wenshang, Jining, Shandong, China
| | - Naifu Liu
- Department of Gynecologic Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan
| | - Hao Yu
- Department of Gynecologic Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan
| | - Xiugui Sheng
- Department of Gynecologic Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan
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Spina S, Nakashima L, Swenerton K. A retrospective review of gemcitabine use in advanced epithelial ovarian cancer. J Oncol Pharm Pract 2016. [DOI: 10.1177/107815529900500405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. In North America, epithelial ovarian cancer (EOC) is the fifth most common cause of cancer death among women. Many drugs are used in the treatment of EOC, with gemcitabine showing recent promise. The objective of this study was to determine whether gemcitabine is a beneficial treatment option for patients with EOC. Methods. The charts of 20 heavily pretreated women (median: four previous treatment protocols, range: 1-6) with a histological diagnosis of EOC were retrospectively reviewed to determine response. Eligible patients were treated with gemcitabine at a starting dose of 800 mg/m2 as an intravenous infusion on days 1, 8, and 15 of each 28-day cycle. The patients had a median age of 56 years (range 37-81). Results. Response to treatment was assessed both clinically and serologically (CA-125 tumor marker was monitored). Of the 20 enrollees, 17 were evaluable clinically and 16 were evaluable serologically (2 were not evaluable by either technique). There were two (12%) patients with a clinical partial response, six (35%) patients with clinical stable disease, nine (53%) patients with clinical progressive disease, and three patients that were not evaluable clinically. There were four (25%) patients with sero-logical partial response, six (38%) patients with stable serological disease, six (38%) patients with serological progressive disease, and four patients that were not evaluable serologically. Physician-reported toxicity included fatigue; however, this information was recorded inconsistently. Conclusion. Gemcitabine showed modest activity in heavily pretreated EOC with a 12% clinical partial response rate and a 25% serological partial response rate. No serious toxicities were encountered.
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Affiliation(s)
- Sean Spina
- British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver, British Columbia, Canada
| | - Lynne Nakashima
- British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver, British Columbia, Canada
| | - Ken Swenerton
- British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver, British Columbia, Canada
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Bai Y, Li LD, Li J, Lu X. Targeting of topoisomerases for prognosis and drug resistance in ovarian cancer. J Ovarian Res 2016; 9:35. [PMID: 27315793 PMCID: PMC4912764 DOI: 10.1186/s13048-016-0244-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/31/2016] [Indexed: 11/22/2022] Open
Abstract
Backgroud As magicians of the DNA world, topoisomerases resolve all of the topological problems in relation to DNA during a variety of genetic processes. While the prognostic value of topoisomerase isoenzymes in epithelial ovarian carcinoma (EOC) is still elusive. In current study, we investigated the prognostic value of topoisomerase isoenzymes in the EOC patients. Kaplan Meier plotter (KM plotter) database were used to assess the relevance of individual topoisomerase isoenzyme mRNA expression to EOC patients overall survival (OS), in which updated survival information and gene expression data were from a total of 1,648 EOC patients. Results High expression of TOP1 and TOP2A were found to be correlated to worse OS in all patients and serous patients, but not in endometrioid patients. Contrary to TOP1 and TOP2A, TOP3A and TOP3B expression were associated with better OS in all patients and serous patients, but not in endometrioid patients. While TOP2B were not found any significant prognostic value for EOC patients. From the Oncomine database, we also found widespread upregulation in the expression of TOP1 and TOP2A genes in primary tumor tissues. Albeit limited in number, all datasets exhibiting differential expression showed TOP3A and TOP3B under-regulated. Conclusion These results strongly supported that TOP1 and TOP2A were potential biomarkers for predicting poor survival of EOC patients, while TOP3A and TOP3B were expected to be further exploited as tumor suppressors. Comprehensive understanding of the topoisomerase isoforms may have guiding significance for the diagnosis treatment and prognosis in EOC patients. Electronic supplementary material The online version of this article (doi:10.1186/s13048-016-0244-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yang Bai
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China.,Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Liang-Dong Li
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, 200030, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200030, China
| | - Jun Li
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China.,Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Xin Lu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China. .,Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, 200032, China. .,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China. .,Permanent address: Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, No.419, Fangxie Road, Shanghai, 200011, China.
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Inside the biochemical pathways of thymidylate synthase perturbed by anticancer drugs: Novel strategies to overcome cancer chemoresistance. Drug Resist Updat 2015; 23:20-54. [PMID: 26690339 DOI: 10.1016/j.drup.2015.10.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 10/08/2015] [Accepted: 10/23/2015] [Indexed: 12/11/2022]
Abstract
Our current understanding of the mechanisms of action of antitumor agents and the precise mechanisms underlying drug resistance is that these two processes are directly linked. Moreover, it is often possible to delineate chemoresistance mechanisms based on the specific mechanism of action of a given anticancer drug. A more holistic approach to the chemoresistance problem suggests that entire metabolic pathways, rather than single enzyme targets may better explain and educate us about the complexity of the cellular responses upon cytotoxic drug administration. Drugs, which target thymidylate synthase and folate-dependent enzymes, represent an important therapeutic arm in the treatment of various human malignancies. However, prolonged patient treatment often provokes drug resistance phenomena that render the chemotherapeutic treatment highly ineffective. Hence, strategies to overcome drug resistance are primarily designed to achieve either enhanced intracellular drug accumulation, to avoid the upregulation of folate-dependent enzymes, and to circumvent the impairment of DNA repair enzymes which are also responsible for cross-resistance to various anticancer drugs. The current clinical practice based on drug combination therapeutic regimens represents the most effective approach to counteract drug resistance. In the current paper, we review the molecular aspects of the activity of TS-targeting drugs and describe how such mechanisms are related to the emergence of clinical drug resistance. We also discuss the current possibilities to overcome drug resistance by using a molecular mechanistic approach based on medicinal chemistry methods focusing on rational structural modifications of novel antitumor agents. This paper also focuses on the importance of the modulation of metabolic pathways upon drug administration, their analysis and the assessment of their putative roles in the networks involved using a meta-analysis approach. The present review describes the main pathways that are modulated by TS-targeting anticancer drugs starting from the description of the normal functioning of the folate metabolic pathway, through the protein modulation occurring upon drug delivery to cultured tumor cells as well as cancer patients, finally describing how the pathways are modulated by drug resistance development. The data collected are then analyzed using network/netwire connecting methods in order to provide a wider view of the pathways involved and of the importance of such information in identifying additional proteins that could serve as novel druggable targets for efficacious cancer therapy.
