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Paclitaxel and Carboplatin, Alone or With Irradiation, in Advanced or Recurrent Endometrial Cancer: A Phase II Study

From the Gynecologic Tumor Group and Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.

Address reprint requests to Paul J. Hoskins, MD, British Columbia Cancer Agency, 600 W 10th Ave, Vancouver, BC, Canada V5Z 4E6; email: phoskins{at}bccancer.bc.ca

	ABSTRACT

TOP ABSTRACT INTRODUCTION PATIENTS AND METHODS RESULTS DISCUSSION REFERENCES

 
PURPOSE: To evaluate the efficacy of carboplatin plus paclitaxel in primarily advanced or recurrent endometrial cancers.

PATIENTS AND METHODS: Four distinct patient groups received carboplatin (area under the curve, 5 to 7) plus paclitaxel 175 mg/m² for 3 hours at 4-week intervals: group 1 (n = 21), patients with primarily advanced, nonpapillary serous cancers; group 2 (n = 20), the same as group 1 but with papillary serous cancers; group 3 (n = 18), recurrent, nonpapillary serous cancers; and group 4 (n = 4), recurrent, papillary serous cancers. Involved-field irradiation was used in groups 1 and 2 for those with radioencompassable disease.

RESULTS: Sixty-three patients were treated. Response rates to chemotherapy in the assessable patients in the four groups were 78% (95% confidence interval [CI], 51% to 100%); 60% (95% CI, 35% to 85%), 56% (95% CI, 34% to 78%), and 50%, respectively. Nineteen patients (90%) in group 1 also were irradiated, and the median failure-free survival time for all 21 patients was 23 months, with a 62% 3-year overall survival rate. Eleven patients (55%) in group 2 were irradiated, and the median failure-free survival time for all 18 patients was 18 months, with a 39% 3-year overall survival rate. The median failure-free interval in the patients in group 3 was 6 months, with a 15-month median overall survival time. Toxicity was manageable, reversible, and predominantly hematologic. Two patients developed neutropenic fever, and three patients, including these two, were hospitalized for complications.

CONCLUSION: Carboplatin-paclitaxel is an efficacious, low-toxicity regimen for managing primarily advanced or recurrent endometrial cancers.

	INTRODUCTION

TOP ABSTRACT INTRODUCTION PATIENTS AND METHODS RESULTS DISCUSSION REFERENCES

 
CHEMOTHERAPY HAS a role in the management of endometrial cancer both in newly diagnosed patients with a high risk of relapse and in patients with recurrent disease. High-risk newly diagnosed patients include the 15% of patients who present with surgical stage IIIB or higher disease. The 5-year overall survival rate is 42% to 59% in the presence of stage IIIC disease and 18% to 30% for stage IV disease.¹ A second high-risk group comprises those with stage III or IV cancers of papillary serous histology, of whom less than 25% will be long-term survivors.^2-4 There is no consensus regarding the optimal chemotherapy, but the combination of cisplatin plus doxorubicin is commonly used. The results from Gynecologic Oncology Group Trial 107 support such an approach in that there was a significantly higher response rate (44% v 28%) and longer progression-free interval with cisplatin-doxorubicin compared with doxorubicin alone.⁵ Better chemotherapy is required because this response rate is too low, the regimen is unpleasantly toxic, the need for a saline diuresis precludes those with heart failure, and it is inconvenient for patients and consuming of nursing resources because of the hydration needed. Paclitaxel attracted attention for use in patients with endometrial cancer because of its success in ovarian and breast cancers. Three studies, all reported in 1996, demonstrated response rates of 36% to 43% when paclitaxel was used as a single agent.^6-8 Importantly, activity was demonstrated in truly platin-resistant patients.⁶ The next logical step to develop a potentially more effective chemotherapy regimen was to combine paclitaxel with a platin analog. We did so, using carboplatin because of its lesser toxicity. The results of treating patients with primarily advanced or recurrent endometrial cancers with carboplatin and paclitaxel are the subject of this article.

