Identification of Patients with Recurrent Epithelial Ovarian Cancer Who Will Benefit from More Than Three Lines of Chemotherapy
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: This study aimed to identify patients who would benefit from third and subsequent lines of chemotherapy in recurrent epithelial ovarian cancer (EOC). Materials and methods: Recurrent EOC patients who received third, fourth, or fifth-line palliative chemotherapy were retrospectively analyzed. Patients' survival outcomes were assessed according to chemotherapy lines. Based on the best objective response, patients were divided into good-response (stable disease or better) and poor response (progressive disease or those who died before response assessment) groups. Survival outcomes were compared between the two groups, and factors associated with chemotherapy responses were investigated. Results: A total of 189 patients were evaluated. Ninety-four and 95 patients were identified as good and poor response group respectively, during the study period of 2008 to 2021. The poor response group showed significantly worse progression-free survival (median, 2.1 months vs. 9.7 months; p < 0.001) and overall survival (median, 5.0 months vs. 22.9 months; p < 0.001) compared with the good response group. In multivariate analysis adjusting for clinicopathologic factors, short treatment-free interval (TFI) (hazard ratio [HR], 5.557; 95% confidence interval [CI], 2.403 to 12.850), platinum-resistant EOC (HR, 2.367; 95% CI, 1.017 to 5.510), and non-serous/endometrioid histologic type (HR, 5.045; 95% CI, 1.152 to 22.088) were identified as independent risk factors for poor response. There was no difference in serious adverse events between good and poor response groups (p=0.167). Conclusion: Third and subsequent lines of chemotherapy could be carefully considered for palliative purposes in recurrent EOC patients with serous or endometrioid histology, initial platinum sensitivity, and long TFIs from the previous chemotherapy regimen.
Abstract
Purpose: This study aimed to identify patients who would benefit from third and subsequent lines of chemotherapy in recurrent epithelial ovarian cancer (EOC). Materials and methods: Recurrent EOC patients who received third, fourth, or fifth-line palliative chemotherapy were retrospectively analyzed. Patients' survival outcomes were assessed according to chemotherapy lines. Based on the best objective response, patients were divided into good-response (stable disease or better) and poor response (progressive disease or those who died before response assessment) groups. Survival outcomes were compared between the two groups, and factors associated with chemotherapy responses were investigated. Results: A total of 189 patients were evaluated. Ninety-four and 95 patients were identified as good and poor response group respectively, during the study period of 2008 to 2021. The poor response group showed significantly worse progression-free survival (median, 2.1 months vs. 9.7 months; p < 0.001) and overall survival (median, 5.0 months vs. 22.9 months; p < 0.001) compared with the good response group. In multivariate analysis adjusting for clinicopathologic factors, short treatment-free interval (TFI) (hazard ratio [HR], 5.557; 95% confidence interval [CI], 2.403 to 12.850), platinum-resistant EOC (HR, 2.367; 95% CI, 1.017 to 5.510), and non-serous/endometrioid histologic type (HR, 5.045; 95% CI, 1.152 to 22.088) were identified as independent risk factors for poor response. There was no difference in serious adverse events between good and poor response groups (p=0.167). Conclusion: Third and subsequent lines of chemotherapy could be carefully considered for palliative purposes in recurrent EOC patients with serous or endometrioid histology, initial platinum sensitivity, and long TFIs from the previous chemotherapy regimen.
