Gemcitabine Combined with Oxaliplatin (GEMOX) as Salvage Treatment in Elderly Patients with Advanced Ovarian Cancer Refractory or Resistant to Platinum: a Single Institution Experience

Abstract

Both oxaliplatin (OXA) and gemcitabine (GEM) have shown single agent activity in patients with recurrent ovarian cancer. Response rates to second-line therapies remain low and there is a need to develop more effective regimens. In view of the synergistic effect of using GEM followed by OXA, we studied these agents in elderly patients with recurrent ovarian cancer refractory or resistant to first-line chemotherapy using platinum with or without paclitaxel. The aim of the study was to evaluate the efficacy and toxicity of combination GEM 1000 mg/m(2) Day 1 i.v. and OXA 100 mg/m(2) in 2h infusion Day 2; treatment was repeated every 2 weeks for 6 courses or until progression of disease or intolerable toxicity. The study was monoinstitutional and started in November 2002. 21 patients, median age 68.6 years (range 65-82) have been treated. Median Performance Status was 0-1, all had at least 1 prior platinum based chemotherapy and 11 had received also a taxane. Patients received a median of 6 cycles of treatment (range 4-11). There were 2 patient (9%) with complete response, 3 patients (14%) achieved a partial response. Low profile toxicity (grade 1-2, WHO criteria) was observed: nausea/vomiting 52%, thrombocytopenia 13%, neuropathy 28%. The GEMOX combination is well tolerated and even in this small group of patients, encouraging responses were documented.

Poor outcome of elderly patients with platinum-sensitive recurrent ovarian cancer: Results from the SOCRATES retrospective study

“…We found that patients older than 75 years showed a higher proportion of drug delays and dose-reductions with respect to patients younger than 75. Only few prospective trials devoted to elderly patients have been published [35] and more studies are clearly needed in this setting.…”

Chemotherapy with Gemcitabine and Oxaliplatin in Patients with Advanced Biliary Tract Cancer: A Single-Institution Experience

“…Our patients had a particularly good PS, which may explain the favorable activity and mild toxicity profile, although the power of the positive observation is low in such a small patient cohort. Moreover, in a recently published study in elderly patients heavily pretreated for advanced ovarian cancer, the GEMOX combination was found to be feasible and effective and resulted in encouraging response rates; therefore this combination may also be appropriate for patients with PS 1–2 [33]. …”

Gemcitabine-oxaliplatin combination for ovarian cancer resistant to taxane-platinum treatment: a phase II study from the GINECO group

“…The combination of GE and OXA has been reported to show activity in ovarian cancer both in earlier treated Raspagliesi et al, 2004;Germano et al, 2007;Harnett et al, 2007) and in first-line treated (Steer et al, 2006) patients. Platinumresistant or platinum-refractory patients treated with the OXA -GE combination have been reported to experience response rates between 20 and 26% (Raspagliesi et al, 2004;Harnett et al, 2007) with median PFS and OS of 5.0 and 9.2 months, respectively.…”