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Increased Dose Single-agent Gemcitabine in Platinum-taxane Resistant Metastatic Ovarian Cancer. TUMORI JOURNAL 2015. [DOI: 10.5301/tj.5000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background In platinum-taxane resistant epithelial ovarian cancer (EOC), we aimed to determine the effectiveness. Patients and Methods Between 2004 and 2013, patients afflicted with platinum-taxane resistant EOC and who were administered a 30-minute i.v. infusion of single-agent gemcitabine at a dose of 1,250 mg/m2 on the 1st, 8th and 15th days, every 28 days, were examined retrospectively. Results Twenty-six patients with platinum-taxane resistant EOC were included in the study. The overall survival (OS) was 48 months. The median survival after becoming platinum-taxane resistant was 16 months for the study population. Median time to progression (TTP) and median survival after becoming platinum-taxane resistant for patients who received second-line treatment were 3.3 months and 16 months, respectively; for patients who received third-line treatment with gemcitabine, these were 3.7 months and 19 months, respectively. Administration of gemcitabine as second- and third-line chemotherapy in platinum-taxane resistant EOC, provides similar TTP and OS outcomes (p = 0.4, p = 0.9) with a similar response and toxicity rate. Conclusions Second- and third-line gemcitabine at a dose of 1,250 mg/m2 on days 1, 8 and 15 every 28 days as a 30-minute i.v. infusion in platinum-taxane resistant EOC is an effective treatment option with a tolerable and manageable toxicity.
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Yang H, Liu YH, Xu L, Liu LH. Efficacy of permanent iodine-125 seed implants and gemcitabine chemotherapy in patients with platinum- resistant recurrent ovarian carcinoma. Asian Pac J Cancer Prev 2014; 15:9009-13. [PMID: 25374244 DOI: 10.7314/apjcp.2014.15.20.9009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to explore the efficacy and adverse reactions of CT-guided radioactive 125I-seed implantation treatment combined with chemotherapy for platinum-resistant recurrent ovarian carcinoma. MATERIALS AND METHODS From September 2010 to December 2012, 23 patients with platinum-resistant recurrent ovarian carcinoma were enrolled. All the patients refused, could not bear, or were not suitable for surgery. They all had no more than 3 lesions, which were detected and could also be measured by CT. All were clarified as single-lesion or multiple-lesion groups. A total of 41 lesions underwent implantation of from 8 to 106 125I seeds (median=43). Multi-plane implanting was adopted and 125I-seeds of (0.4-0.7)mCi were placed at intervals of (0.5-1.0) cm. After implantation treatment, all patients underwent 4 cycles of chemotherapy with gemcitabine 800 mg/m2 (days 1, 8 and 15). RESULTS The outcome was evaluated with CT 3 weeks and every 3 months after implantation treatment. After 6 months, the volume of 32 out of 41 lesions (78.0%) was reduced at least 30%, within which 9 lesions completely disappeared(22.0%). Complete response was observed in 7 cases (30.4%), with a partial response in 4 cases (17.4%),4 cases stable(17.4%)and 8 cases showing progression (34.8%). The total clinical remission rate was 47.8% (11/23). The clinical remission rate was 77.8% (7/9) in the single-lesion group and 28.6% (4/14) in the multiple-lesion group with a significant difference between the two(P=0.036). The common side effects observed were mild gastrointestinal reactions. CONCLUSIONS 125I-seed implantation combined with chemotherapy applies an effective way in the treatment of platinum-resistant recurrent ovarian epithelial carcinoma with the advantages of high local control rates, good short-term effects, little trauma and less side effects.
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Affiliation(s)
- Hui Yang
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, The Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan, China E-mail : ;
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Chanpanitkitchot S, Tangjitgamol S, Khunnarong J, Thavaramara T, Pataradool K, Srijaipracharoen S. Treatment Outcomes of Gemcitabine in Refractory or Recurrent Epithelial Ovarian Cancer Patients. Asian Pac J Cancer Prev 2014; 15:5215-21. [DOI: 10.7314/apjcp.2014.15.13.5215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kawaguchi H, Terai Y, Tanabe A, Sasaki H, Takai M, Fujiwara S, Ashihara K, Tanaka Y, Tanaka T, Tsunetoh S, Kanemura M, Ohmichi M. Gemcitabine as a molecular targeting agent that blocks the Akt cascade in platinum-resistant ovarian cancer. J Ovarian Res 2014; 7:38. [PMID: 24713296 PMCID: PMC4234938 DOI: 10.1186/1757-2215-7-38] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 04/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gemcitabine (2', 2' -difluorodeoxycytidine) is one of many nonplatinum drugs that exhibit activity in recurrent, platinum-resistant ovarian cancer. However, the molecular mechanisms by which Gemcitabine treatment inhibits the proliferation of platinum-resistant ovarian cancer cells still remain unclear. We investigated whether Gemcitabine increases the efficacy of Cisplatin in platinum-resistant ovarian cancer models in vitro and in vivo. METHODS We used Cisplatin-resistant Caov-3 cells, A2780CP cells and Cisplatin-sensitive A2780 cells to examine the sensitivity of the cell viability of Cisplatin and Gemcitabine using a 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay and the sensitivity of the invasive activity of Cisplatin and Gemcitabine using an invasion assay with Matrigel. We examined the Akt kinase activity and matrix metalloproteinase 9 (MMP9) expression following Cisplatin and Gemcitabine treatment using a Western blot analysis and the mRNA expression of vascular endothelial growth factor (VEGF) using semi-quantitative RT-PCR. Moreover, we evaluated the effects of Cisplatin and Gemcitabine on the intra-abdominal dissemination of ovarian cancer in vivo. RESULTS Gemcitabine significantly inhibited Cisplatin-induced Akt activation in the Caov-3 and A2780CP cells, but not in the A2780 cells. In the presence of Gemcitabine, Cisplatin-induced growth inhibition and apoptosis were significantly enhanced in the Caov-3 and A2780CP cells. Co-treatment with Cisplatin and Gemcitabine almost completely inhibited invasion of both types of cells through the Matrigel; however, neither Cisplatin nor Gemcitabine alone inhibited the invasion of both types of cells. Gemcitabine inhibited not only the Cisplatin-induced activation of Akt, but also the MMP9 and mRNA expression of VEGF. Moreover, treatment with Gemcitabine increased the efficacy of Cisplatin-induced growth inhibition of the intra-abdominal dissemination and production of ascites in the athymic nude mice inoculated with Caov-3 cells. CONCLUSIONS We herein demonstrated that Gemcitabine inhibits the Akt kinase activity and angiogenetic activity following treatment with Cisplatin in platinum-resistant ovarian cancer cells. These results provide a rationale for using Gemcitabine in clinical regimens containing molecular targeting agents against platinum-resistant ovarian cancers.
