Delays in cycles and reduction of chemotherapy dose reduce the effectiveness of treatment in patients with ovarian cancer
DOI:
https://doi.org/10.22141/oncology.2.1.2019.165445Keywords:
ovarian cancer, polychemotherapy, delay in cycles, dose reduction, the effectiveness of treatmentAbstract
Every year, 205,000 new cases of ovarian cancer (OC) and 125,000 deaths from this pathology are diagnosed worldwide. The standard approach to treating patients with epithelial OC stages III–IV is primary cytoreduction with subsequent adjuvant chemotherapy or neoadjuvant chemotherapy followed by cytoreduction. Numerous studies have shown the safety and good tolerability of combined platinum-based palliative chemotherapy (PCT) in patients with OC, but in some patients, the toxicity caused by the use of chemotherapeutic agents results in delay in cycles and reduced PCT doses. In the meta-analysis conducted by Olawaiye et al. (2018), the effect of PCT dose modification on treatment outcomes in patients with OC was evaluated. In the study, in the group of patients without PCT dose modification, the median of disease-free survival was 17.5 months, whereas in patients with PCT dose modification, this indicator was 9.9 months (p = 0.001). Patients without PCT dose modification showed a statistically significant advantage in terms of the overall survival (OS) (48.0 versus 28.7 months in patients with PCT dose modification) (p = 0.021). In another study, in patients with one time delay in cycles, the median OS was 2.5 years, in women with 2 or more delays in cycles, median OS was 1.7 years (p = 0.03), while in women without dose delays, this indicator was 4.0 years (p = 0.02). The delay in PCT cycles, as well as the reduction of chemotherapy doses, are factors that can reduce the effectiveness of treatment, so the above phenomena must be avoided to ensure the effectiveness of chemotherapy for ovarian cancer.
References
Parkin D.M., Bray F., Ferlay J., Pisani P. Global cancer statistics, 2002 // CA Cancer J. Clin. — 2005. — 55. — 74-108.
American Cancer Society, Cancer Facts & Figures 2011, American Cancer Society, Atlanta, 2011.
Vergote I., Trope C.G., Amant F., Kristensen G.B., Ehlen T., Johnson N. et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer // N. Engl. J. Med. — 2010. — 363. — 943-953.
Bristow R.E., Tomacruz R.S., Armstrong D.K., Trimble E.L., Montz F.J. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis // J. Clin. Oncol. — 2002. — 20. — 1248-1259.
Aabo K., Adams M., Adnitt P., Alberts D.S., Athanazziou A., Barley V. et al. Chemotherapy in advanced ovarian cancer: four systematic meta-analyses of individual patient data from 37 randomized trials. Advanced Ovarian Cancer Trialists’ Group // Br. J. Cancer. — 1998. — 78. — 1479-1487.
Chemotherapy in advanced ovarian cancer: an overview of randomised clinical trials. Advanced Ovarian Cancer Trialists Group // BMJ. — 1991. — 303. — 884-893 (No authors listed).
Cyclophosphamide plus cisplatin versus cyclophosphamide, doxorubicin, and cisplatin chemotherapy of ovarian carcinoma: a meta-analysis. The Ovarian Cancer Meta-Analysis Project // J. Clin. Oncol. — 1991. — 9. — 1668-1674 (No authors listed).
A’Hern R.P., Gore M.E. Impact of doxorubicin on survival in advanced ovarian cancer // J. Clin. Oncol. — 1995. — 13. — 726-732.
McGuire W.P., Hoskins W.J., Brady M.F., Kucera P.R., Partridge E.E., Look K.Y. et al. Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer // N. Engl. J. Med. — 1996. — 334. — 1-6.
Piccart M.J., Bertelsen K., James K., Cassidy J., Mangione C., Simonsen E. et al. Randomized intergroup trial of cisplatin-paclitaxel versus cisplatin-cyclophosphamide in women with advanced epithelial ovarian cancer: three-year results // J. Natl. Cancer Inst. — 2000. — 92. — 699-708.
