Outcomes of advanced epithelial ovarian cancer with integration of metronomic chemotherapy: An Indian rural cancer centre experience

Avinash Pandey; Desai Abhay; Jandyal Sunny; Ostwal Vikas; Patil Vijay; Kulkarni Rajeshri; Patil Netaji; Gupta Sudeep; Shripad D. Banavali

doi:10.4103/2278-330X.181627

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METRONOMIC THERAPY IN OVARIAN CANCER : Original Article

05 (

); 059-062

doi:

10.4103/2278-330X.181627

Outcomes of advanced epithelial ovarian cancer with integration of metronomic chemotherapy: An Indian rural cancer centre experience

Avinash Pandey^1,2, Desai Abhay³, Jandyal Sunny¹, Ostwal Vikas¹, Patil Vijay¹, Kulkarni Rajeshri⁴, Patil Netaji⁵, Gupta Sudeep¹, Shripad D. Banavali^1,

1 Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra

2 Department of Medical Oncology, BKLWH, Dervan, Chiplun, Ratnagiri, Maharashtra

3 Department of Surgical Oncology, BKLWH, Dervan, Chiplun, Ratnagiri, Maharashtra

4 Department of Pathology, BKLWH, Dervan, Chiplun, Ratnagiri, Maharashtra

5 Department of Radiodiagnosis, BKLWH, Dervan, Chiplun, Ratnagiri, Maharashtra

*Corresponding author: Dr. Shripad D. Banavali. banavali_2000@yahoo.com

Published: 2020-12-28

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Abstract

Background: Paclitaxel-platinum and optimal cytoreductive surgery are the standard of care for ovarian carcinoma. Poor socioeconomic profile and therapeutic constraints in rural India poses a therapeutic challenge. Aim: To evaluate outcomes of epithelial ovarian carcinoma. Objectives: To calculate disease-free survival (DFS), overall survival (OS), and factors affecting outcomes. Materials and Methods: Data of patients diagnosed as ovarian carcinoma registered between March 2009 and March 2014 were retrieved. Demographic profile, chemotherapy and response, surgery, and disease progression were collected. Patients who underwent surgery or completed three cycles of chemotherapy were selected. Kaplan-Meir survival was used to determine disease-free and OS. Log-rank test used to evaluate factors affecting outcome. Results: Median follow-up is 26 months. 93/102 patients (91%) underwent cytoreductive surgery, of which 37 had primary cytoreduction (40%) while 56 had interval cytoreduction. 21/93 (23%), 57/93 (61%), and 15/93 (16%) patients were operated by local surgeons, surgeons of our hospital, and trained oncosurgeons, respectively. Induction paclitaxel-platinum was used in 35/63 (56%) patients while 28/63 patients (44%) received neoadjuvant metronomic chemotherapy. Median DFS and OS are 17 and 54 months respectively while 3 year OS of 66%. Median DFS of patients operated by oncosurgeons versus local surgeons were 22 months versus 15 months (P = 0.01), OS was 54 versus 26 months (P = 0.01).40/88 (45%) patients received maintenance metronomic therapy after adjuvant chemotherapy with median of 6 months (range 2-18 months). Patients receiving metronomic maintenance had better DFS, 18 months versus 15 months (P = 0.69). Conclusion: Induction therapy in ovarian carcinoma helps in selecting patients for cytoreductive surgery. Outcomes are better if operated by trained oncosurgeons. Maintenance metronomic has potential to delay disease progression.

Keywords

References

Murthy NS, Shalini S, Suman G, Pruthvish S, Mathew A. Changing trends in incidence of ovarian cancer - The Indian scenario. Asian Pac J Cancer Prev 2009;10:1025-30.
Available from: http://www.ncrpindia.org/ALL_NCRP_REPORTSPBCR_REPORT_2009_2011/ALL_CONTENT/ALL_PDF/Chapter 2.pdf. [Last accessed on 2016 Apr 03].
Available from: http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf.
McGuire WP, Hoskins WJ, Brady MF, Kucera PR, Partridge EE, Look KY, et al. Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N Engl J Med 1996;334:1-6.
Ozols RF, Bundy BN, Greer BE, Fowler JM, Clarke-Pearson D, Burger RA, et al. 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 2003;21:3194-200.
Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010;363:943-53.
Thorat VA, Dhekale JS, Patil HK, Tilekar SN. Determinants of rural-urban migration in Konkan region of Maharashtra. Agric Econ Res Rev 2011;24:503-9.
Available from: http://www.hss.iitb.ac.in/ties07/paper/ts2/psE/2.pdf. [Last accessed on 2016 Apr 03].
Noronha V, Krishna MV, Patil V, Joshi A, Banavali SD, Prabhash K. Metronomic therapy: Chemotherapy revisited. Indian J Cancer 2013;50:142-8.
André N, Banavali S, Snihur Y, Pasquier E. Has the time come for metronomics in low-income and middle-income countries? Lancet Oncol 2013;14:e239-48.
Su WH, Ho TY, Li YT, Lu CH, Lee WL, Wang PH. Metronomic therapy for gynecologic cancers. Taiwan J Obstet Gynecol 2012;51:167-78.
Kamat AA, Kim TJ, Landen CN Jr., Lu C, Han LY, Lin YG, et al. Metronomic chemotherapy enhances the efficacy of antivascular therapy in ovarian cancer. Cancer Res 2007;67:281-8.
Pujade-Lauraine E. Bevacizumab and oral metronomic cyclophosphamide in platinum-resistant ovarian cancer. J Gynecol Oncol 2013;24:209-11.
Gupta S, Goyal G, Ghosh J, Bhosale B, Bajpai J, Maheshwari A. A phase II study of oral metronomic combination therapy in relapsed epithelial ovarian cancer. Available from: http://www.meetinglibrary.asco.org/content/113958-132. [Last accessed on 2016 Apr 26].
Chan JK, Kapp DS, Shin JY, Husain A, Teng NN, Berek JS, et al. Influence of the gynecologic oncologist on the survival of ovarian cancer patients. Obstet Gynecol 2007;109:1342-50.
Eisenhauer EL, Abu-Rustum NR, Sonoda Y, Aghajanian C, Barakat RR, Chi DS. The effect of maximal surgical cytoreduction on sensitivity to platinum-taxane chemotherapy and subsequent survival in patients with advanced ovarian cancer. Gynecol Oncol 2008;108:276-81.
du Bois A, Reuss A, Harter P, Pujade-Lauraine E, Ray-Coquard I, Pfisterer J. Potential role of lymphadenectomy in advanced ovarian cancer: A combined exploratory analysis of three prospectively randomized phase III multicenter trials. J Clin Oncol 2010;28:1733-9.
Fader AN, Rose PG. Role of surgery in ovarian carcinoma. J Clin Oncol 2007;25:2873-83.
Schorge JO, Garrett LA, Goodman A. Cytoreductive surgery for advanced ovarian cancer: Quo vadis? Oncology (Williston Park) 2011;25:928-34.