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Safra T, Asna N, Veizman A, Shpigel S, Matcejevsky D, Inbar M, Grisaru D. The combination of gemcitabine and carboplatin shows similar efficacy in the treatment of platinum-resistant and platinum-sensitive recurrent epithelial ovarian cancer patients. Anticancer Drugs 2014; 25:340-5. [DOI: 10.1097/cad.0000000000000042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vergote IB, Garcia A, Micha J, Pippitt C, Bendell J, Spitz D, Reed N, Dark G, Fracasso PM, Ibrahim EN, Armenio VA, Duska L, Poole C, Gennigens C, Dirix LY, Leung AC, Zhao C, Soufi-Mahjoubi R, Rustin G. Randomized multicenter phase II trial comparing two schedules of etirinotecan pegol (NKTR-102) in women with recurrent platinum-resistant/refractory epithelial ovarian cancer. J Clin Oncol 2013; 31:4060-6. [PMID: 24081946 PMCID: PMC4878105 DOI: 10.1200/jco.2012.45.1278] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Etirinotecan pegol (NKTR-102) is a unique, long-acting topoisomerase-I inhibitor with prolonged systemic exposure to SN38 (7-ethyl-10-hydroxycamptothecin), the active metabolite of irinotecan. This randomized phase II trial investigated two dosing schedules of etirinotecan pegol in patients with platinum-resistant/refractory ovarian carcinoma. PATIENTS AND METHODS A total of 71 eligible patients were randomly assigned to receive etirinotecan pegol 145 mg/m(2) every 14 or 21 days until progression or unacceptable adverse events (AEs). The primary end point was objective response rate (ORR) by RECIST (version 1.0). Secondary end points included response by Gynecologic Cancer Intergroup criteria, duration of ORR, progression-free survival (PFS), and overall survival (OS). RESULTS The overall confirmed ORR was 20% (95% CI, 10% to 30%): 20% for once every 14 days, and 19% for once every 21 days. Median response duration was 4.1 months for once every 14 days and 4.0 months for once every 21 days. Median PFS for every 14 and every 21 days was 4.1 and 5.3 months, respectively, and median OS was 10.0 and 11.7 months, respectively. Etirinotecan pegol was well tolerated, with the most common grade 3 to 4 AEs being dehydration (24%) and diarrhea (23%). Diarrhea, dehydration, nausea, and neutropenia were less frequent with the schedule of once every 21 days than with that of once every 14 days. CONCLUSION Both schedules of etirinotecan pegol showed activity in patients with heavily pretreated ovarian cancer, with encouraging ORR and PFS rates. The schedule of once every 21 days was better tolerated and had slightly longer PFS and OS rates. The treatment schedule of etirinotecan pegol 145 mg/m(2) once every 21 days was selected for the expanded phase II study and is preferred for future phase III studies. These findings provide support to directly compare etirinotecan pegol versus one of the approved drugs (eg, pegylated liposomal doxorubicin or topotecan) in platinum-resistant ovarian cancer.
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Affiliation(s)
- Ignace B. Vergote
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Agustin Garcia
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - John Micha
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Charles Pippitt
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Johanna Bendell
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Daniel Spitz
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Nicholas Reed
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Graham Dark
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Paula M. Fracasso
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Emad N. Ibrahim
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Vincent A. Armenio
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Linda Duska
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Chris Poole
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Christine Gennigens
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Luc Y. Dirix
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Abraham C.F. Leung
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Carol Zhao
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Raoudha Soufi-Mahjoubi
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Gordon Rustin
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
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Phase II study of ifosfamide and cisplatin for the treatment of recurrent ovarian cancer. Cancer Chemother Pharmacol 2013; 72:653-60. [PMID: 23912693 DOI: 10.1007/s00280-013-2241-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/21/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this phase II study was to investigate the efficacy and toxicity of combined ifosfamide and cisplatin chemotherapy in patients with recurrent epithelial ovarian cancer (EOC). EXPERIMENTAL DESIGN Forty-seven patients with recurrent EOC were treated with ifosfamide 5 g/m(2) and cisplatin 50 mg/m(2) on day 1, every 3 weeks for 6 cycles. The primary outcomes were response rate (RR) and toxicity. Other measurements were duration of response, time to progression (TTP), and overall survival (OS). RESULTS All 47 patients with 160 cycles were assessed for response and toxicity. The overall RR was 31.9 %; there were 3 complete responses (6.4 %) and 12 partial responses (25.5 %). Grade 3 and 4 hematologic toxicities included neutropenia (23.6 %), anemia (12.8 %), and thrombocytopenia (10.7 %). Non-hematologic toxicities were mild, and no drug-related toxic deaths occurred. The median duration of response, TTP, and OS was 5.1, 4.8, and 17.0 months, respectively. In the initially platinum-sensitive group, RR and OS were 44.4 % and 20.4 months, while in the initially platinum-resistant group, these values were 15.0 and 8.7 months, respectively (P = 0.027 and P = 0.002, respectively). CONCLUSION Ifosfamide combined with cisplatin is a well-tolerated regimen with modest activity in recurrent EOC. In addition, this regimen was especially effective in patients whose disease was initially platinum-sensitive.
