Importance of platinum-free interval in second-line chemotherapy for advanced or recurrent endometrial cancer

Purpose: To investigate the effectiveness of platinum-based combination chemotherapy as second-line chemotherapy for patients with advanced or recurrent endometrial cancer treated initially by platinum-based combination chemotherapy. Materials and Methods: Subjects were patients who had received platinum-based combination chemotherapy as second-line chemotherapy: 56 patients with recurrent disease who had previously received postoperative adjuvant platinum-based combination chemotherapy (Category 1) and 21 patients who had received first-line chemotherapy but not adjuvant chemotherapy for advanced or recurrent disease (Category 2). Patients’ records were searched for the response to second-line chemotherapy and survival, particularly in relation to the platinum-free interval (PFI). Results: A PFI over 12 months was a predictor of response (64.7%) and overall survival time (23 months) in Category 1 patients. A PFI of less than three months was a negative predictor of response (0%) and overall survival (nine months) in Category 2 patients. Conclusion: Platinum-based combination chemotherapy appears to be effective as second-line chemotherapy for endometrial cancer if the PFI is sufficiently long.

Second-line chemotherapy; Advanced and recurrent endometrial cancer; Platinum-free interval.

[1] Thigpen J.T., Blessing J.A., DiSaia P.J., Yordan E, Carson L.F., Evers C.: “A randomized comparison of doxorubicin alone versus doxorubicin plus cyclophosphamide in the management of advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group study”. J. Clin. Oncol., 1994, 12, 1408.

[2] Thigpen J.T., Brady M.F., Homesley H.D., Malfetano J., DuBeshter B., Burger R.A. et al..: “Phase III trial of doxorubicin with or without cisplatin in advanced endometrial carcinoma: A Gynecologic Oncology Group study”. J. Clin. Oncol. 2004, 22, 3902.

[3] Fleming G.F., Filiaci V.L., Bentley R.C., Herzog T., Sorosky J., Vaccarello L. et al.: “Phase III randomized trial of doxorubicin + cisplatin versus doxorubicin + 24-h paclitaxel + filgrastim in endometrial carcinoma: A Gynecologic Oncology Group study”. Ann. Oncol. 2004, 15, 1173.

[4] 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.

[5] Markman M., Rothman R., Hakes T., Reichman B., Hoskins W., Rubin S. et al.: “Second-line platinum therapy in patients with ovarian cancer previously treated with cisplatin”. J. Clin. Oncol. 1991, 9, 389.

[6] Moore K.N., Tian C., McMeekin D.S., Thigpen J.T., Randall M.E., Gallion H.H.: “Does the progression-free interval after primary chemotherapy predict survival after salvage chemotherapy in advanced and recurrent endometrial cancer? A Gynecologic Oncology Group ancillary data analysis”. Cancer, 2010, 116, 5407.

[7] Rose P.G., Blessing J.A., Lewandowski G.A., Creasman W.T., Webster K.D.: “A phase II trial of prolonged oral etoposide (VP-16) as second-line therapy for advanced or recurrent endometrial carcinoma: A Gynecologic Oncology Group study”. Gynecol. Oncol., 1996, 63, 101.

[8] Lincoln S., Blessing J.A., Lee R.B., Rocereto T.F.: “Activity of paclitaxel as second-line chemotherapy in endometrial carcinoma: A Gynecologic Oncology Group study”. Gynecol. Oncol., 2003, 88, 277.

[9] Moore D.H., Blessing J.A., Dunton C., Buller R.E., Reid G.C.: “Dactinomycin in the treatment of recurrent or persistent endometrial carcinoma: a phase II study of the Gynecologic Oncology Group”. Gynecol. Oncol., 1999, 75, 473.

[10] Muggia F.M., Blessing J.A., Sorosky J., Reid G.C.: “Phase II trial of the pegylated liposomal doxorubicin in previously treated metastatic endometrial cancer: a Gynecologic Oncology Group study”. J. Clin. Oncol., 2002, 20, 2360.

[11] Plaxe S., Blessing J.A., Husseindazeh N., Webster K.D., Rader J. S., Dunton C.J.: “Phase II trial of pyrazoloacridine in the treatment of recurrent or persistent endometrial carcinoma: A Gynecologic Oncology Group study”. Gynecol. Oncol., 2002, 84, 241.

[12] Miller D.S., Blessing J.A., Lentz S.S., Waggoner S.E.: “A phase II trial of topotecan in patients with advanced, persistent, or recurrent endometrial carcinoma: a Gynecologic Oncology Group study”. Gynecol. Oncol., 2002, 87, 247.

[13] Fracasso P.M., Blessing J.A., Molpus K.L., Adler L.M., Sorosky J. I., Rose P.G.: “Phase II study of oxaliplatin as second-line chemotherapy in endometrial carcinoma: a Gynecologic Oncology Group study”. Gynecol. Oncol., 2006, 103, 523.

[14] Schilder R., Blessing J.A., Pearl M.L., Rose P.G.: “Evaluation of irofulven (MGI-114) in the treatment of recurrent or persistent endometrial carcinoma: a phase II study of the Gynecologic Oncology Group”. Invest. New Drugs, 2004, 22, 343.

[15] Grendys E.C. Jr., Blessing J.A., Burger R., Hoffman J.: “A phase II evaluation of flavorpiridol as second-line chemotherapy of en-dometrial carcinoma: a Gynecologic Oncology Group study”. Gynecol. Oncol., 2005, 98, 249.

[16] Aghajanian C., Sill M.W., Dancy K.M., Greer B., McMeekin D.S., Rose P.G. et al.: “Phase II trial of bevacizumab in recurrent or persistent endometrial cancer: a Gynecologic Oncology Group study”. J. Clin. Oncol., 2011, 29, 2259.

[17] Oza A.M., Elit L., Tsao M.S., Kamel-Reid S., Biagi J., Provencher D. M. et al.: “Phase II study of temsirolimus in women with recurrent or metastatic endometrial cancer: a trial of the NCIC Clinical Trials Group”. J. Clin. Oncol., 2001, 29, 3278.

[18] Alvarez E.A., Brady W.E., Walker J.L., Rotmensch J., Zhou X.C., Kendrick J.E. et al.: “Phase II trial of combination bevacizumab and temsirolimus in the treatment of recurrent or persistent endometrial carcinoma: a Gynecologic Oncology Group study”. Gynecol. Oncol., 2013, 129, 22. doi: 10.1016/j.ygyno.2012.12.022. Epub 2012 Dec 20.