Adjuvant Taxane Plus Platinum Can Replace Doxorubicin Plus Cisplatin in Endometrial Cancer

Regimens combining taxane and platinum are feasible alternatives to doxorubicin plus cisplatin in adjuvant chemotherapy for patients with endometrial cancer at risk for progression, results from a recent study show (JAMA Oncol. 2019 Mar 21. Epub ahead of print).

“The efficacy of taxane plus platinum regimens has been demonstrated for advanced or recurrent endometrial cancer; however, it has not been assessed in postoperative adjuvant chemotherapy for endometrial cancer,” explained lead investigator Hiroyuki Nomura, MD, Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan, and colleagues.

To examine the clinical benefits of using taxane plus platinum versus doxorubicin plus cisplatin in the postoperative adjuvant chemotherapy setting for patients with endometrial cancer, Dr Nomura and colleagues carried out a multi-center, open-label, phase 3 clinical trial.

A total of 788 patients (mean age, 59 years) with endometrial cancer at high-risk stage I or II or stage III or IV that did not extend beyond the abdominal cavity and had ≥2 cm residual tumor were recruited from 118 institutions across Japan between November 2006 and January 2011.

Patients were randomized in a 1:1:1 ratio to receive 6 cycles of doxorubicin 60 mg/m2 plus cisplatin 50 mg/m2 (n = 263); docetaxel 70 mg/m2 plus cisplatin 60 mg/m2 (n = 263); or paclitaxel 180 mg/m2 plus carboplatin (area under the curve, 6.0 mg/mL × min; n = 262) on day 1 every 3 weeks.

The primary end point of the study was progression-free survival (PFS), and secondary end points were overall survival (OS), adverse events, tolerability, and lymph node dissection status. Dr Nomura and colleagues analyzed the patient data from March 15, 2017, to June 30, 2017.

The full 6 cycles of treatment were left incomplete by 53 (20.1%) patients in the doxorubicin plus cisplatin arm, 45 (17.1%) patients in the docetaxel plus cisplatin arm, and 63 (24.0%) patients in the paclitaxel plus carboplatin arm.

According to the findings, tolerability did not vary statistically between the treatment arms. After a median of 7 years’ follow-up, Dr Nomura and colleagues reported no statistical difference of in PFS (doxorubicin plus cisplatin, 191; docetaxel plus cisplatin, 208; paclitaxel plus carboplatin, 187; P = .12) or OS (doxorubicin plus cisplatin, 217; docetaxel plus cisplatin, 223; paclitaxel plus carboplatin, 215; P = .67) between the 3 study arms.

At 5 years, the PFS rates were 73.3% for the doxorubicin plus cisplatin arm, 79.0% for the docetaxel plus cisplatin arm, and 73.9% for the paclitaxel plus carboplatin arm; 5-year OS rates were 82.7%, 88.1%, and 86.1%, respectively.

“There was no significant difference of survival among patients receiving doxorubicin plus cisplatin, docetaxel plus cisplatin, or paclitaxel plus carboplatin as postoperative adjuvant chemotherapy for endometrial cancer,” Dr Nomura and colleagues reported.

“Because each regimen showed adequate tolerability but different toxic effects, taxane plus platinum regimens may be a reasonable alternative to treatment with doxorubicin plus cisplatin,” they concluded.—Hina Khaliq