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Miller RE, Banerjee S. The current state of pemetrexed in ovarian cancer. Expert Opin Investig Drugs 2013; 22:1201-10. [DOI: 10.1517/13543784.2013.820703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Leijen S, Veltkamp SA, Huitema ADR, van Werkhoven E, Beijnen JH, Schellens JHM. Phase I dose-escalation study and population pharmacokinetic analysis of fixed dose rate gemcitabine plus carboplatin as second-line therapy in patients with ovarian cancer. Gynecol Oncol 2013; 130:511-7. [PMID: 23665458 DOI: 10.1016/j.ygyno.2013.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 04/30/2013] [Accepted: 05/02/2013] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This phase I study of fixed dose rate (FDR) gemcitabine and carboplatin assessed the maximum tolerated dose (MTD), dose-limiting toxicities (DLTs), safety, pharmacokinetic (PK)/pharmacodynamic (PD) profile and preliminary anti-tumor activity in patients with recurrent ovarian cancer (OC). METHODS Patients with recurrent OC after first line treatment were treated with carboplatin and FDR gemcitabine (infusion speed 10mg/m(2)/min) on days 1, 8 and 15, every 28 days. Pharmacokinetics included measurement of platinum concentrations in plasma ultrafiltrate (pUF) and plasma concentrations of gemcitabine (dFdC) and metabolite dFdU. Intracellular levels of dFdC triphosphate (dFdC-TP), the most active metabolite of gemcitabine, were determined in peripheral blood mononuclear cells (PBMCs). Population pharmacokinetic modeling and simulation were performed to further investigate the optimal schedule. RESULTS Twenty three patients were enrolled. Initial dose escalation was performed using FDR gemcitabine 300 mg/m(2) (administered at infusion speed of 10 mg/m(2)/min) combined with carboplatin AUC 2.5 and 3. Excessive bone marrow toxicity led to a modified dose escalation schedule: carboplatin AUC 2 and dose escalation of FDR gemcitabine (300 mg/m(2), 450 mg/m(2), 600 mg/m(2) and 800 mg/m(2)). DLT criteria as defined per protocol prior to the study were not met with carboplatin AUC 2 in combination with FDR gemcitabine 300-800 mg/m(2) because of myelosuppressive dose-holds (especially thrombocytopenia and neutropenia). CONCLUSIONS FDR gemcitabine in combination with carboplatin administered in this 28 days schedule resulted in increased grade 3/4 toxicity compared to conventional 30-minute infused gemcitabine. A two weekly schedule (chemotherapy on days 1 and 8) would be more appropriate.
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Affiliation(s)
- Suzanne Leijen
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Khemapech N, Oranratanaphan S, Termrungruanglert W, Lertkhachonsuk R, Vasurattana A. Salvage Chemotherapy in Recurrent Platinum-Resistant or Refractory Epithelial Ovarian Cancer with Carboplatin and Distearoylphosphatidylcholine Pegylated Liposomal Doxorubicin (Lipo-Dox®). Asian Pac J Cancer Prev 2013; 14:2131-5. [DOI: 10.7314/apjcp.2013.14.3.2131] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Miller DS, Tai DF, Obasaju C, Vergote I. Safety and efficacy of pemetrexed in gynecologic cancers: A systematic literature review. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/mc.2013.22004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chemotherapy Treatment Patterns in Elderly Patients Initially Diagnosed With Advanced Ovarian Cancer. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.cogc.2013.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
The US FDA has recently approved the combination of carboplatin and gemcitabine as a second-line therapy for recurrent platinum-sensitive ovarian cancer. This article briefly reviews the pharmacokinetics and mechanism of action of gemcitabine and its synergistic effect with platinum. An overview of the literature on the role of gemcitabine in the treatment of epithelial ovarian cancer is also presented.
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Affiliation(s)
- Fadi Abushahin
- Department of Obstetrics & Gynecology, Section of Gynecologic Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Berek JS, Crum C, Friedlander M. Cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet 2012; 119 Suppl 2:S118-29. [DOI: 10.1016/s0020-7292(12)60025-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Garcia AA, Yessaian A, Pham H, Facio G, Muderspach L, Roman L. Phase II study of gemcitabine and docetaxel in recurrent platinum resistant ovarian cancer. Cancer Invest 2012; 30:295-9. [PMID: 22468744 DOI: 10.3109/07357907.2012.657812] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
UNLABELLED To evaluate the activity of gemcitabine and docetaxel in patients with recurrent ovarian cancer. METHODS Patients with platinum-resistant disease and prior treatment with paclitaxel received treatment with docetaxel on day 1 and gemcitabine on days 1 and 8, repeated every three weeks. RESULTS Twenty patients, with a platinum-free interval of three months, were enrolled. Overall response rate was 25%. Treatment was associated with significant myelosuppression. CONCLUSIONS In chemotherapy-resistant patients, this regimen exhibited encouraging activity. Excessive myelosuppression led to early closure. This was prevented by administering docetaxel on day 8 (instead of day 1) and prophylactic use of G-CSF.
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Affiliation(s)
- Agustin A Garcia
- Kenneth Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
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Giuntoli RL, Bristow RE, Diaz-Montes TP, Armstrong DK. Feasibility of intravenous gemcitabine and an intraperitoneal platinum agent in the treatment of ovarian cancer. J Chemother 2011; 23:163-7. [PMID: 21742586 DOI: 10.1179/joc.2011.23.3.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The goal of this study is to determine the feasibility of intravenous gemcitabine and an intraperitoneal platinum agent in the treatment of patients with ovarian cancer. We performed a retrospective chart review of patients with primary, persistent or recurrent ovarian cancer, who received intravenous gemcitabine and an intraperitoneal platinum agent. Patients received gemcitabine (750 mg/m²) intravenous on days 1 and 8 and cisplatin (100 or 60 mg/m²) intraperitoneal on day 1 every 21 - 28 days. An alternate regimen was composed of gemcitabine (750 mg/m²) intravenous and carboplatin (AUC 5) intraperitoneal on day 1 every 21 days. Dose reductions occurred at the discretion of the prescribing physician.Intravenous gemcitabine and an intraperitoneal platinum agent were administered to 12 patients with advanced primary or recurrent ovarian cancer. Myelosuppression was the most common toxicity. Grade 3 or 4 thrombocytopenia, neutropenia and anemia occurred in 7, 8 and 2 patients respectively. Dose reductions were required in 7 of 12 patients. 10 of 12 patients received 6 cycles of the regimen. Treatment was discontinued prior to 6 cycles in 2 of 12 patients secondary to progression in one case and to grade 4 neutropenia and thrombocytopenia in another.The combination of intravenous gemcitabine and an intraperitoneal platinum agent appears to be a feasible regimen in patients with ovarian cancer. The most common toxicity was myelosuppression, which resulted in dose reductions in almost half of the patients.