	PATIENTS AND METHODS

TOP ABSTRACT INTRODUCTION PATIENTS AND METHODS RESULTS DISCUSSION REFERENCES

 
Study Population
Patients were eligible if they had histologically documented endometrial cancer fulfilling any of the following criteria: (1) newly diagnosed, primarily advanced, ie, surgical stages IIIB, IIIC, or IV; clinical stage IV; IIIA with macroscopic ovarian involvement; or any stage with residual disease; or (2) recurrent after surgery and/or radiotherapy. There was no upper age limit, performance status had to be an Eastern Cooperative Oncology Group score of 3 or better, serum creatinine had to be less then 180 µmol/L, platelets had to be greater than 100 x 10⁹/L, and granulocytes had to be greater than 1.5 x 10⁹/L. The exclusion criteria included the presence of any sarcoma or small-cell component, second- or third-degree heart block, preexisting motor or sensory neuropathy, prior chemotherapy, or recurrent disease limited to a previously irradiated volume. Formal biopsy proof of recurrence was not required.

Treatment Regimen
Paclitaxel at a dose of 175 mg/m² was infused intravenously in 500 mL of normal saline for 3 hours using non–polyvinyl chloride equipment with in-line filtering. This was followed by carboplatin in 250 mL of 5% dextrose for 30 minutes, with the dose calculated using an area under the curve (AUC) of 5 to 7 as per the Calvert formula.⁹ Because this combination was new to us, we started the protocol using an AUC of 5 or 6 based on the individual treating physician’s subjective assessment of the patient’s potential ability to tolerate the treatment. With increased familiarity, this was modified to an AUC of 6 or 7. Fifty percent of patients were treated with an AUC of 6, 33% with an AUC of 5, and 17% with an AUC of 7. The glomerular filtration rate value was obtained either by nuclear renogram or calculated from the Cockcroft formula. Hydration was not required before or after treatment. A serotonin antagonist and dexamethasone were used as the antiemetics for the acute phase, followed by dexamethasone alone for the delayed phase. Standard paclitaxel anaphylaxis premedication was given using dexamethasone, diphenhydramine, and ranitidine. All treatment was on an outpatient basis and was repeated every 28 days. This time interval was chosen because this was the interval we used with single-agent carboplatin. Six cycles were administered unless there was documented disease progression, undue toxicity, or the patient had radioencompassable, newly diagnosed cancer (ie, stages III or IVA/IVB with inguinal or para-aortic nodal disease), in which case three cycles were administered, followed by irradiation. The aim of the radiotherapy was to treat all known areas of disease.

Dose Modification
Treatment was delayed until count recovery if the neutrophil count was less then 1.0 x 10⁹/L or if platelets were less than 100 x 10⁹/L. The dose was modified according to the hematologic nadirs as follows: if the patient had neutrophils less than 0.5 x 10⁹/L or platelets less than 75 x 10⁹/L, 80% of the preceding dose of carboplatin and paclitaxel was administered. If both values were above these values, full doses were administered. The carboplatin at cycle 2 was escalated to 120% of the cycle 1 dose if the neutrophils were greater than 1.5 x 10⁹/L and the platelets were greater than 100 x 10⁹/L. No further dose increases were allowed. If the serum creatinine increased by 20% over baseline, a new glomerular filtration rate was calculated or measured, and the carboplatin dose was decreased accordingly. The protocol was discontinued if the patient experienced severe myalgia or anaphylaxis.

