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The standard chemotherapy regimen used to treat patients with ovarian cancer (carboplatin and paclitaxel administered every 3 weeks) was established based on results from the Gynecologic Oncology Group (GOG) 111 and GOG-158 studies.
The Japanese GOG (JGOG) phase III trial compared a dose-dense regimen administered once weekly with the standard regimen administered every 3 weeks. Results from this analysis showed an impressive survival advantage with the dose-dense regimen, notes Michael J. Birrer, MD. However, the JGOG trial was a small study in an ethnically different population, and thus the results may not be generalizable to patients in the United States, comments Birrer. Also, there were concerns about the potential for neuropathy and myelosuppression in the US patient population.
The GOG-262 study showed that a weekly regimen can be given with acceptable toxicity, remarks James Tate Thigpen, MD. The results of the GOG-262 study demonstrated that in the 15% of patients who did not receive bevacizumab, there was a survival advantage with the dose-dense paclitaxel regimen compared with patients who received the standard regimen. However, in patients who received bevacizumab, there was no difference between the 2 groups.
Thigpen and Birrer acknowledge that a limitation of GOG-262 is that it involved a subgroup analysis in a small number of patients. With regard to route of administration, Birrer adds that 3 randomized studies have demonstrated a survival advantage in patients who received intraperitoneal chemotherapy compared with patients who received intravenous chemotherapy.