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Affiliation(s)
- R L Giuntoli
- Kelly Gynecologic Oncology Service, Department of Gynecology and Onstetrics, Sidney Kimmel Comprehensive Cancer Center, 600 North Wolfe Street, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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The Efficacy and Toxicity of Bevacizumab in Combination With Gemcitabine in Patients With Recurrent Ovarian Cancer. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.cloc.2011.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
At the 4th Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup (GCIG) held in Vancouver, Canada, in June 2010, representatives of 23 cooperative research groups studying gynecologic cancers gathered to establish international consensus on issues critical to the conduct of large randomized trials. The process focused on 13 predetermined questions. Group A, 1 of the 3 discussion groups, addressed the first 5 questions, examining first-line therapies in newly diagnosed ovarian cancer patients. A1: What are the appropriate end points for different trials (maintenance, upfront chemotherapy trials including molecular drugs)? A2: Are there any subgroups defined by tumor biology who need specific treatment options/trials? A3: Is the 2004 GCIG-recommended standard comparator arm still valid? A4: What is the role of modifying dose, schedule, and delivery of chemotherapy? A5: What role does surgery play today?
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Phase 1/2 study of atrasentan combined with pegylated liposomal doxorubicin in platinum-resistant recurrent ovarian cancer. Neoplasia 2011; 12:941-5. [PMID: 21076619 DOI: 10.1593/neo.10582] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 08/25/2010] [Accepted: 08/26/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ovarian cancer overexpresses ET-1, and in vitro studies have shown that ET-1 confers resistance to anthracycline-containing chemotherapy. Atrasentan has been developed as an oral selective endothelin-A receptor antagonist. The objective of the study was to investigate the feasibility and toxicity of adding increasing doses of atrasentan (to a maximum of 10 mg/d) and liposomal doxorubicin in patients with progressive ovarian cancer, refractory for platinum and paclitaxel. METHODS Patients with platinum-resistant ovarian cancer were treated with pegylated liposomal doxorubicin (PLD) 50 mg/m(2) on day 1 (and repeated every 4 weeks) in combination with escalating doses of atrasentan once daily. The starting dose was 2.5 mg and escalated in cohorts of three patients from 5 to 10 mg. RESULTS Twenty-six patients (mean age = 60 years, range = 42-74 years) were treated at the three dose levels. Atrasentan could be safely administered in combination at a dose of 10 mg. All patients were evaluable for toxicity, and 19 patients, included in the phase 2 period, were evaluable for response. Adverse events included nausea, vomiting, mucositis, skin toxicity, and rhinitis. Clinical cardiac toxicity, intensively monitored, was not observed, although two patients had a decrease in cardiac ejection fraction. Three objective responses were observed and another six patients had stable disease with a median time to progression of 14 weeks and an overall survival of 13.1 months. CONCLUSIONS The addition of atrasentan to standard dose PLD in platinum-resistant ovarian cancer is feasible with some suggestion of prolonged survival.
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Abu-Hamar AEH. A Pilot Study of Gemcitabine and Epirubicin Combination Chemotherapy as a Salvage Regimen for Recurrent Platinum Resistant and/or Refractory Epithelial Ovarian Cancer. JOURNAL OF CANCER THERAPY 2011; 02:490-496. [DOI: 10.4236/jct.2011.24066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Bruzzone M, Centurioni M, Giglione P, Gualco M, Merlo D, Miglietta L, Cosso M, Giannelli F, Cristoforoni P, Ferrarini M. Second-Line Treatment with Intravenous Gemcitabine and Oral Etoposide in Platinum-Resistant Advanced Ovarian Cancer Patients: Results of a Phase II Study. Oncology 2011; 80:238-46. [DOI: 10.1159/000328451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 02/22/2011] [Indexed: 11/19/2022]
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Tsunetoh S, Terai Y, Sasaki H, Tanabe A, Tanaka Y, Sekijima T, Fujioka S, Kawaguchi H, Kanemura M, Yamashita Y, Ohmichi M. Topotecan as a molecular targeting agent which blocks the Akt and VEGF cascade in platinum-resistant ovarian cancers. Cancer Biol Ther 2010; 10:1137-46. [PMID: 20935474 DOI: 10.4161/cbt.10.11.13443] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Topotecan, a novel topoisomerase-1 inhibitor, is a drug that appears to be effective against platinum-resistant ovarian cancers. However, the molecular mechanisms by which Topotecan treatment inhibits cancer cell proliferation are unclear. We investigated whether Topotecan increases the efficacy of Cisplatin in platinum-resistant ovarian cancer models in vitro and in vivo. METHODS We used Cisplatin-resistant Caov-3 cells and Cisplatin-sensitive A2780 cells. We examined the effect of Cisplatin and Topotecan on the cell viability of Caov-3 and A2780 cells by MTS assay. We examined the Akt kinase activity, VEGF and HIF-1α expression after Cisplatin and Topotecan by a Western blot analysis. Moreover, we also evaluated the effects of Cisplatin and Topotecan on the intraabdominal dissemination of ovarian cancer in vivo. RESULTS Topotecan significantly inhibited Cisplatin-induced Akt activation in Caov-3 cells, but not in A2780 cells. In the presence of Topotecan, Cisplatin-induced growth inhibition and apoptosis were significantly enhanced in Caov-3 cells. Topotecan inhibited not only Cisplatin-induced Akt activation but also VEGF and HIF-1α expression. Moreover, treatment with Topotecan increased the efficacy of Cisplatin-induced growth inhibition in the intraabdominal dissemination and production of ascites in athymic nude mice inoculated with Caov-3 cells. CONCLUSION We herein demonstrated that Topotecan inhibits Akt kinase activity and VEGF transcriptional activation after Cisplatin treatment in platinum-resistant ovarian cancers. We clarified how Topotecan enhanced the clinical activity in the platinum-resistant ovarian cancer. These results provide a rationale for using Topotecan in clinical regimens aimed at molecular targeting agents in platinum-resistant ovarian cancers.