Response Assessment/Survival
Response to the chemotherapy was assessed in those with measurable disease using repeat radiographic and clinical assessment. Responses were assessed before the use of any irradiation. A complete response was defined as the complete resolution of all disease. Partial response was defined as a 50% decrease in the sum of the products of the measured lesions, and any nonmeasurable lesions had to remain stable or regress. Stable disease was defined as a steady state of response, either less than a partial response or progression of less than 25%. Progressive disease was defined as an unequivocal increase of at least 25% in the sum of the products of the measured lesions or the appearance of any new lesions. Overall and failure-free survival were calculated from the date of first tissue diagnosis for advanced disease or from the date of initial recurrence for recurrent disease. Treatment failure was defined as disease progression, patient relapse, or death as a result of toxicity. Kaplan-Meier estimates were used.¹⁰

Toxicity
Toxicity was recorded as the worst ever per patient for this treatment regimen. For the purpose of this report, it is only recorded for the chemotherapy cycles and not for the radiotherapy component.

	RESULTS

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Sixty-three patients with a median age of 67 years (range, 35 to 85 years) were treated from the initiation of the study in August 1995 through November 1998. This later cutoff date was chosen to allow for a sufficiently long period of follow-up. Survival outcomes were updated as of August 2000. Four separate groups were treated: newly diagnosed, primarily advanced endometrial cancer, excluding papillary serous (group 1, n = 21); newly diagnosed, primarily advanced papillary serous (group 2, n = 20); recurrent endometrial cancer, excluding papillary serous (group 3, n = 18); and recurrent papillary serous (group 4, n = 4). Further details are given in Table 1. At diagnosis, the 18 patients in group 3 who had experienced relapse had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy (n = 15), the same plus omentectomy (n = 1), or dilation and curettage (n = 2). Their stages were I (n = 5), II (n = 6), III (n = 5), IV (n = 1), and unknown (n = 1). Sixteen then went on to receive pelvic irradiation (external beam plus brachytherapy), one had a vault cesium, and one received megestrol acetate. Only one other patient received hormones, and that was at the time of first relapse. Carboplatin and paclitaxel were administered at first relapse in 15 patients and at second relapse in three. The median time from diagnosis to the administration of chemotherapy was 31 months (range, 3 to 145 months). All the patients in groups 1 and 2, with the exception of six patients with widespread disseminated disease, underwent at least total abdominal hysterectomy, bilateral salpingo-oophorectomy, and abdominal exploration. During this period, nine patients who could have been treated on this protocol were treated in a different fashion. The reasons for this were physician choice (n = 7) and patient choice (n = 2). Nineteen (90%) of the patients in group 1 were treated with chemotherapy followed by irradiation, and two were treated with chemotherapy alone. In group 2, 11 (55%) received chemotherapy and irradiation, and nine received chemotherapy alone. The chemotherapy always preceded the irradiation. All the patients with recurrent disease received chemotherapy alone.

View larger version (9K): [in this window] [in a new window]   Fig 1. Overall and failure-free survival in patients with primarily advanced, nonpapillary serous cancers (group 1, n = 21). Solid line, overall survival; dotted line, failure-free survival.

View larger version (9K): [in this window] [in a new window]   Fig 2. Overall and failure-free survival in patients with primarily advanced, papillary serous cancers (group 2, n = 20). Solid line, overall survival; dotted line, failure-free survival.

View larger version (10K): [in this window] [in a new window]   Fig 3. Overall and failure-free with recurrent, nonpapillary serous cancers (group 3, n = 18). Solid line, overall survival; dotted line, failure-free survival.

Treatment Delivery
Fifty-eight patients received more than one cycle of chemotherapy. None of these treatments were delayed, but 13 patients (22%) had dose reductions. Thirty patients were irradiated. For group 1, the areas irradiated were whole abdomen and pelvis (n = 4; dose range, 22.5 Gy in 10 fractions to the pelvis followed by 22.5 Gy in 22 fractions to the whole abdomen, with kidney shielding after 15 Gy), pelvis and para-aortics (n = 8; dose range, 40 Gy in 25 fractions to 60 Gy in 33 fractions), and pelvis alone (n = 7; dose range, 45 to 50 Gy in 25 fractions). For group 2, the same doses were used, with the treated volumes being pelvis alone (n = 3), pelvis and para-aortics (n = 6), pelvis plus whole abdomen (n = 1), and para-aortics alone (n = 1).The use of chemotherapy did not adversely affect the delivery of irradiation. Only two patients (7%) had an interruption of the irradiation course because of count problems, and two received a diminished dose of irradiation.

