For patients with endometrial cancer at high risk of progression, receiving a combination of taxane and platinum chemotherapy after surgery offers similar efficacy and tolerability as doxorubicin and cisplatin, the standard therapy, according to a recent phase 3 trial.
Progression-free and overall survival rates were similar across treatment types, reported lead author Hiroyuki Nomura, MD, of Keio University, Tokyo, and his colleagues. The findings maintain doxorubicin/cisplatin as standard therapy; however, taxane/platinum chemotherapy could be a possible alternative for some patients because of similar efficacy and tolerability with a distinct toxicity profile.
“Establishment of evidence and validation of the optimal postoperative adjuvant chemotherapy regimen for endometrial cancer are important issues,” the investigators wrote in JAMA Oncology.
The multicenter, open-label study involved 788 patients with endometrial cancer at risk of progression, based on histologic findings. Eligibility required that patients have a residual tumor of at least 2 cm without extension beyond the abdominal cavity. Patients were randomly grouped into one of three treatment groups: doxorubicin/cisplatin, paclitaxel/carboplatin, or docetaxel/cisplatin. If tolerated, six 3-week cycles were given. The median follow-up period was 7 years. The primary and secondary endpoints were 5-year progression free survival and overall survival, respectively.
Survival rates were statistically similar between groups. The 5-year progression-free survival rate was 73.3% for doxorubicin/cisplatin, 73.9% for paclitaxel/carboplatin, and 79.0% for docetaxel/cisplatin (P = .12); the 5-year overall survival rate was 82.7% for doxorubicin/cisplatin, 86.1% for paclitaxel/carboplatin, and 88.1% for docetaxel/cisplatin (P = .67). Tolerability was also comparable, with a small range of discontinuation rates across treatment types, from 20.2% to 25.5% (P = .14).
“Although the superiority of docetaxel plus cisplatin and paclitaxel plus carboplatin over doxorubicin plus cisplatin was not demonstrated, we found that the three regimens were comparable in therapeutic effect,” the investigators concluded. “[C]onsidering efficacy and tolerability, taxane plus platinum regimens may be an alternative to treatment with doxorubicin plus cisplatin.”
The study was funded by a Health Labour Sciences Research Grant with nonspecific funding from AstraZeneca, Eisai, Bristol-Myers Squibb, and others. The investigators reported financial relationships with Chugai, Sanofi, Takeda, AbbVie, and others.
SOURCE: Nomura H et al. JAMA Oncol. 2019 Mar 21. doi: 10.1001/jamaoncol.2019.0001.