Nab-paclitaxel Versus Sb-taxanes As First-Line Treatment in Advanced Ovarian Cancer

Efficacy evaluation of albumin-bound paclitaxel combined with carboplatin as neoadjuvant chemotherapy for primary epithelial ovarian cancer

AbstractObjectiveThis study aimed to compare the efficacy of albumin-bound paclitaxel combined with carboplatin (Nab-TC) with that of traditional solvent-based paclitaxel combined with carboplatin (TC) as neoadjuvant chemotherapy (NAC) regimens for primary epithelial ovarian cancer.MethodsEighty patients with advanced primary epithelial ovarian cancer admitted for treatment at the Harbin Medical University Cancer Hospital from January 2015 to January 2020 were retrospectively selected. All patients underwent surgery after 1–4 courses of NAC with Nab-TC or TC regimen. Among the patients included for study, 40 patients in each group.ResultsThe ORR in Nab-TC group was better compared to TC group (45% vs 40%), but the difference was not significant (P = 0.651). While the reduction rate of CA-125 value in the Nab-TC group was significantly better (P < 0.05). The postoperative complication rate such as postoperative blood transfusion (5% vs 35%) and postoperative infusion of human albumin (25% vs 55%) were significantly lower relative to the TC group. The median progression-free survival of the Nab-TC group was significantly longer relative to the TC group (20 months vs 13 months,P = 0.012), and the patient’s quality of life was also better in the Nab-TC group (P < 0.05). Our study demonstrated that Nab-TC regimen and R0 represented the independent prognostic factors.ConclusionThe efficacy of the Nab-TC regimen as NAC for advanced primary epithelial ovarian cancer was non-inferior to that of the TC regimen along with a lower incidence of adverse reactions, a longer PFS and a higher quality of life, supporting its therapeutic value in the clinic.

Systemic treatment of newly diagnosed advanced epithelial ovarian cancer: From chemotherapy to precision medicine

Despite optimal first-line treatment based on debulking surgery and platinum-paclitaxel chemotherapy, most of the patients with advanced ovarian cancer (AOC) will eventually relapse. Over the last decades, different strategies have been assessed to improve AOC patients' outcomes in the front-line treatment. However, first line treatment landscape of AOC had not undergone major changes until the last three years. In the present review, we will navigate through the different therapeutic approaches developed in first-line AOC which range from variations in dose/administration via of conventional carboplatin-based chemotherapy to the incorporation of anti-angiogenic agents and PARP inhibitors.

Incidence and mortality of ovarian cancer at the global, regional, and national levels, 1990–2017

Ovarian cancer (OC) is a commonly diagnosed gynecologic cancer. Knowing the incidence and mortality rates of OC is critical to understanding the disease burden and updating prevention strategies. We retrieved the age-standardized incidence and mortality rates (ASIR and ASMR, respectively) of OC from the Global Burden of Disease study online database. Estimated average percentage change (EAPC) was used to quantify the trends of OC incidence and mortality from 1990 to 2017. Worldwide, the number of incident cases and deaths from OC increased from 152.1 and 95.5 thousand in 1990 to 286.1 and 176.0 thousand in 2017, respectively. Both the ASIR and ASMR decreased slightly during the study period (EAPC = -0.10, 95% CI, -0.16, -0.03; EAPC = -0.32, 95% CI, -0.38, -0.27). The greatest decreases of ASIR and ASMR were observed in Western Europe (EAPC = -1.22, 95% CI, -1.31, -1.14; EAPC = -1.31, 95% CI, -1.37, -1.25). A total of 137, 10, and 48 countries or territories experienced an increase, remained stable, and experienced a decrease in OC ASIR, respectively, between 1990 and 2017. For ASMR, a total of 129, 9, and 57 countries or territories experienced an increase, remained stable, and experienced a decrease, respectively, during the same period. The greatest increases in the ASIR and the ASMR were found in countries located in the Caribbean and Latin America. The incidence and mortality of OC significantly decreased in developed countries. However, remarkable increases were observed in more than two-thirds of all countries, suggesting that OC will be more frequently diagnosed in developing countries.