	DISCUSSION

TOP ABSTRACT INTRODUCTION PATIENTS AND METHODS RESULTS DISCUSSION REFERENCES

 
The intent of this phase II protocol was to assess the efficacy and toxicity of the combination of carboplatin and paclitaxel in women with primarily advanced or recurrent endometrial cancers. The toxicity was easily manageable and predominantly hematologic. Of the 63 patients, only 4% were hospitalized because of complications. The two patients (3%) experiencing febrile neutropenia were part of this group. All patients lost their hair. Our impression was that this regimen was tolerated much better then our previously used regimen of doxorubicin and cisplatin. This is not surprising given the switch to carboplatin from cisplatin that has occurred in the treatment of ovarian cancer because of its improved therapeutic index.¹¹ An additional advantage is convenience, in that this regimen is an outpatient treatment without the need for extensive hydration.

Four distinct groups of patients were treated. Group 1 consisted of women with newly diagnosed, primarily advanced cancer (defined as surgical stage IIIB or greater, IIIA with macroscopic ovarian involvement, or stage II with residual disease), excluding those with papillary serous histology. Nine of the 21 patients in this group had measurable disease, and the response rate was 78% (95% CI, 51% to 100%). Nineteen of this group then went on to receive involved-field irradiation. The median failure-free survival time was 23 months, and the median overall survival time has not yet been reached, with 62% alive at 3 years. Group 3 consisted of 18 patients with recurrent endometrial cancer, again excluding those with any papillary serous component. Chemotherapy alone was used, with an overall response rate of 56% (95% CI, 34% to 78%). Nine of the 10 responses were partial. The median failure-free survival time was 6 months, and the overall survival time was 15 months. All patients eventually died from their disease. There are four other series reporting on the activity of either carboplatin or cisplatin and paclitaxel in similar patients. In two of the studies, patients with both primarily advanced and recurrent disease were treated, with no differentiation between these distinct biologic entities. The response rates were similar to ours, 63% and 72%.^12,13 Trudeau et al¹⁴ reported a 75% response rate in eight patients with recurrent disease. In the final study, there was a 67% response rate in 24 patients with newly diagnosed, primarily advanced cancers, including a few with papillary serous histology.¹⁵

Our remaining two groups consisted of women who had at least some component of papillary serous carcinoma. Group 2 consisted of patients with primarily advanced disease, and the patients in group 4 had recurrent disease. They were analyzed separately from the other histologic types because of the different behavior pattern of papillary serous carcinoma. It is more aggressive and has a pattern of spread similar to epithelial ovarian cancer. Patients with stage III or IV disease have reported 5-year survival rates of 0% to 25%, which is much lower than those of other histologic types.^2-4,16 The response rate in the 15 assessable, primarily advanced patients in group 2 was 60% (95% CI, 35% to 85%). The majority of these responses were partial. Eleven of these newly diagnosed patients were then irradiated as part of their primary therapy. Despite this aggressive approach, there was no evidence for a plateau to the survival curves, with a median failure-free survival time of 18 months and a median overall survival time of 28 months. The response rate in the four patients with recurrent disease was 50% (group 4). There are two other reports of carboplatin and paclitaxel in this particular histologic sub type. In 11 patients with recurrent papillary serous cancers, the response rate was 64%. Thirteen other patients received the combination as adjuvant therapy for newly diagnosed stage III or IV disease, with a median survival time of 40 months.¹⁷ In the second study, 16 patients with either recurrent or advanced disease were treated, and there was an 82% response rate.¹⁸

