Endometrial cancer: adjuvant taxane-platinum regimens effective in Japanese study

  • Nomura H & al.
  • JAMA Oncol
  • 21 Mar 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In high-risk patients with advanced endometrial cancer, adjuvant docetaxel+cisplatin and paclitaxel+carboplatin showed similar survival vs standard doxorubicin+cisplatin.
  • 3 regimens had different toxicity profiles. 
    • Hematologic toxicities were less frequent with taxane-based treatment.
    • Gastrointestinal toxicities were more common with cisplatin regimen and neurotoxicity with paclitaxel+carboplatin.

Why this matters

  • Based on toxicity profile, clinician can choose individualized treatment.
  • Taxane-platinum regimens have previously shown efficacy in advanced or recurrent disease, but postoperative adjuvant use has not been assessed.

Study design

  • Multicenter, phase 3 randomized Japanese Gynecologic Oncology Group study of 788 patients with high-risk early-stage or optimally debulked advanced endometrial cancer.
  • Patients were randomly assigned to doxorubicin+cisplatin, docetaxel+cisplatin, or paclitaxel+carboplatin.
  • Funding: Health Labour Sciences Research Grant.

Key results

  • Median follow-up duration, 7 years. 
  • No statistical difference was observed between doxorubicin+cisplatin, docetaxel+cisplatin, paclitaxel+carboplatin in:
    • 5-year PFS rate: 73.3%, 79.0%, and 73.9%, respectively (2-sided P=.12).
    • 5-year OS rate: 82.7%, 88.1%, and 86.1%, respectively (2-sided P=.67).
  • Leukopenia, neutropenia, febrile neutropenia, and anemia were less frequent with taxane-based regimen.
  • Gastrointestinal toxicities were more common with cisplatin regimen.
  • The incidence of neurotoxicity was higher with paclitaxel+carboplatin.
  • Adverse-event-related discontinuations were more frequent with paclitaxel+carboplatin (12.2%) vs doxorubicin+cisplatin (6.5%) and docetaxel+cisplatin (5.7%).

Limitations

  • Open-label study.

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