Comparison of outcomes in patients treated with multi-agent regiments of cisplatin, adriamycin, and VP-16 versus carboplatin and paclitaxel for advanced and recurrent endometrial cancer

Objective: The objective of this study was to compare the efficacy of two multi-agent chemotherapeutic regiments that were previously used at the Institution for treatment of advanced and recurrent endometrial cancer. Methods: A retrospective review of patients with Stage III, IV, and recurrent endometrial cancer who received adjuvant chemotherapy at Roswell Park Cancer Institute over a period of 21 years. Two patient groups were defined based on treatment received: cisplatin, adriamycin, and VP-16 with or without megace (PAV-M), or carboplatin and paclitaxel (CT). Results: Forty-two patients with advanced or recurrent endometrial cancer were included in this review based on regimen received. Median duration of follow up was 55 months. Treatment with PAV-M resulted in more dose modifications compared to CT group (42% vs 11%, respectively). There were no significant differences in disease-free survival or overall survival. Conclusions: PAV/PAV-M is active in patients with advanced or recurrent endometrial cancer. However, toxicity associated with this triplet regimen may limit clinical use.

Advanced endometrial carcinoma; Multi-agent chemotherapies; Adriamycin; Cisplatin; Etoposide

[1] Fleming G.F., Brunetto V.L., Cella D., Look K.Y., Reid G.C., Munkarah A.R. et al.: “Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study”. J. Clin. Oncol., 2004, 22, 2159.

[2] Akram T., Maseelall P., Fanning J.: “Carboplatin and paclitaxel for the treatment of advanced or recurrent endometrial cancer”. Am. J. Obstet. Gynecol., 2005, 192, 1365.

[3] Hoskins P.J., Swenerton K.D., Pike J.A., Wong F., Lim P., Acquino-Parsons C. et al.: “Paclitaxel and carboplatin, alone or with irradiation, in advanced or recurrent endometrial cancer: a phase II study”. J. Clin. Oncol., 2001, 19, 4048.

[4] Michener C.M., Peterson G., Kulp B., Webster K.D., Markman M.: “Carboplatin plus paclitaxel in the treatment of advanced or recurrent endometrial carcinoma”. J. Cancer Res. Clin. Oncol., 2005, 131, 581.

[5] Kelley R.M., Baker W.H.: “Progestational agents in the treatment of carcinoma of the endometrium”. N. Engl. J. Med., 1961, 264, 216.

[6] Lentz S.S., Brady M.F., Major F.J., Reid G.C., Soper J.T.: “Highdose megestrol acetate in advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group Study”. J. Clin. Oncol., 1996, 14, 357.

[7] Thigpen J.T., Brady M.F., Alvarez R.D., Adelson M.D., Homesley H.D., Manetta A. et al.: “Oral medroxyprogesterone acetate in the treatment of advanced or recurrent endometrial carcinoma: a doseresponse study by the Gynecologic Oncology Group”. J. Clin. Oncol., 1999, 17, 1736.

[8] Thigpen T., Brady M.F., Homesley H.D., Soper J.T., Bell J.: “Tamoxifen in the treatment of advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group study”. J. Clin. Oncol., 2001, 19, 364.

[9] Whitney C.W., Brunetto V.L., Zaino R.J., Lentz S.S., Sorosky J., Armstrong D.K. et al.: “Phase II study of medroxyprogesterone acetate plus tamoxifen in advanced endometrial carcinoma: a Gynecologic Oncology Group study”. Gynecol. Oncol., 2004, 92, 4.

[10] Ozols R.F., Bundy B.N., Greer B.E., Fowler J.M., Clarke-Pearson D., Burger R.A. et al.: “Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected Stage III ovarian cancer: a Gynecologic Oncology Group study”. J. Clin. Oncol., 2003, 21, 3194.

[11] Piccart M.J., Stuart G.C., Cassidy J., Bertelsen K., Parmar M.K., Eisenhauer E.A. et al.: “Intergroup collaboration in ovarian cancer: a giant step forward”. Ann. Oncol., 1999, 10 (suppl. 1), 83.

[12] Price F.V., Edwards R.P., Kelley J.L., Kunschner A.J., Hart L.A.: “A trial of outpatient paclitaxel and carboplatin for advanced, recurrent, and histologic high-risk endometrial carcinoma: preliminary report”. Semin. Oncol., 1997, 24 (5 suppl. 15), S15-78.

[13] Nakamura T., Onishi Y., Yamamoto F., Kouno S., Maeda Y., Hatae M.: “Evaluation of paclitaxel and carboplatin in patients with endometrial cancer”. Gan To Kagaku Ryoho, 2000, 27, 257.

[14] Cornelison T.L., Baker T.R., Piver M.S., Driscoll D.L.: “Cisplatin, adriamycin, etoposide, megestrol acetate versus melphalan, 5-fluorouracil, medroxyprogesterone acetate in the treatment of endometrial carcinoma”. Gynecol. Oncol., 1995, 59, 243.

[15] Piver, M.S., Fanning J., Baker T.R. Phase II trial of cisplatin, adriamycin, and etoposide for metastatic endometrial adenocarcinoma”. Am. J. Clin. Oncol., 1991, 14, 200.