Comparing Paclitaxel–Carboplatin with Paclitaxel–Cisplatin as the Front-Line Chemotherapy for Patients with FIGO IIIC Serous-Type Tubo-Ovarian Cancer

The use of weekly chemotherapy for the treatment of patients with advanced-stage serous-type epithelial Tubo-ovarian cancer (ETOC), and primary peritoneal serous carcinoma (PPSC) is acceptable as the front-line postoperative chemotherapy after primary cytoreductive surgery (PCS). The main component of dose-dense chemotherapy is weekly paclitaxel (80 mg/m2), but it would be interesting to know what is the difference between combination of triweekly cisplatin (20 mg/m2) or triweekly carboplatin (carboplatin area under the curve 5-7 mg/mL per min [AUC 5-7]) in the dose-dense paclitaxel regimen. Therefore, we compared the outcomes of women with Gynecology and Obstetrics (FIGO) stage IIIC ETOC and PPSC treated with PCS and a subsequent combination of dose-dense weekly paclitaxel and triweekly cisplatin (paclitaxel–cisplatin) or triweekly carboplatin using AUC 5 (paclitaxel–carboplatin). Between January 2010 and December 2016, 40 women with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC EOC, FTC, or PPSC were enrolled, including 18 treated with paclitaxel–cisplatin and the remaining 22 treated with paclitaxel–carboplatin. There were no statistically significant differences in disease characteristics of patients between two groups. Outcomes in paclitaxel–cisplatin group seemed to be little better than those in paclitaxel–carboplatin (median progression-free survival [PFS] 30 versus 25 months as well as median overall survival [OS] 58.5 versus 55.0 months); however, neither reached a statistically significant difference. In terms of adverse events (AEs), patients in paclitaxel–carboplatin group had more AEs, with a higher risk of neutropenia and grade 3/4 neutropenia, and the need for a longer period to complete the front-line chemotherapy, and the latter was associated with worse outcome for patients. We found that a period between the first-time chemotherapy to the last dose (6 cycles) of chemotherapy >21 weeks was associated with a worse prognosis in patients compared to that ≤21 weeks, with hazard ratio (HR) of 81.24 for PFS and 9.57 for OS. As predicted, suboptimal debulking surgery (>1 cm) also contributed to a worse outcome than optimal debulking surgery (≤1 cm) with HR of 14.38 for PFS and 11.83 for OS. Based on the aforementioned findings, both regimens were feasible and effective, but maximal efforts should be made to achieve optimal debulking surgery and following the on-schedule administration of dose-dense weekly paclitaxel plus triweekly platinum compounds. Randomized trials validating the findings are warranted.

Peng-Hui Wang

Name Peng-Hui, Wang Title Professor, Director, Department of Obstetrics and Gynecology, National Yang-Ming University Address No. 201, Sec.2, Shih-Pai Road, Taipei, 112 Taiwan Email phwang@vghtpe.gov.tw pongpongwang@gmail.com Telephone 886-2-2875-7566 Education 2002-2003 Post-Dr. Pathology University of Rochester, NY, USA 2002 Ph.D. Philosophy National Yang-Ming University, Taiwan 1990 M.D. Medicine National Yang-Ming University, Taiwan. Academic appointments 2009-present Professor, Department of Obstetrics and Gynecology, National Yang-Ming University 2009-present Professor and Director, Department of Obstetrics and Gynecology, National Yang-Ming University 2009-present Professor, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital 2011- present Chief, Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital 2006-2009 Associate Professor, Department of Obstetrics and Gynecology, National Yang-Ming University 2002-2006 Assistant Professor, Department of Obstetrics and Gynecology, National Yang-Ming University 1998-2002 Instructor, Department of Obstetrics and Gynecology, National Yang-Ming University 1996-present More than 300 SCI peer review papers Honors 2015 Silver Award of Research Paper for Cancer in the Hsu Chien-Tien Cancer Foundation 2015 Golden Award of Research Paper in the Taiwan Association of Obstetrics and Gynecology 2014 Silver Award of Research Paper in the Taipei Veterans General Hospital, Taipei 2013 Golden Award of Research Paper in the Chinese Medical Association, Taipei 2012 Life-long Outstanding Teacher Award from the National Yang-Ming University 2008-2012 Outstanding Teacher Award from the National Yang-Ming University 2010 Yung-Kuei Soong Endoscopy and Minimally Invasive Medicine Best paper honor (6th Taiwan Association for Minimally Invasive Gynecology) in 2010 2004 The outstanding Young Persons of Republic of China (42th) in 2004 2003 Prize Paper Award-Honorable Mention- Best Clinical Research Article form a Developing Country in 2003 2003 Best Postgraduate Prize Paper third place in Global Congress of Gynecologic Endoscopy AAGL 32nd Annual Meeting in 2003 2000 Outstanding Performance Award from the Taipei Veterans General Hospital, Taiwan in 2000 1999 Outstanding Researcher Award from the National Science Council, Taiwan in 1999 Academic Members 2014-present Supervisor, The Taiwan Association of Perinatology 2014-present Director, The Taiwan Society of Gynecologic Cancer 2013-present President, The Taiwan Association of Gynecology 2013-present Supervisor, The Taiwan Association of Obstetrics and Gynecology 201- present Chief, Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital Publications in Peer-Review Journal 385 SCI and peer-review articles