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Lai CH, Vallikad E, Lin H, Yang LY, Jung SM, Liu HE, Ou YC, Chou HH, Lin CT, Huang HJ, Huang KG, Qiu J, Hung YC, Wu TI, Chang WY, Tan KT, Lin CY, Chao A, Chang CJ. Maintenance of pegylated liposomal doxorubicin/carboplatin in patients with advanced ovarian cancer: randomized study of an Asian Gynecologic Oncology Group. J Gynecol Oncol 2019; 31:e5. [PMID: 31788995 PMCID: PMC6918895 DOI: 10.3802/jgo.2020.31.e5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/19/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives An Asian Gynecologic Oncology Group phase III randomized trial was conducted to determine whether maintenance chemotherapy could improve progression-free survival (PFS) in stages III/IV ovarian cancer. Methods Between 2007 and 2014, 45 newly-diagnosed ovarian cancer patients were enrolled after complete remission and randomized (1:1) to arm A (4-weekly carboplatin area under the curve 4 and pegylated liposomal doxorubicin [PLD] 30 mg/m2, n=24) for 6 cycles or arm B (observation, n=21). The primary end-point was PFS. A post hoc translational study was conducted to deep sequence BRCA/homologous recombination deficiency (HRD) genes, because BRCA/HRD mutations (BRCA/HRDm) are known to be associated with better prognosis. Results Enrollment was slow, accrual was closed when 7+ years had passed. With a median follow-up of 88.9 months, the median PFS was significantly better in arm A (55.5 months) than arm B (9.2 months) (hazard ratio [HR]=0.40; 95% confidence interval [CI]=0.19–0.87; p=0.020), yet the median overall survival was not significantly different in arm A (not reached) than arm B (95.1 months) (p=0.148). Overall grade 3/4 adverse events were more frequent in arm A than arm B (60.9% vs 0.0%) (p<0.001). Quality of life was generally not significantly different. Distribution of BRCA1/2m or BRCA/HRDm was not significantly biased between the two arms. Wild-type BRCA/non-HRD subgroup seemed to fare better with maintenance therapy (HR=0.35; 95% CI=0.11–1.18; p=0.091). Conclusions Despite limitations in small sample size, it suggests that maintenance carboplatin-PLD chemotherapy could improve PFS in advanced ovarian cancer.
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Affiliation(s)
- Chyong Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan.
| | - Elizabeth Vallikad
- Department of Gynecologic Oncology, St. John's Medical College, Bangalore, India
| | - Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Lan Yan Yang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Data Management and Biostatistical Core, Asian Gynecologic Oncology Group, Taoyuan, Taiwan
| | - Shih Ming Jung
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsueh Erh Liu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Department of Rheumatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Yu Che Ou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi Branch, Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Hung Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng Tao Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Huei Jean Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuan Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jiantai Qiu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yao Ching Hung
- Department of Obstetrics and Gynecology, China Medical University and China Medical University Hospital, Taichung, Taiwan
| | - Tzu I Wu
- Department of Obstetrics and Gynecology, Taipei Municipal Wanfang Hospital, Taipei, Taiwan
| | - Wei Yang Chang
- Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Data Management and Biostatistical Core, Asian Gynecologic Oncology Group, Taoyuan, Taiwan
| | | | - Chiao Yun Lin
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Angel Chao
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chee Jen Chang
- Data Management and Biostatistical Core, Asian Gynecologic Oncology Group, Taoyuan, Taiwan.,Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
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