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[1] Murthy NS, Shalini S, Suman G, Pruthvish S, Mathew A. Changing trends in incidence of ovarian cancer - The Indian scenario. Asian Pac J Cancer Prev 2009;10:1025-30.

[2] Available from: http://www.ncrpindia.org/ALL_NCRP_REPORTSPBCR_REPORT_2009_2011/ALL_CONTENT/ALL_PDF/Chapter 2.pdf. [Last accessed on 2016 Apr 03].

[3] Available from: http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf.

[4] McGuire WP, Hoskins WJ, Brady MF, Kucera PR, Partridge EE, Look KY, et al. Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N Engl J Med 1996;334:1-6.

[5] Ozols RF, Bundy BN, Greer BE, Fowler JM, Clarke-Pearson D, Burger RA, et al. 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 2003;21:3194-200.

[6] Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010;363:943-53.

[7] Thorat VA, Dhekale JS, Patil HK, Tilekar SN. Determinants of rural-urban migration in Konkan region of Maharashtra. Agric Econ Res Rev 2011;24:503-9.

[8] Available from: http://www.hss.iitb.ac.in/ties07/paper/ts2/psE/2.pdf. [Last accessed on 2016 Apr 03].

[9] Noronha V, Krishna MV, Patil V, Joshi A, Banavali SD, Prabhash K. Metronomic therapy: Chemotherapy revisited. Indian J Cancer 2013;50:142-8.

[10] André N, Banavali S, Snihur Y, Pasquier E. Has the time come for metronomics in low-income and middle-income countries? Lancet Oncol 2013;14:e239-48.

[11] Su WH, Ho TY, Li YT, Lu CH, Lee WL, Wang PH. Metronomic therapy for gynecologic cancers. Taiwan J Obstet Gynecol 2012;51:167-78.

[12] Kamat AA, Kim TJ, Landen CN Jr., Lu C, Han LY, Lin YG, et al. Metronomic chemotherapy enhances the efficacy of antivascular therapy in ovarian cancer. Cancer Res 2007;67:281-8.

[13] Pujade-Lauraine E. Bevacizumab and oral metronomic cyclophosphamide in platinum-resistant ovarian cancer. J Gynecol Oncol 2013;24:209-11.

[14] Gupta S, Goyal G, Ghosh J, Bhosale B, Bajpai J, Maheshwari A. A phase II study of oral metronomic combination therapy in relapsed epithelial ovarian cancer. Available from: http://www.meetinglibrary.asco.org/content/113958-132. [Last accessed on 2016 Apr 26].

[15] Chan JK, Kapp DS, Shin JY, Husain A, Teng NN, Berek JS, et al. Influence of the gynecologic oncologist on the survival of ovarian cancer patients. Obstet Gynecol 2007;109:1342-50.

[16] Eisenhauer EL, Abu-Rustum NR, Sonoda Y, Aghajanian C, Barakat RR, Chi DS. The effect of maximal surgical cytoreduction on sensitivity to platinum-taxane chemotherapy and subsequent survival in patients with advanced ovarian cancer. Gynecol Oncol 2008;108:276-81.

[17] du Bois A, Reuss A, Harter P, Pujade-Lauraine E, Ray-Coquard I, Pfisterer J. Potential role of lymphadenectomy in advanced ovarian cancer: A combined exploratory analysis of three prospectively randomized phase III multicenter trials. J Clin Oncol 2010;28:1733-9.

[18] Fader AN, Rose PG. Role of surgery in ovarian carcinoma. J Clin Oncol 2007;25:2873-83.

[19] Schorge JO, Garrett LA, Goodman A. Cytoreductive surgery for advanced ovarian cancer: Quo vadis? Oncology (Williston Park) 2011;25:928-34.

Outcomes of advanced epithelial ovarian cancer with integration of metronomic chemotherapy: An Indian rural cancer centre experience

Abstract

Abstract

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