Superiority of Weekly Paclitaxel Challenges Ovarian Cancer Treatment Paradigm

lindaprocopio

This just came out February, 2010, and I found it fascinating:

Superiority of Weekly Paclitaxel Challenges Ovarian Cancer Treatment Paradigm

Dr. Maurie Markman is Vice President, Clinical Research; Professor, Gynecologic Medical Oncology; and Chair, Gynecologic Medical Oncology; The University of Texas M.D. Anderson Cancer Center.

1. In your view, which development that has occurred since September 2007 could have the most significant impact on gynecologic oncology?

There were several highly meaningful events over the past year in the management of female pelvic malignancies, but, in my opinion, the single most important report came from the Japanese Gynecologic Oncology Group, as presented at the 2008 Annual Meeting of the American Society of Clinical Oncology (ASCO). These investigators presented preliminary data from their randomized phase III trial that compared a regimen of carboplatin (delivered every 3 weeks) plus paclitaxel, administered either on an every-3-weeks schedule (standard approach) or weekly (experimental approach) (J Clin Oncol. 2008;26:294s).
The study revealed a highly statistically significant 11-month improvement in median progression-free survival in favor of the weekly schedule (17.2 vs 28 months; P = .0015; hazard ratio [HR], 0.714), and a more modest improvement in 2-year overall survival (77% vs 83.6%; P = 0.0496; HR, 0.735). Data on median overall survival were not available at the time of the ASCO presentation.

2. What specific changes in oncology have you observed or do you foresee as a result of this development?

This study seriously challenges the current management paradigm for the use of paclitaxel in ovarian cancer, whereby the agent is routinely employed on an every-3-weeks schedule. These data also raise the issue of whether paclitaxel should be delivered on the more frequent schedule in the treatment of endometrial and cervical cancer, for which paclitaxel is a component of several routinely administered treatment programs.
Future studies in ovarian cancer will need to consider employing the weekly approach. In addition, the implications of the new results for any ongoing studies (including those exploring the addition of novel targeted therapies) that are employing an every-3-weeks regimen, rather than weekly administration, will need to be addressed.
I believe that, based on the data from this important Japanese trial, oncologists should consider the use of weekly paclitaxel with carboplatin as primary therapy for advanced ovarian cancer.

3. Could you put this development into historical perspective for the practicing oncologist?

This was the first evidence-based, randomized, phase III trial reported in more than a decade that has revealed an improvement in outcome for a systemically delivered chemotherapy strategy administered as primary treatment of advanced ovarian cancer. (Three randomized trials over this period have shown the superiority of intraperitoneal cisplatin, compared with the systemic delivery of this agent, when employed as front-line therapy for small-volume residual advanced ovarian cancer.)

While the Japanese Gynecologic Oncology Group trial is only a single study, the results are consistent with those from 2 recently reported studies in breast cancer that demonstrated the superiority of weekly scheduling over an every-3-weeks paclitaxel regimen (N Engl J Med 2008;358:1663-1671; J Clin Oncol 2008;26:1642). These data provide important support for the validity of the Japanese phase III trial.

4. Would you sum up, in a single sentence, why you chose this development as the top story of the past year?

I consider this development to be the single most important event in the management of female pelvic malignancies because it challenges the long-standing (>10-year) existing paradigm in the systemic treatment of ovarian cancer, and it represents an approach that may be employed in several settings to improve outcomes in gynecologic malignancies.

MK_4Dani

I hope it works...I did it.
I have seen this article...is it from the up-to-date website? When I started chemo, I wondered why I was getting weekly taxol and then saw a similar subject matter article. I hope this is a break-thru for all new OVCA patients. I like the stats! Anyone with a new diagnosis should talk to their ONC about this trial. I will let everyone know the results of my scans scheduled in a few weeks.
MK

lindaprocopio

MK_4Dani said:

I hope it works...I did it.
I have seen this article...is it from the up-to-date website? When I started chemo, I wondered why I was getting weekly taxol and then saw a similar subject matter article. I hope this is a break-thru for all new OVCA patients. I like the stats! Anyone with a new diagnosis should talk to their ONC about this trial. I will let everyone know the results of my scans scheduled in a few weeks.
MK

Brand-new: Feb 2010: www.oncologystat.com
You have to register to access the articles on this website, but it is free to register: oncologystat.com

The email I got after I registered for their e-Bulletins on Ovararian and Gynecologic cancer said "You are now a part of a growing group of 30,000+ oncology professionals,", so clearly this is targeted to oncologists, so we'll see how much of the research they send I can understand.

froggy1

Thanks Linda
Thanks for posting. I only hope that our oncologists have the time to keep up with the research. I know Dr. Markman is one the leaders in ovarian cancer research. It does seem with so many of these studies, however, that they are not 100% definitive. There is always a "BUT." I have mentioned a few to my onc. and he just kind of shrugs. This darn disease is just so finicky. It makes is difficult to decide which course of treatment to take when there is no agreement among the professionals! AND, we are all different fingerprints, so who knows. If they could figure out why some women never have a recurrence, we would all be shopping on Ebay right now instead of being here! LOL
I was thinking of switching to MD Anderson, but what told all they are interested in is research and making you a guinea pig, so not sure what to do. And yet, these guinea pigs give us all hope!
Thanks again for sharing, Froggy

Hissy_Fitz

froggy1 said:

Thanks Linda
Thanks for posting. I only hope that our oncologists have the time to keep up with the research. I know Dr. Markman is one the leaders in ovarian cancer research. It does seem with so many of these studies, however, that they are not 100% definitive. There is always a "BUT." I have mentioned a few to my onc. and he just kind of shrugs. This darn disease is just so finicky. It makes is difficult to decide which course of treatment to take when there is no agreement among the professionals! AND, we are all different fingerprints, so who knows. If they could figure out why some women never have a recurrence, we would all be shopping on Ebay right now instead of being here! LOL
I was thinking of switching to MD Anderson, but what told all they are interested in is research and making you a guinea pig, so not sure what to do. And yet, these guinea pigs give us all hope!
Thanks again for sharing, Froggy

MDACC
Froggy....

MDA is one of the foremost cancer centers in the entire USA. My "Plan B" is to go to MD Anderson Cancer Center if I have a recurrence in less than a year. It's true that they conduct a lot of trials, and that they are aggressive in many of their treatment plans, but my thinking is, what do I have to lose?

Unknown

Hissy_Fitz said:

MDACC
Froggy....

MDA is one of the foremost cancer centers in the entire USA. My "Plan B" is to go to MD Anderson Cancer Center if I have a recurrence in less than a year. It's true that they conduct a lot of trials, and that they are aggressive in many of their treatment plans, but my thinking is, what do I have to lose?

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