Prognostic impact of adjuvant chemotherapy treatment intensity for ovarian cancer

Abstract

ObjectiveWe aimed to investigate the prognostic impact of duration of first-line chemotherapy administration in patients with epithelial ovarian cancer (EOC).MethodsChemotherapy records were abstracted from the electronic medical record. Patients with on-time completion (105 days) were compared to patients finishing early (<105 days), delays of 1–4 weeks, or >4 weeks. For 222 women with stage IIIC/IV, stage-stratified estimates of progression-free survival (PFS) and overall survival (OS) were compared. A delay sub-study was performed with outliers removed. Each week of delay was correlated with the change in PFS and OS to identify time points associated with change in outcome.ResultsMost women had on-time completion of chemotherapy (23.6%) or a treatment delay of ≤4 weeks (21.8%); 21.6% of women experienced a delay longer than 4 weeks. R0 resection at initial debulking (OR = 1.99, 95%CI: 1.18–3.36, p = 0.010) and RECIST complete response (OR = 4.88, 95%CI: 2.47–10.63, p<0.001) were strongly associated with on-time completion. Patients with on-time completion and < 1 month delay had similar median survivals of 43.1 months (lower 95% CI bound 33.7 months) and 44.5 months (lower bound 37.0, p = 0.93). Women with >1 month delay had decreased median survival of 18.1 months (14.7–24.9 months), while women with short intervals survived 35.0 months (95%CI: 21.8–49.8 months). Short-term delays lead to progressively decreasing OS. This was significantly different from the on-schedule survival estimate after 6 weeks of delay.ConclusionsOn-time completion of chemotherapy correlates with increased survival and higher complete response rates. Increasing delays in chemotherapy completion were associated with decreased survival.

The interval between the primary cytoreductive surgery and adjuvant chemotherapy in patients with advanced ovarian cancer

“…A similar effect is also exerted by a decrease in time between ACT cycles, which was reviewed by Starbuck K.D. et al In their results, even short delays in the passage of all cycles lead to a progressive decrease in OS [15].…”

“…In the analysis of the first group of patients (the time interval before the start of ACT to 1 month), we obtained a variable series of periods (in months) between the start of special treatment and the establishment of death from the underlying disease and / or its complications: 10,10,12,14,15,15,16,17,18,18,19,19,20,21,22,25,26,33,35,39,43,43,43,51,53,56,63,85,101,126. Variation indices: weighted average -36, mode -43, median -26, standard deviation -27.513.…”

What is Elective Oncologic Surgery in the Time of COVID-19? A Literature Review of the Impact of Surgical Delays on Outcomes in Patients with Cancer

“…A cohort study was conducted by Starbuck KD et al from May 2006 to December 2016 involving 505 primary Stage IIIC/IV ovarian cancer patients who received platinum/taxane adjuvant chemotherapy following upfront cytoreductive surgery [ 75 ]. They compared on-time completion of adjuvant chemotherapy (105 days) to early finishing (<105 days) to delays of 1–4 weeks, and delays of >4 weeks.…”

The natural compound n-butylidenephthalide kills high-grade serous ovarian cancer stem cells by activating intrinsic apoptosis signaling pathways

“…Cisplatin and taxol are standard treatments in adjuvant chemotherapy for ovarian cancer [35]. Taxol stabilizes microtubules, resulting in mitosis arrest and cell death.…”