Platinum-based adjuvant chemotherapy for early-stage epithelial ovarian cancer: single or combination chemotherapy?

Objective: To evaluate the clinical benefit and toxicity of two regimens; single agent carboplatin (C) and a carboplatin/paclitaxel (CP) combination in early epithelial ovarian cancer.

Design: A retrospective review.

Setting: Single cancer centre serving a population of 2.1 million in the northwest of England.

Population: All women treated with adjuvant chemotherapy for International Federation of Obstetrics and Gynecology stage Ia-IIc ovarian cancer between 2002 and 2005.

Methods: Case and operation notes were reviewed. Details of the surgery performed, performance status (PS), tumour histology, stage, grade, intended chemotherapy, chemotherapy received, acute and late toxicity, relapse and death were all recorded.

Main outcome measures: Overall survival (OS), relapse-free survival (RFS), acute and late toxicity.

Results: Sixty women received CP and 35 received C. Younger women (P < 0.0001) and those with a better performance status (P = 0.045) were more likely to receive CP. Median follow- up was 38 months (range 0-70). Five-year OS was 62% (95% CI 44-81%) for C and 73% (95% CI 61-85%) for CP P= = 0.316. For the subgroup with stage I disease and good PS (0/1) 5-year OS was 80% (59-100%) for C and 79% (63-95%) for CP; P = 1.0. For those with stage 2 disease, 5-year OS was 29% (95% CI 0-62%) for C and 63% (95% CI 44-82%) for CP; P = 0.025. Subgroup analyses by grade or histology showed no difference in OS. P was discontinued prematurely in nine (15%) women on account of toxicity, whereas C was not stopped early. P-related neuropathy (G1/2) was reported in ten (17%) women at 6 months and in two (3%) at 1 year.

Conclusions: Combination therapy is administered more often than carboplatin; especially in those with younger age, better PS and nonmucinous histology. Recurrence and death rates were similar with both treatments. Well-designed trials are needed to identify the optimum chemotherapy regimen in this group.