Randomized study of sequential cisplatin-topotecan/carboplatin-paclitaxel versus carboplatin-paclitaxel: effects on quality of life

• Published in: Supportive care in cancer Vol. 24; no. 3; pp. 1241 - 1249
• Main Authors: Brotto, Lori, Brundage, Michael, Hoskins, Paul, Vergote, Ignace, Cervantes, Andres, Casado, Herraez A., Poveda, A., Eisenhauer, Elizabeth, Tu, Dongsheng
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2016; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Analysis; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Body Image - psychology; Carboplatin - adverse effects; Carboplatin - therapeutic use; Chemotherapy; Cisplatin - adverse effects; Cisplatin - therapeutic use; Clinical trials; Disease-Free Survival; Female; Humans; Medicine; Medicine & Public Health; Middle Aged; Nausea; Nursing; Nursing Research; Oncology; Original Article; Ovarian cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - psychology; Paclitaxel - adverse effects; Paclitaxel - therapeutic use; Pain Medicine; Quality of life; Quality of Life - psychology; Rehabilitation Medicine; Studies; Surveys and Questionnaires; Topotecan - adverse effects; Topotecan - therapeutic use; Cisplatin-topotecan; Carboplatin-paclitaxel; Ovarian cancer; Quality of life
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-015-2873-8

Background
A recent phase III trial compared the efficacy of cisplatin-topotecan (a topoisomerase I inhibitor) followed by carboplatin-paclitaxel (Arm 1) versus paclitaxel-carboplatin (Arm 2) in women with newly diagnosed stage IIB or greater ovarian cancer. There was a significantly lower response rate in the experimental arm compared to standard treatment, and less likelihood of normalized CA125 within the first 3 months. At 43 months follow-up, there were no significant group differences in progression-free survival. There were also significantly more side effects in the experimental arm.
Methods
The current study examined quality of life (QoL) endpoints using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and the ovarian cancer module, QLQ-OV28, administered prior to randomization, at day 1 of treatment cycles 3, 5, and 7, at completion of the last cycle, and at 3 and 6 months following completion of chemotherapy.
Results
Global QoL, physical symptoms, fatigue, and role, emotional, cognitive and social function (all from the EORTC QLQ-C30) significantly improved in both treatment arms, with no significant between-arm differences. Between-group differences in pain, insomnia, and peripheral neuropathy reported while on treatment did not differ at follow-up. Nausea and vomiting improved more with standard treatment both during and after treatment. Body image significantly differed between the groups only at cycle 5 (more deterioration in Arm 2) but group differences disappeared at follow-up. A stratified analysis of global QoL by debulking surgery status found no greater effect indicating that overall improvements in QoL were unrelated to surgical recovery.
Conclusions
There was no significant QoL advantage of cisplatin-topotecan. This finding, combined with no progression-free survival conferred by this combination, reaffirms carboplatin-paclitaxel as the standard of care for women with newly diagnosed ovarian cancer.