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Affiliation(s)
- Satoshi Tsunetoh
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
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Choi CH, Lee YY, Song TJ, Park HS, Kim MK, Kim TJ, Lee JW, Lee JH, Bae DS, Kim BG. Phase II study of belotecan, a camptothecin analogue, in combination with carboplatin for the treatment of recurrent ovarian cancer. Cancer 2010; 117:2104-11. [PMID: 21523722 DOI: 10.1002/cncr.25710] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 08/09/2010] [Accepted: 09/08/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND Belotecan (CKD602; Camtobell, Chong Keun Dang Corp., Seoul, Korea) is a recently developed camptothecin derivative with antitumor properties. This phase II study was designed to evaluate the toxicity and efficacy of belotecan combined with carboplatin in patients with recurrent epithelial ovarian cancer (EOC). METHODS Thirty-eight patients with recurrent EOC were treated with belotecan 0.3 mg/m(2) /day (days 1-5) and carboplatin AUC 5 (day 5) every 3 weeks for 6 cycles. The primary objective was to determine the response rate as defined by Response Evaluation Criteria in Solid Tumors and CA-125 response. Other end points included toxicities and progression-free survival (PFS). RESULTS All 38 patients were assessed for toxicity, and 35 patients were assessed for response. The overall response rate was 57.1%; there were 7 complete responses (20.0%), 13 partial responses (37.1%), 6 patients with stable disease (17.1%), and 9 patients with progressive disease (25.7%). Grades 3 and 4 hematologic toxicities included neutropenia (28.8%), thrombocytopenia (19.8%), and anemia (14.4%), and there were 2 episodes of febrile neutropenia. Median PFS was 7 months, with a median follow-up of 12 months. CONCLUSIONS The newly developed topoisomerase I inhibitor belotecan (CKD-602) combined with carboplatin is a well-tolerated regimen with activity in recurrent EOC. Further testing of this regimen is warranted to further characterize efficacy and indications for use.
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Affiliation(s)
- Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim YM, Lee SW, Kim DY, Kim JH, Nam JH, Kim YT. The efficacy and toxicity of belotecan (CKD-602), a camptothericin analogue topoisomerase I inhibitor, in patients with recurrent or refractory epithelial ovarian cancer. J Chemother 2010; 22:197-200. [PMID: 20566426 DOI: 10.1179/joc.2010.22.3.197] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study evaluated the efficacy and toxicity of belotecan (CKD-602), a new camptothecin analogue topoisomerase i inhibitor, in patients with recurrent or refractory epithelial ovarian cancer. Data from 63 patients who had been treated with intravenous belotecan (0.5 mg/m(2)/day), administered for 5 days every 3 weeks at a single institute in Seoul, Korea, were collected retrospectively. The overall response rate was 30.2% including 9 patients with complete remission (CR) and the progression free survival was a median of 6.5 (0.7 - 29.7) months. The platinumsensitive group had a significantly higher response rate and longer progression-free survival more than the platinum-resistant group. The most common adverse effect of belotecan was hematologic toxicity which was tolerable. As a single chemotherapy agent, belotecan was effective in treating recurrent or refractory epithelial ovarian cancer, and had acceptable toxicity. Further studies of the efficacy of belotecan in combination with platinum or the other agents are warranted.
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Affiliation(s)
- Yong-Man Kim
- Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea.
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Abstract
Weekly paclitaxel is a highly active and well tolerated regimen that is increasingly being adopted for the treatment of relapsed ovarian cancer. This regimen is usually administered at 80-90 mg/m(2)/week, and the use of a 1 h infusion helps minimize myelosuppression. When compared with the 3-weekly schedule, weekly paclitaxel is better tolerated, with a reduced frequency of grade 3-4 toxic effects. Single-agent weekly paclitaxel for relapsed ovarian cancer yields response rates in the range of 20-62%; however, response duration can be short. Responses to weekly paclitaxel have been observed in patients whose tumors are resistant to 3-weekly paclitaxel. The level of activity of weekly paclitaxel for relapsed disease has led to its detailed evaluation in the first-line setting, and interest has been enhanced by the results of a Japanese Gynecological Oncology Group study that demonstrated a survival advantage for weekly paclitaxel compared with 3-weekly paclitaxel in combination with carboplatin as initial treatment. The enhanced efficacy of weekly paclitaxel may be due to greater drug exposure, a direct antiangiogenic effect, or both. Current research topics include the combination of weekly paclitaxel with molecular-targeted agents and the use of molecular profiling to better select patients for treatment.
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Mirza MR, Lund B, Lindegaard JC, Keldsen N, Mellemgaard A, Christensen RD, Bertelsen K. A phase II study of combination chemotherapy in early relapsed epithelial ovarian cancer using gemcitabine and pegylated liposomal doxorubicin. Gynecol Oncol 2010; 119:26-31. [PMID: 20638711 DOI: 10.1016/j.ygyno.2010.06.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 06/18/2010] [Accepted: 06/21/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Treatment of epithelial ovarian cancer patients relapsing with a short treatment-free interval (TFI) after prior chemotherapy is unsatisfactory. This phase II trial evaluated the activity and feasibility of pegylated liposomal doxorubicin (PLD) plus gemcitabine in this setting. METHODS Patients who had received prior platinum and paclitaxel with a TFI 0-12 months received PLD 25 mg/m(2)day 1 plus gemcitabine 800 mg/m(2)day 1, 8 every 21 days. Gemcitabine was dose escalated to 1000 mg/m(2)day 1, 8 from course 2 in the absence of grade 3/4 toxicity. The primary endpoint was progression-free survival (PFS). Patients were stratified according to response to primary chemotherapy. RESULTS Seventy-nine patients (n=26 with CR on prior chemotherapy and TFI 6-12 months; n=20 with CR and TFI 0-6 months; n=33 with PR/SD and TFI 0-12 months) were enrolled. The median age was 59 years (range 31-77 years), and 33 patients had received ≥ 2 prior treatments. A median of five courses was delivered per patient (total 389 courses). Gemcitabine was dose escalated in 124 courses and reduced in 105 courses. No PLD dose reductions occurred. Grade 3/4 toxicities were febrile neutropenia (n=4), PPE (n=2), and mucositis (n=2). One toxic death occurred (pneumonitis/alveolitis). Responses were complete in 5.1%, partial in 27.9%, and stable disease in 55.7%. Median OS and PFS were 12.5 and 6.4 months, respectively. CONCLUSIONS The PLD-gemcitabine combination is an effective and well-tolerated salvage treatment for relapsed epithelial ovarian cancer and is a valid candidate for evaluation in a phase III trial.