Are these results any different from those achieved with cisplatin and doxorubicin? In the absence of a randomized comparison, one can only compare this regimen with other series, with all the pitfalls inherent in such an approach. Additionally, we included involved-field irradiation in the majority of our primarily advanced patients. For the papillary serous cancers, the comparison is with cisplatin, doxorubicin, and cyclophosphamide (Table 3). The response rates were higher with carboplatin and paclitaxel (50% to 82% v 18% to 27%). The median survivals were similar but favored carboplatin and paclitaxel.^17-21 When comparing outcomes in patients with nonpapillary serous histologies (Table 4), the response rates with platinum and paclitaxel were superior to those with cisplatin and doxorubicin (67% v 52%).^5,22-28

	NOTES

 
Presented in part at the Thirty-Seventh Annual Meeting of the American Society of Clinical Oncology, San Francisco, CA, May 12-15, 2001.

	REFERENCES

TOP ABSTRACT INTRODUCTION PATIENTS AND METHODS RESULTS DISCUSSION REFERENCES

 
1. Pettersson F: Annual Report on the Results of Treatment in Gynecological Cancer, vol 22. Stockholm, Sweden, International Federation of Gynecology and Obstetrics, 1995

2. Kato DT, Ferry JA, Goodman A, et al: Uterine papillary serous carcinoma (UPSC): A clinicopathologic study of 30 cases. Gynecol Oncol 59: 384-389, 1995[Medline]

3. Grice J, Ek M, Greer B, et al: Uterine papillary serous carcinoma: Evaluation of long-term survival in surgically staged patients. Gynecol Oncol 69: 69-73, 1998[Medline]

4. Gitsch G, Friedlander ML, Wain GV, et al: Uterine papillary serous carcinoma: A clinical study. Cancer 75: 2239-2243, 1995[Medline]

5. Thigpen T, Blessing J, Homesley H, et al: Phase III trial of doxorubicin ± cisplatin in advanced or recurrent endometrial carcinoma: A Gynecological Oncology Group (GOG) study. Proc Am Soc Clin Oncol 12: 261, 1993 (abstr 830)

6. Woo HL, Swenerton KD, Hoskins PJ: Taxol is active in platinum-resistant endometrial adenocarcinoma. Am J Clin Oncol 19: 290-291, 1996[Medline]

7. Ball HG, Blessing JA, Lentz SS, et al: A phase II trial of paclitaxel in patients with advanced or recurrent adenocarcinoma of the endometrium: A Gynecologic Oncology Group study. Gynecol Oncol 62: 278-281, 1996[Medline]

8. Lissoni A, Zanetta G, Losa G, et al: Phase II study of paclitaxel as salvage treatment in advanced endometrial cancer. Ann Oncol 7: 861-863, 1996[Abstract/Free Full Text]

9. Calvert AH, Newell DR, Gumbrell LA, et al: Carboplatin dosage: Prospective evaluation of a simple formula based on renal function. J Clin Oncol 7: 1748-1756, 1989[Abstract]

10. Kaplan E, Meier P: Non-parametric estimation from incomplete observations. J Am Stat Assoc 53: 457-481, 1958

11. Du Bois A, Lueck HJ, Meier W, et al: Cisplatin/paclitaxel vs carboplatin/paclitaxel in ovarian cancer: Update of an Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) Study group trial. Proc Am Soc Clin Oncol 18: 356, 1999 (abstr 1374)

12. Price FV, Edwards RP, Kelley JL, et al: A trial of outpatient paclitaxel and carboplatin for advanced, recurrent, and histologic high-risk endometrial carcinoma: Preliminary report. Semin Oncol 24: 78-82, 1997 (suppl 15)

13. Nakamura T, Onishi Y, Yamamoto F, et al: Evaluation of paclitaxel and carboplatin in patients with endometrial cancer. Gan To Kagaku Ryoho 27: 257-262, 2000[Medline]

