Uterine cancer is the most common gynecologic cancer in the United States. In 2013, 49,000 women is estimated to develop this cancer. We think many of these cancers are related to obesity.
Fortunately, many patients are cured with hysterectomy surgery. However, about 20 percent will have advanced cancer and ofter recurred. We thought that we ought to treat these patients aggressively. Thus, Cisplatin, doxorubicin, plus paclitaxel regimen was promoted based on GOG 177, which enrolled 273 women with previously untreated stage III/IV or recurrent endometrial cancer and randomized them to treatment with Cisplatin+Doxorubicin vs Taxol+Adriamycin (or Doxorubicin)+Platinum (Cisplatin). The study showed better survival with TAP (15 months) vs CD (12 months). However, TAP is very toxic especially with neuropathy. Thus, another study (GOG 209) compared carbo+taxol vs TAP. Carbo+taxol seems to be equally effective as TAP with less toxicities: sensory neuropathy (19 versus 26 percent), thrombocytopenia (12 versus 23 percent), emesis (4 versus 7 percent), diarrhea (2 versus 6 percent), and metabolic derangements (8 versus 14 percent).
Thus, the studies suggest that patients with advanced or recurrent uterine cancer should receive carbo+taxol.
Reference:
Fortunately, many patients are cured with hysterectomy surgery. However, about 20 percent will have advanced cancer and ofter recurred. We thought that we ought to treat these patients aggressively. Thus, Cisplatin, doxorubicin, plus paclitaxel regimen was promoted based on GOG 177, which enrolled 273 women with previously untreated stage III/IV or recurrent endometrial cancer and randomized them to treatment with Cisplatin+Doxorubicin vs Taxol+Adriamycin (or Doxorubicin)+Platinum (Cisplatin). The study showed better survival with TAP (15 months) vs CD (12 months). However, TAP is very toxic especially with neuropathy. Thus, another study (GOG 209) compared carbo+taxol vs TAP. Carbo+taxol seems to be equally effective as TAP with less toxicities: sensory neuropathy (19 versus 26 percent), thrombocytopenia (12 versus 23 percent), emesis (4 versus 7 percent), diarrhea (2 versus 6 percent), and metabolic derangements (8 versus 14 percent).
Thus, the studies suggest that patients with advanced or recurrent uterine cancer should receive carbo+taxol.
Reference:
Fleming GF, et al. Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2004;22(11):2159. GOG 177
Miller DS, Filiaci G, Mannel R, et al. Randomized Phase III Noninferiority Trial of First Line Chemotherapy for Metastatic or Recurrent Endometrial Carcinoma: A Gynecologic Oncology Group Study. LBA2. Presented at the 2012 Society of Gynecologic Oncology Annual Meeting, Austin, TX. GOG 209
Does the neuropathy go away once treatment is completed?
ReplyDelete