Muggia F.M., Braly P.S., Brady M.F., Sutton G., Niemann T.H., Lentz S.L. et al. Phase III randomized study of cisplatin versus paclitaxel versus cisplatin and paclitaxel in patients with suboptimal stage III or IV ovarian cancer: a Gynecologic Oncology Group study // J. Clin. Oncol. — 2000. — 18. — 106-115.
Ozols R.F., Bundy B.N., Greer B.E., Fowler J.M., Clarke-Pearson D., Burger R.A. et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study // J. Clin. Oncol. — 2003. — 21. — 3194-3200.
du Bois A., Luck H.J., Meier W., Adams H.P., Möbus V., Costa S. et al. A Randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer // J. Natl. Cancer Inst. — 2003. — 95. — 1320-1329.
Neijt J.P., Engelholm S.A., Tuxen M.K., Sorensen P.G., Hansen M., Sessa C. et al. Exploratory phase III study of paclitaxel and cisplatin versus paclitaxel and carboplatin in advanced ovarian cancer // J. Clin. Oncol. — 2000. — 18. — 3084-3092.
Armstrong D.K., Bundy B., Wenzel L., Huang H.Q., Baergen R., Lele S. et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer // N. Engl. J. Med. — 2006. — 354. — 34-43.
Cannistra S.A. Canceroftheovary // N. Engl. J. Med. — 2004. — 351. — 2519-2529.
Watring W., Semrad N., Alaverdian V., Latino F., Pretorius G. Second-look procedures in ovarian cancer patients receiving six vs. nine courses of platinum, adriamycin, cytoxan (PAC) chemotherapy: the SCPMG experience 1982–1985 // Gynecol. Oncol. — 1989. — 32. — 245-247.
Hakes T.B., Chalas E., Hoskins W.J., Jones W.B., Markman M., Rubin S.C. et al. Randomized prospective trial of 5 versus 10 cycles of cyclophosphamide, doxorubicin, and cisplatin in advanced ovarian carcinoma // Gynecol. Oncol. — 1992. — 45. — 284-289.
Bertelsen K., Jakobsen A., Stroyer J., Nielsen K., Sandberg E., Andersen J.E. et al. A prospective randomized comparison of 6 and 12 cycles of cyclophosphamide, adriamycin and cisplatin in advanced epithelial ovarian cancer: a Danish Ovarian Study Group trial (DACOVA) // Gynecol. Oncol. — 1993. — 49. — 30-36.
Lambert H.E., Rustin G.J., Gregory W.M., Nelstrop A.E. A randomized trial of five versus eight courses of cisplatin or carboplatin in advanced epithelial ovarian carcinoma. A North Thames Ovary Group study // Ann. Oncol. — 1997. — 8. — 327-333.
Bolis G., Scarfone G., Polverino G., Raspagliesi F., Tateo S., Richiardi G. et al. Paclitaxel 175 or 225 mg per meters squared with carboplatin in advanced ovarian cancer: a randomized trial // J. Clin. Oncol. — 2004. — 22. — 686-690.
Olawaiye et al. Does adjuvant chemotherapy dose modification have an impact on the outcome of patients diagnosed with advanced stage ovarian cancer... // Gynecol. Oncol. — 2018. — https://doi.org/10.1016/j.ygyno.2018.07.021
Bookman M.A., Brady M.F., McGuire W.P., Harper P.G., Alberts D.S., Friedlander M. et al. Evaluation of new platinum-based treatment regimens in advanced-stage ovarian cancer: Phase III Trial of the Gynecologic Cancer Intergroup // J. Clin. Oncol. — 2009. — 27. — 1419-1425.
Family L. et al. The effect of chemotherapy-induced anemia on dose reduction and dose delay // Support Care Cancer. — 2016. — 24. — 4263-4271. DOI 10.1007/s00520-016-3258-3
Watring W., Semrad N., Alaverdian V., Latino F., Pretorius G. Second-look procedures in ovarian cancer patients receiving six vs. nine courses of platinum, adriamycin, cytoxan (PAC) chemotherapy: the SCPMG experience 1982–1985 // Gynecol. Oncol. — 1989. — 32. — 245-247.
