Relationship between relative dose intensity and mortality in women receiving combination chemotherapy for stage III-IV epithelial ovarian cancer.
5084 Background: Although considerable progress has been made in the treatment of advanced ovarian cancer, complications of both disease and treatment limit long term survival. Further research is needed on specific patient- and treatment-related factors that are associated with increased mortality in this population. METHODS: A multicenter retrospective study of women with surgical FIGO stage III-IV epithelial ovarian cancer treated postoperatively with multi-agent intravenous chemotherapy between 1995 and 2008 was conducted. Data were obtained from each institution's tumor registry and medical records to include the first four cycles of chemotherapy administered. Outcomes included: (1) Chemotherapy relative dose intensity (RDI), defined as actual delivered dose intensity over the course of chemotherapy in comparison with standard ovarian cancer regimens based on literature review; (2) Overall survival. Survival estimates were based on the method of Kaplan and Meier and multivariate analysis was based on the proportion hazards regression method of Cox. RESULTS: Evaluable patients included 327 women with stage III or IV ovarian cancer. With median followup of 26 months (range, 1-170), progression or recurrence was noted in 246 patients (74.3%) and death was recorded in 180 (54.4%). Median time to recurrence or progression was 18 months while median time to death was 48 months. Factors associated with overall survival included disease stage, baseline CA 125 and chemotherapy RDI. In multivariate regression analysis, the following factors were independently associated with overall survival: Noncaucasian race (HR=1.46; P=0.045); Stage IV (HR=1.38; P=0.035); Elevated baseline CA 125 (HR=2.41; P=0.007) and RDI <85% (HR=1.52; P=0.011). Age, type of treatment and comorbidities did not appear to influence overall survival after adjustment for the above prognostic factors. CONCLUSIONS: Women who receive reduced relative dose intensity of primary chemotherapy for ovarian cancer have lower survival even after adjustment for race, stage and baseline CA-125. These data suggest that women with ovarian cancer should be treated with target RDI whenever possible.
Havrilesky, LJ; Hanna, RK; Poniewierski, MS; Laskey, R; Secord, AA; Gehrig, PA; Lopez, MA; Shafer, A; Van Le, L; Dale, DC; Crawford, J; Lyman, GH
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