14. Trudeau M, Stanimir G, Langleben A, et al: Paclitaxel and cisplatin: An active regimen in metastatic cancer of the endometrium. Int J Gynecol Cancer 9: 69, 1999 (suppl 1, abstr)

15. Dimopoulos MA, Papadimitriou CA, Georgoulias V, et al: Paclitaxel and cisplatin in advanced or recurrent carcinoma of the endometrium: Long-term results of a phase II multicenter study. Gynecol Oncol 78: 52-57, 2000[Medline]

16. Goff BA, Kato D, Schmidt RA, et al: Uterine papillary serous carcinoma: Patterns of metastatic spread. Gynecol Oncol 54: 264-268, 1994[Medline]

17. Zanotti KM, Belinson JL, Kennedy AW, et al: The use of paclitaxel and platinum-based chemotherapy in uterine papillary serous carcinoma. Gynecol Oncol 74: 272-277, 1999[Medline]

18. Boente MP, Schilder RJ, Campbell FJ, et al: Carboplatin (carbo) and paclitaxel (pac) in advanced and recurrent papillary serous uterine carcinoma (UPSC). Int J Gynecol Cancer 9: 74, 1999 (suppl 1, abstr)

19. Price FV, Chambers SK, Carcangiu ML, et al: Intravenous cisplatin, doxorubicin, and cyclophosphamide in the treatment of uterine papillary serous carcinoma (UPSC). Gynecol Oncol 51: 383-389, 1993[Medline]

20. Chambers JT, Chambers SK, Kohorn EI, et al: Uterine papillary serous carcinoma treated with intraperitoneal cisplatin and intravenous doxorubicin and cyclophosphamide. Gynecol Oncol 60: 438-442, 1996[Medline]

21. Levenback C, Burke TW, Silva E, et al: Uterine papillary serous carcinoma (UPSC) treated with cisplatin, doxorubicin, and cyclophosphamide. Gynecol Oncol 46: 317-321, 1992[Medline]

22. Deppe G, Malviya VK, Malone JM, et al: Treatment of recurrent and metastatic endometrial carcinoma with cisplatin and doxorubicin. Eur J Gynaecol Oncol 15: 263-266, 1994[Medline]

23. Barrett RJ, Blessing JA, Homesley HD, et al: Circadian-timed combination doxorubicin-cisplatin chemotherapy for advanced endometrial carcinoma. Am J Clin Oncol 16: 494-496, 1993[Medline]

24. Pasmantier MW, Coleman M, Silver RT, et al: Treatment of advanced endometrial carcinoma with doxorubicin and cisplatin: Effects on both untreated and previously treated patients. Cancer Treat Rep 69: 539-542, 1985[Medline]

25. Seltzer V, Vogl SE, Kaplan BH: Adriamycin and cis-diamminedichloroplatinum in the treatment of metastatic endometrial adenocarcinoma. Gynecol Oncol 19: 308-313, 1984[Medline]

26. Trope C, Johnsson JE, Simonsen E, et al: Treatment of recurrent endometrial adenocarcinoma with a combination of doxorubicin and cisplatin. Am J Obstet Gynecol 149: 379-381, 1984[Medline]

27. Fleming GF, Brunetto V, Rader BJ, et al: Randomized trial of doxorubicin plus cisplatin versus doxorubicin plus paclitaxel plus GCSF in patients with advanced or recurrent endometrial cancer. Proc Am Soc Clin Oncol 19: 379, 2000 (abstr 1498)

28. Aapro M, Bolis G, Chevallier B, et al: An EORTC GCCC randomized phase II trial of doxorubicin versus doxorubicin plus DDP in endometrial cancer. Proc Am Soc Clin Oncol 13: 275, 1994 (abstr 885)

Submitted January 2, 2001; accepted June 1, 2001.

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This Article Abstract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hoskins, P. J. Articles by Lee, N. Search for Related Content PubMed PubMed Citation Articles by Hoskins, P. J. Articles by Lee, N. Social Bookmarking                            What's this?