Carboplatin–Paclitaxel Doublet More Effective than Carboplatin Alone in Older Patients with Ovarian Cancer

A study recently found that a conventional carboplatin–paclitaxel doublet regimen was more effective than single-agent carboplatin in improved survival for older women with ovarian cancer and should be considered an option for this patient population.

The single-agent option is often offered to “vulnerable older” patients, noted the researchers of the randomized clinical trial; however, “Such an approach could have a detrimental effect on outcomes for these patients.”

Four hundred and forty-seven women aged 70 years and older with newly diagnosed stage III/IV ovarian cancer were assessed per the Geriatric Vulnerability Score, and 120 patients had a score of 3 or higher. These patients were classified by country and surgical outcome. They were randomized to receive six cycles of: carboplatin, area under the curve (AUC) 5 mg/mL·min, plus paclitaxel, 175 mg/m2, every 3 weeks; single-agent carboplatin, AUC 5 mg/mL·min or AUC 6 mg/mL·min, every 3 weeks; or weekly carboplatin, AUC 2 mg/mL·min, plus paclitaxel, 60 mg/m2, on days 1, 8, and 15 every 4 weeks.

Treatment feasibility was the main outcome and was defined as “the ability to complete 6 chemotherapy cycles without disease progression, premature toxic effects–related treatment discontinuation, or death.”

The mean and median age among the women was 80 years, and nearly half of the patients had a Geriatric Vulnerability Score of 4 (36%) or 5 (11%); a third of them had stage IV cancer.

The use of single-agent carboplatin was terminated based on a recommendation from the independent data monitoring committee, which found the treatment was correlated with much poorer survival.

Forty patients had been randomized to each of the three groups. In the every-3-weeks combination group, 26 women completed six cycles of treatment, as did 19 women in the single-agent carboplatin and 24 in the weekly combination groups. Women receiving the standard every-3-weeks combination treatment were less likely to sustain adverse events compared to the single-agent carboplatin and weekly combination groups (17 vs 23 and 23). Four patients sustained treatment-related deaths, two each in the combination groups.

The study was published in JAMA Oncology.

“This randomized clinical trial shows that compared with every-3-weeks or weekly carboplatin–paclitaxel regimens, single-agent carboplatin was less active with significantly worse survival outcomes in vulnerable older patients with ovarian cancer,” the researchers wrote in their conclusion.