참고문헌 (30)
- Bray F, "Global cancer statistics 2018 : GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries", CA Cancer J Clin, 68, pp.394~424 (2018)
- Sung H, "Global cancer statistics 2020 : GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries", CA Cancer J Clin, 71, pp.209~249 (2021)
- Ferlay J, "Estimates of worldwide burden of cancer in 2008 : GLOBOCAN 2008", Int J Cancer, 127, pp.2893~2917 (2010)
- Ozols RF, "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, 21, pp.3194~3200 (2003)
- Jayson GC, "Ovarian cancer", Lancet, 384, pp.1376~1388 (2014)
- Herzog TJ, "Recurrent ovarian cancer : how important is it to treat to disease progression?", Clin Cancer Res, 10, pp.7439~7449 (2004)
- Browner I, "Palliative chemotherapy : historical perspective, applications, and controversies", Semin Oncol, 32, pp.145~155 (2005)
- Jang TK, "Trends in treatment during the last stages of life in end-stage gynecologic cancer patients who received active palliative chemotherapy : a comparative analysis of 10-year data in a single institution", BMC Palliat Care, 17, pp.99~ (2018)
- Ventafridda V, "According to the 2002 WHO definition of palliative care", Palliat Med, 20, pp.159~ (2006)
- Earle CC, "Trends in the aggressiveness of cancer care near the end of life", J Clin Oncol, 22, pp.315~321 (2004)
- Murillo JR Jr, "Chemotherapy given near the end of life by community oncologists for advanced non-small cell lung cancer", Oncologist, 11, pp.1095~1099 (2006)
- Watanabe-Galloway S, "Quality of end-of-life care among rural Medicare beneficiaries with colorectal cancer", J Rural Health, 30, pp.397~405 (2014)
- Urban RR, "The end of life costs for Medicare patients with advanced ovarian cancer", Gynecol Oncol, 148, pp.336~341 (2018)
- Lamont EB, "Prognostic disclosure to patients with cancer near the end of life", Ann Intern Med, 134, pp.1096~1105 (2001)
- Eisenhauer EA, "New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)", Eur J Cancer, 45, pp.228~247 (2009)
- National Institutes of Health, "Common Terminology Criteria for Adverse Events (CTCAE) version 4.0", National Institutes of Health, ~ (2009)
- Giorgi F, "Chemotherapy use at the end of life : an analysis of the decision making process", J Clin Oncol, 22, pp.6081~ (2004)
- Dans M, "NCCN Guidelines(R) insights: palliative care, version 2.2021", J Natl Compr Canc Netw, 19, pp.780~788 (2021)
- Hui D, "Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients", Cancer, 120, pp.1743~1749 (2014)
- Harrington SE, "The role of chemotherapy at the end of life : "when is enough, enough?"", JAMA, 299, pp.2667~2678 (2008)
- Shepherd FA, "Erlotinib in previously treated non-small-cell lung cancer", N Engl J Med, 353, pp.123~132 (2005)
- Massarelli E, "A retrospective analysis of the outcome of patients who have received two prior chemotherapy regimens including platinum and docetaxel for recurrent non-small-cell lung cancer", Lung Cancer, 39, pp.55~61 (2003)
- Griffiths RW, "Outcomes after multiple lines of chemotherapy for platinum-resistant epithelial cancers of the ovary, peritoneum, and fallopian tube", Int J Gynecol Cancer, 21, pp.58~65 (2011)
- Morita T, "The Palliative Prognostic Index : a scoring system for survival prediction of terminally ill cancer patients", Support Care Cancer, 7, pp.128~133 (1999)
- Chou WC, "The application of the Palliative Prognostic Index, charlson comorbidity index, and Glasgow Prognostic Score in predicting the life expectancy of patients with hematologic malignancies under palliative care", BMC Palliat Care, 14, pp.18~ (2015)
- Prigerson HG, "Chemotherapy use, performance status, and quality of life at the end of life", JAMA Oncol, 1, pp.778~784 (2015)
- Rose PG, "Nomogram for predicting individual survival after recurrence of advanced-stage, high-grade ovarian carcinoma", Obstet Gynecol, 133, pp.245~254 (2019)
- Tang ST, "Determinants of aggressive end-of-life care for Taiwanese cancer decedents, 2001 to 2006", J Clin Oncol, 27, pp.4613~4618 (2009)
- Hui D, "Quality of end-of-life care in patients with hematologic malignancies : a retrospective cohort study", Cancer, 120, pp.1572~1578 (2014)
- He Y, "Early onset neutropenia : a useful predictor of chemosensitivity and favorable prognosis in patients with serous ovarian cancer", BMC Cancer, 20, pp.116~ (2020)