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von Gruenigen V, Frasure H, Fusco N, DeBernardo R, Eldermire E, Eaton S, Waggoner S. A double-blind, randomized trial of pyridoxine versus placebo for the prevention of pegylated liposomal doxorubicin-related hand-foot syndrome in gynecologic oncology patients. Cancer 2010; 116:4735-43. [DOI: 10.1002/cncr.25262] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kim HS, Park NH, Kang S, Seo SS, Chung HH, Kim JW, Song YS, Kang SB. Comparison of the efficacy between topotecan- and belotecan-, a new camptothecin analog, based chemotherapies for recurrent epithelial ovarian cancer: a single institutional experience. J Obstet Gynaecol Res 2010; 36:86-93. [PMID: 20178532 DOI: 10.1111/j.1447-0756.2009.01101.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To compare the efficacy and toxicity between topotecan- and belotecan-based chemotherapies in recurrent epithelial ovarian cancer (EOC). METHODS The clinical data of 80 patients treated with topotecan- (n = 45) or belotecan- (n = 35) based chemotherapy as at least a second-line chemotherapy were reviewed retrospectively between July 2001 and December 2007. Response was evaluated using the Response Evaluation Criteria in Solid Tumours (RECIST) and serum CA-125 levels. Hematological toxicity was examined according to the National Cancer Institute Common Toxicity Criteria (NCI-CTC) version 2.0. Time to progressive disease (TTPD), chemotherapy-specific survival (CSS) and overall survival (OS) according to the 2 chemotherapies were evaluated by the Kaplan-Meier analysis with the log-rank test. RESULTS Overall response rate (ORR) was 24.4% in patients treated with topotecan-based chemotherapy, while it was 45.7% in those treated with belotecan-based chemotherapy (P = 0.046). Moreover, ORR was higher in platinum-sensitive patients treated with belotecan-based chemotherapy (58.8%) than those treated with topotecan-based chemotherapy (22.2%) (P = 0.041) although it was not significantly different in platinum-resistant patients (P = 0.471). Grade 3 or 4 anemia, neutropenia and thrombocytopenia developed in 14.8% vs 3.6%, 43.1% vs 55.6%, and 20.0% vs 12.8% of cycles in topotecan- and belotecan-based chemotherapies, respectively (P < 0.05). There were no significant difference in survival between the 2 chemotherapies. CONCLUSIONS In our experience, belotecan-based chemotherapy seemed to be efficient with acceptable toxicity, compared to topotecan-based chemotherapy in recurrent EOC. However, randomized controlled trials are required for the comparison of the efficacy and toxicity between topotecan- and belotecan-based chemotherapies in recurrent EOC.
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Affiliation(s)
- Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Welch SA, Hirte HW, Elit L, Schilder RJ, Wang L, MacAlpine K, Wright JJ, Oza AM. Sorafenib in Combination With Gemcitabine in Recurrent Epithelial Ovarian Cancer: A Study of the Princess Margaret Hospital Phase II Consortium. Int J Gynecol Cancer 2010; 20:787-93. [DOI: 10.1111/igc.0b013e3181e273a8] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives:Antiangiogenic strategies have demonstrated efficacy in epithelial ovarian cancer (EOC). Sorafenib is a novel multitargeted kinase inhibitor with antiangiogenic activity. Gemcitabine has known activity against EOC. A phase 1 clinical trial of this combination suggested activity in ovarian cancer with no dose-limiting toxicity. This phase 2 study was designed to examine the safety and efficacy of gemcitabine and sorafenib in patients with recurrent EOC.Methods:Patients with recurrent EOC after platinum-based chemotherapy and who had subsequently received up to 3 prior chemotherapy regimens were eligible. Gemcitabine (1000 mg/m2 intravenous [IV]) was administered weekly for 7 of 8 weeks in the first cycle, then weekly for 3 weeks of each subsequent 4-week cycle. Sorafenib (400 mg p.o. bid) was given continuously. The primary end point for this trial was objective response rate by the Response Evaluation Criteria in Solid Tumors. Secondary endpoints included Gynecologic Cancer Intergroup (GCIG) CA-125 response, time to progression, overall survival, and toxicity.Results:Forty-three patients were enrolled, and 33 completed at least 1 cycle. Two patients had a partial response (Response Evaluation Criteria in Solid Tumors objective response rate = 4.7%). Ten patients (23.3%) maintained response or stable disease for at least 6 months. GCIG CA-125 response was 27.9%. The median time to progression was 5.4 months, and the median overall survival was 13.0 months. Hematologic toxicity was common but manageable. The most common nonhematologic adverse events were hand-foot syndrome, fatigue, hypokalemia, and diarrhea.Conclusion:This trial of gemcitabine and sorafenib in recurrent EOC did not meet its primary efficacy end point, but the combination was associated with encouraging rates of prolonged stable disease and CA-125 response.
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Tomao F, Panici PB, Frati L, Tomao S. Emerging role of pemetrexed in ovarian cancer. Expert Rev Anticancer Ther 2010; 9:1727-35. [PMID: 19954283 DOI: 10.1586/era.09.141] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current treatment of choice of epithelial ovarian cancer involves aggressive tumor cytoreductive surgery followed by platinum- and taxane-based chemotherapy; however, despite the encouraging activity of these agents, most ovarian carcinomas relapse and many patients die from drug-resistant disease. After the failure of platinum- and taxane-based schedules, several cytotoxic agents have demonstrated activity in advanced ovarian cancer but none were able to induce significant and durable responses. Among the new cytotoxic agents, pemetrexed plays an emerging role in different tumors, demonstrating competitive activity and a promising safety profile. In ovarian cancer, pemetrexed has been investigated, with encouraging results, as a single agent and in association with platinum compounds; moreover, the drug has shown interesting activity both in platinum-sensitive and platinum-resistant ovarian cancer. According to these clinical results it appears reasonable to explore the combination of pemetrexed with other cytotoxic agents and also with targeted therapies in relapsed ovarian cancer patients.
