Prolonging platinum-free interval (PFI) by introducing non-platinum-based chemotherapy may actually worsen efficacy outcomes in patients with recurrent ovarian cancer, according to clinical trial results presented at the 2016 American Society of Clinical Oncology Annual Meeting in Chicago, IL (June 3-7).
It has long been thought that artificially prolonging PFI through the introduction of non-platinum-based chemotherapy might improve sensitivity to platinum and improve outcomes.
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In a clinical trial led by Sandro Pignata, MD, National Institute for the Study and Treatment of Cancer (Napoli, Italy), investigators tested the validity of this theory by randomly assigning 215 patients with ovarian cancer to undergo treatment with platinum-based chemotherapy (n=108) or non-platinum-based chemotherapy (n=107).
All patients included in the trial had ovarian cancer recurrence 6 to 12 months after platinum therapy; two or fewer previous chemotherapy lines, Eastern Cooperative Oncology Group performance status of 0 to 2; and normal bone marrow, heart, liver, and kidney function. The primary outcome of the trial was overall survival.
Results of the trial revealed that treatment with non-platinum therapy did prolong PFI, but it did not improve overall survival. In fact, investigators observed that there was a trend toward worse overall survival among those in the non-platinum group compared with the platinum group (21.8 months vs 24.5 months, respectively). Additionally, progression-free survival was also found to be longer in those treated with platinum chemotherapy compared with patients who received non-platinum regimens (16.4 months vs 12.8 months, respectively).
Thus, the investigators concluded that trying to prolong PFI with non-platinum-based chemotherapy does not improve outcomes and may in fact worsen survival in patients with ovarian cancer.
“Prolongation of the platinum-free interval with a single-agent non-platinum therapy does not improve and even worsens the outcome of ovarian cancer patients recurring 6–12 months after a platinum-containing chemotherapy,” said Dr. Pignata. “Immediate re-treatment with platinum-based chemotherapy remains the standard treatment strategy.”