paywalled- Comparison of weekly versus every 3 weeks paclitaxel in the treatment of advanced solid tumors: A meta-analysis

Comparison of weekly versus every 3 weeks paclitaxel in the treatment of advanced solid tumors: A meta-analysis

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Abstract

Background

Paclitaxel is commonly given as a 3-h infusion every 3 weeks for a variety of malignancies. Several randomized clinical trials comparing weekly paclitaxel with Q3-week (Q3W) have produced mixed results in terms of efficacy and toxicity creating controversy about the ideal dose and schedule.

Methods

A literature search using PubMed, Cochrane Library, and Proceedings of the American Society of Clinical oncology from 1995 to 2011 was performed..........Moderators of cancer types, ethnicity, and paclitaxel dose ratio were analyzed for primary dependent variables.

Results

Ten trials were included....

Conclusion

Weekly paclitaxel has a favorable toxicity profile compared to the current standard of Q3W paclitaxel.

Phase II Study of Docetaxel Weekly in Combination With Carboplatin Every 3 Weeks as First-Line Chemotherapy in Stage IIB to Stage IV Epithelial Ovarian Cancer

 Objectives: 
The purpose of this study was to assess the response rate, toxicity, progression-free survival, and overall survival in a series of patients with advanced-stage ovarian carcinoma treated with a first-line weekly docetaxel and 3 weekly carboplatin regimen.
 
Conclusions:
The tolerable hematologic toxicity (no need for colony-stimulating factors) and the low rate of neurotoxicity (only grades 1–2) and response rates in line with the standard 3-week paclitaxel-carboplatin regimen for advanced primary ovarian carcinoma after suboptimal cytoreductive surgery make this regimen an interesting alternative in selected patients.

Markman commentary: Can weekly topotecan substitute for a multi-day regimen in the treatment of ovarian cancer? Sadly, 10 years later the answer remains unknown

Gynecologic Oncology
Article in Press

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doi:10.1016/j.ygyno.2011.04.020 | How to Cite or Link Using DOI Copyright © 2011 Elsevier Inc. All rights reserved.

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Clinical Commentary

Can weekly topotecan substitute for a multi-day regimen in the treatment of ovarian cancer? Sadly, 10 years later the answer remains unknown

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Maurie Markman^a,

^a Cancer Treatment Centers of America, Eastern Regional Medical Center, 1331 East Wyoming Avenue, Philadelphia, PA 19046 USA

Received 28 March 2011; 

accepted 16 April 2011. 

Available online 12 May 2011.

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abstract: Weekly paclitaxel as a single agent or in combination with carboplatin or weekly topotecan in patients with resistant ovarian cancer:

CONCLUSIONS:

Combination chemotherapy in platinum-resistant ROC was more toxic than weekly paclitaxel and did not significantly prolong PFS.

Randomized Phase III Clinical Trial Evaluating Weekly Cisplatin for Advanced Epithelial Ovarian Cancer — J. Natl. Cancer Inst.

Thus, increasing dose intensity of cisplatin does not improve PFS or OS compared with standard chemotherapy.

Randomized Phase III Clinical Trial Evaluating Weekly Cisplatin for Advanced Epithelial Ovarian Cancer

"Thus, increasing dose intensity of cisplatin does not improve PFS or OS compared with standard chemotherapy."

Weekly paclitaxel in the treatment of recurrent ovarian cancer - abstract

Abstract:

Weekly paclitaxel is a highly active and well tolerated regimen that is increasingly being adopted for the treatment of relapsed ovarian cancer. This regimen is usually administered at 80-90 mg/m(2)/week, and the use of a 1 h infusion helps minimize myelosuppression. When compared with the 3-weekly schedule, weekly paclitaxel is better tolerated, with a reduced frequency of grade 3-4 toxic effects. Single-agent weekly paclitaxel for relapsed ovarian cancer yields response rates in the range of 20-62%; however, response duration can be short. Responses to weekly paclitaxel have been observed in patients whose tumors are resistant to 3-weekly paclitaxel. The level of activity of weekly paclitaxel for relapsed disease has led to its detailed evaluation in the first-line setting, and interest has been enhanced by the results of a Japanese Gynecological Oncology Group study that demonstrated a survival advantage for weekly paclitaxel compared with 3-weekly paclitaxel in combination with carboplatin as initial treatment. The enhanced efficacy of weekly paclitaxel may be due to greater drug exposure, a direct antiangiogenic effect, or both. Current research topics include the combination of weekly paclitaxel with molecular-targeted agents and the use of molecular profiling to better select patients for treatment.

Efficacy of lower dose of weekly topotecan in recurrent epithelial ovarian and primary peritoneal cancer resistant to platinum-based therapy

Conclusions: Lower dose of weekly topotecan was well tolerated in patients with platinum-resistant ovarian or peritoneal cancer at first relapse, with a favourable hematologic profile. Moreover, antitumor activity was similar to that reported for the standard dose of weekly regimen.

Jan 23, 2009: Commentary (1 of 2): Dose-dense paclitaxel for advanced ovarian cancer : The Lancet

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