Thatcher N., Girling D.J., Hopwood P., Sambrook R.J., Qian W., Stephens R.J. Improving survival without reducing quality of life in small-cell lung cancer patients by increasing the dose-intensity of chemotherapy with granulocyte colony-stimulating factor support: results of a British Medical Research Council Multicenter Randomized Trial. Medical Research Council Lung Cancer Working Party // J. Clin. Oncol. — 2000. — 18. — 395-404.
Siegel R., Ward E., Brawley O., Jemal A. Cancer Statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths // CA Cancer J. Clin. — 2011. — 61. — 212-236.
Joseph N., Clark M., Dizon S. Delay in chemotherapy administration impacts survival in elderly patients with epithelial ovarian cancer // Gynecologic Oncology. — 2015. — http://dx.doi.org/10.1016/j.ygyno.2015.03.052
Thigpen T., Brady M.F., Omura G.A., Creasman W.T., Hoskins W.J., Williams S. Age as a prognostic factor in ovarian carcinoma. The Gynecologic Oncology Group Experience // Cancer. — 1993. — 71 (suppl. 2). — 606-14.
Cloven N.G., Manetta A., Berman M.L., Kohler M.F., DiSaia P.J. Management of ovarian cancer in patients older than 80 years of age // Gynecol. Oncol. — 1999. — 73(1). — 137-9.
Sundararajan V., Hershman D., Gann V.R., Jacobson J.S., Neugut A.I. Variations in the use of chemotherapy for elderly patients with advanced ovarian cancer: a population-based study // J. Clin. Oncol. — 2002. — 20(1). — 173-8.
Hershman D., Jacobson J.S., McBride R., Mitra N., Sundararahan V., Grann V.R., Neugut A.I. Effectiveness of platinum-based chemotherapy among elderly patients with advanced ovarian cancer // Gynecol. Oncol. — 2004. — 94(2). — 540-9.
Alberts D.S., Dahlberg S., Green S.J., Garcia D., Hannigan E.V., O’Toole R., Stock-Novack D., Surwit E.A., Malviya V.K., Jolles C.J. Analysis of patient age as an independent prognostic factor for survival in a phase III study of cisplatin-cyclophosphamide versus carboplatin-cyclophosphamide in stage III (suboptimal) and IV ovarian cancer. A Southwest Oncology Group study // Cancer. — 1993. — 71(2). — 618-27.
Chiara S., Lionetto R., Vincenti M., Bruzzone M., Nobile M.T., Gadducci A., Carnino F., Rosso R., Conte P.F. Advanced ovarian cancer in the elderly: results of consecutive trials with cisplatin-based chemotherapy // Crit. Rev. Oncol. Hematol. — 2001. — 37(1). — 27-34.
Ten Berg M.J. Thrombocytopenia in adult cancer patients receiving cytotoxic chemotherapy: results from a retrospective hospital-based cohort study / Ten Berg M.J., van den Bemt P.M., Shantakumar S. // Drug Saf. — 2011 Dec 1. — 34(12). —1151-60.
Прихована загроза — тромбоцитопенія, індукована хіміотерапією / Є.С. Готько, В.Ф. Завізіон, С.А. Лялькін та ін. // Медична газета «Здоров’я України». — 2018. — № 13–14(434-435).
Тромбоцитопенія: перспективи діагностики та лікування. Виступи провідних лікарів Китайської Народної Республіки на конференції 27–28 квітня 2018 року в Києві / К. Марушко // Медична газета «Здоров’я України», тематичний номер «Онкологія. Гематологія. Хіміотерапія». — 2018. — № 3(54).
Vadhan-Raj S., Patel S., Bueso-Ramos C., Folloder J., Papadopolous N., Burgess A., Broemeling L.D., Broxmeyer H.E., Benjamin R.S. Importance of Predosing of Recombinant Human Thrombopoietin to Reduce Chemotherapy-Induced Early Thrombocytopenia // Journal of Clinical Oncology. — 2003. — Vol. 21, № 16. — 3158-3167.
Downloads
Issue
Section
License
Copyright (c) 2019 Practical oncology

This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
- The rights to the article are deemed transferred by the authors to the edition (the publisher) since the moment of the publication of the article in the printed or electronic version of journal.