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Affiliation(s)
- Federica Tomao
- Dipartimento di Ginecologia, Perinatologia ed Ostetricia, Università di Roma Sapienza, Viale Regina Elena 324,00161, Rome, Italy
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Gordon AN, Teneriello M, Lim P, Janicek MF, Burkholder TL, Wang Y, Orlando M, Obasaju CK, Gill JF, Tai DF. Phase III Trial of Induction Gemcitabine or Paclitaxel Plus Carboplatin Followed by Elective Paclitaxel Consolidation in Ovarian Cancer: Interim Analysis of Induction Chemotherapy. ACTA ACUST UNITED AC 2009. [DOI: 10.3816/coc.2009.n.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Alvarez RD, Mannel R, García AA, Gallion HH, Lucci J, Kilgore LC, Numnum TM, Zou SX, Orlando M, Tai DF. Fixed-dose rate gemcitabine plus carboplatin in relapsed, platinum-sensitive ovarian cancer patients: results of a three-arm Phase I study. Gynecol Oncol 2009; 115:389-95. [PMID: 19800673 DOI: 10.1016/j.ygyno.2009.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 09/01/2009] [Accepted: 09/07/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Standard infusion of gemcitabine plus carboplatin showed improved efficacy compared to carboplatin alone in patients with platinum-sensitive (Pt-S) ovarian cancer (OC). Fixed-dose rate (FDR) administration of gemcitabine produces more efficient intracellular phosphorylation of gemcitabine to its active form. This study was designed to identify the maximum tolerated dose (MTD), toxicity profile, and response rate of FDR gemcitabine plus carboplatin in Pt-S OC. METHODS Patients with measurable OC relapsing > or =6 months after exposure to platinum (N=60) were assigned to one of three treatment cohorts, each with a different delivery schedule and escalating doses of both FDR gemcitabine (10 mg/m(2)/min) and standard infusion carboplatin (60 min). MTDs were determined using dose-limiting toxicities (DLTs). Measurable disease was assessed using modified RECIST criteria. CA-125 levels were evaluated using Rustin criteria. Toxicities were assessed using NCI Common Toxicity Criteria, version 2.0. RESULTS The MTD of Arm 1 was FDR gemcitabine 1000 mg/m(2) on days 1 and 8 plus carboplatin AUC 5 on day 1, every 21 days. The MTD of Arm 2 was FDR gemcitabine 1000 mg/m(2) on days 1 and 8 plus carboplatin AUC 2.5+AUC 2.5 on days 1 and 8, every 21 days. Patient accrual on Arm 3 consisting of bi-weekly FDR gemcitabine plus carboplatin was terminated because dose level 1 exceeded the MTD. Overall response rates were 38.1% (Arm 1), 58.8% (Arm 2), and 44.4% (Arm 3). CONCLUSIONS FDR gemcitabine+carboplatin on a 21-day schedule was active and produced no unusual safety signals in patients with Pt-S OC.
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Hoekstra AV, Hurteau JA, Kirschner CV, Rodriguez GC. The combination of monthly carboplatin and weekly paclitaxel is highly active for the treatment of recurrent ovarian cancer. Gynecol Oncol 2009; 115:377-81. [PMID: 19800107 DOI: 10.1016/j.ygyno.2009.08.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 08/19/2009] [Accepted: 08/27/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the response rate and toxicity of a regimen comprised of monthly carboplatin and weekly paclitaxel for recurrent ovarian cancer. METHODS We performed a retrospective chart review of patients with recurrent ovarian cancer treated between 2001 and 2006 at a single institution with carboplatin AUC 5 (day 1), and paclitaxel 80 mg/m(2) (days 1, 8, 15) of a 28-day cycle. Primary endpoints were response rate, progression-free survival and overall survival. RESULTS Twenty patients were treated with this regimen from 2001 to 2006. Stage ranged from stages IC to IV. All received intravenous platinum and taxane as their initial therapy. Histologic subtypes included papillary serous (17), carcinosarcoma (1), and clear cell (2). The median number of prior regimens was 1 (range 1-3). The overall response rate was 85.0% (15 complete responses, 2 partial responses). Patients with tumors categorized as platinum sensitive had a response rate of 93.3% (14/15) and those with tumors deemed platinum resistant had a response rate of 60.0% (3/5). The median survival has not yet been reached after a median follow-up of 28 months. Neutropenia was the only grade 3/4 toxicity, occurring in 7 patients (35.0%). Platinum hypersensitivity reactions occurred in 5 patients (25.0%) who all successfully continued treatment using a carboplatin desensitization protocol. CONCLUSIONS A monthly carboplatin and weekly paclitaxel regimen is highly active for women with recurrent platinum-sensitive and platinum-resistant epithelial ovarian cancer. The regimen is well tolerated. This pilot series demonstrates the potential for this regimen as treatment of choice among doublet first salvage regimens for patients with recurrent epithelial ovarian cancer, thus warranting multi-institutional study.
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Affiliation(s)
- Anna V Hoekstra
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, NorthShore University HealthSystem, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Kang H, Kim TJ, Choi CH, Lee JW, Lee JH, Bae DS, Kim BG. Phase II study of combination chemotherapy with etoposide and ifosfamide in patients with heavily pretreated recurrent or persistent epithelial ovarian cancer. J Korean Med Sci 2009; 24:945-50. [PMID: 19794997 PMCID: PMC2752782 DOI: 10.3346/jkms.2009.24.5.945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 10/31/2008] [Indexed: 11/28/2022] Open
Abstract
The aim of this trial was to investigate the efficacy and toxicity of combination chemotherapy with etoposide and ifosfamide (ETI) in the management of heavily pretreated recurrent or persistent epithelial ovarian cancer (EOC). Patients with recurrent or persistent EOC who had measurable disease and at least two prior chemotherapy participating in this phase II trial were to receive etoposide at a dose of 100 mg/m(2)/day intravenously (IV) on days 1 to 3 in combination with ifosfamide 1 g/m(2)/day IV on days 1 to 5, every 21 days. Thirty-seven patients were treated; about 78% had previously received more than two separate regimens. The response rate (RR) was 18.9% and median duration of response was 7 months (range, 1-15). Treatment free interval prior to ETI (TFI) has significant correlation with RR rate (P=0.034). Patients (n=6) with TFI > or =6 months had 50% of RR, while patients (n=31) with TFI <6 months had 12.9%. Median survival was 9 months at a median follow-up of 9.2 months. Grade 3 or 4 toxicities included neutropenia in 20.1% of the 139 cycles of ETI, anemia in 7.2% and thrombocytopenia in 8.6%. The ETI produces relatively low toxicity and modest activity in heavily pretreated recurrent or persistent EOC. This is significant in patients with TFI > or =6 months.
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Affiliation(s)
- Heeseok Kang
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Je-Ho Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk-Soo Bae
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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