Analysis of the toxicity induced by carboplatin and paclitaxel regimen in ovarian cancer patients
Objective: to analyze of the toxicities induced by carboplatin and paclitaxel regimen in ovarian cancer patients, seeking to identify possible risk factors related to its occurrence and clinical interventions. Method: a retrospective cohort study was conducted involving ovarian cancer patients, enrolled between 2015 and 2017 in a reference oncology hospital in Brazil. They were collected from medical records and prescriptions: demographic, clinical, and pharmacotherapeutic data; information on toxicities induced by treatment; and clinical interventions (chemotherapy dose reduction, chemotherapy suspension, and change of treatment regimen). Drugs were classified according to the Anatomical Therapeutic Chemical (ATC) code. The toxicities were classified as to their severity according to the Common Terminology Criteria for Adverse Events. A descriptive analysis of the variables was performed, the relative risk was calculated, and Fischer’s exact test was used to check for possible associated risk factors. A value of p < 0.05 was assumed as statistical significance. Results: the study included 105 patients. Of these, 47% had some comorbidity, 71% were polymedicated, 2% were exposed to drug interactions with the regimen studied, 73% had toxicities, 35% of which were grade > 2. Alopecia and asthenia were the most severe toxicities, and 55% had at least one of the clinical interventions studied, which resulted in a worse prognosis. Women under the age of 60 had a higher risk of developing toxicities (51.0%; p= 0.038), while those with stage III had a lower risk (24.0%; p= 0.052). Of the total, 40.9% (n= 43) of the women had some clinical intervention recorded. Dose reduction was the most common clinical intervention (48.8%, n= 21) with the main cause being the severity of toxicities (57.1%, n= 12). No association was observed between the variables investigated and the occurrence of toxicities grade > 2. Conclusions: the study was able to identify the main toxicities that occured with ovarian cancer patients treated at the institution, and has the potential to assist health professionals in carrying out preventive measures and clinical interventions related to the severity of toxicities that treatment with the investigated regimen can cause.
Matulonis UA, Sood AK, Fallowfield L, et al. Ovarian cancer. Nat Rev Dis Primers. 2016;2(1):1-22.
Lheureux S, Gourley C, Vergote I, et al. Epithelial ovarian cancer. Lancet. 2019; 393(10177):1240-1253.
Kehoe S, Hook J, Nankivell M, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet. 2015;386(9990):249–257.
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249.
Instituto Nacional de Câncer José Alencar Gomes da Silva. Estimativa 2020: incidência de câncer no Brasil. 1ª ed. Rio de Janeiro: INCA; 2019.
Santos MAP, Fernandes FCGM, Santos EGO, et al. Tendências de Incidência e Mortalidade por Câncer de Ovário nos Países da América Latina. Rev Bras Cancerol. 2020;66(4):e-06813.
Stewart C, Ralyea C, Lockwood S. Ovarian cancer: an integrated review. Semin Oncol Nurs. 2019;35(2):151-156.
Kim J, Park E, Kim O, et al. Cell Origins of High-Grade Serous Ovarian Cancer. Cancers. 2018;10(11):433.
Orr B, Edwards RP. Diagnosis and treatment of ovarian cancer. Hematol Oncol Clin North Am. 2018;32(6):943-964.
Ozols RF, Bundy BN, Greer BE, 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(17):3194–3200.
Kurnit KC, Fleming GF, Lengyel E. Updates and new options in advanced epithelial ovarian cancer treatment. Obstet Gynecol. 2021;137(1):108-121.
Boyd LR, Muggia FM. Carboplatin/Paclitaxel Induction in Ovarian Cancer: The Finer Points. Oncology. 2018;32(8):418-420.
Safra T, Waissengrin B, Levy T, et al. Weekly carboplatin and paclitaxel: A retrospective comparison with the three‐weekly schedule in first‐line treatment of ovarian cancer. Oncologist. 2021;26(1):30-39.
Ferracini AC, Lopes‐Aguiar L, Lourenço GJ, et al. GSTP1 and ABCB1 Polymorphisms Predicting Toxicities and Clinical Management on Carboplatin and Paclitaxel‐Based Chemotherapy in Ovarian Cancer. Clin Transl Sci. 2021;14(2):720–728.
Edwards SJ. Prevention and treatment of adverse effects related to chemotherapy for recurrent ovarian cancer. Semin Oncol Nurs. 2003;19(3-Suppl-1):19-39.
Noer MC, Sperling CD, Ottesen B, et al. Ovarian cancer and comorbidity: is poor survival explained by choice of primary treatment or system delay?. Int J Gynecol Cancer. 2017;27(6):1123-1133.
Oldak S, Ioannou S, Kamath P, et al. Polypharmacy in patients with ovarian Cancer. Oncologist. 2019;24(9):1201–1208.
Lheureux S, Clarisse B, Launay-Vacher V, et al. Evaluation of current practice: management of chemotherapy-related toxicities. Anticancer Drugs. 2011;22(9):919-925.
Eisenhauer EA. Real-world evidence in the treatment of ovarian cancer. Ann Oncol. 2017;28(suppl_8):61-65.
Ministério da Saúde. Serviço de oncologia clínica: Rotinas internas do INCA. 1ª ed. Rio de Janeiro: INCA; 2011.
World Health Organization. Guidelines for ATC classification and DDD assignment. WHOCC - ATC/DDD Index; 2019. Disponível em: https://www.whocc.no/atc_ddd_index/. Acessado em: 15 Jan 2019.
Drugs.com Statistics®. Drug Interaction Checker; c1996-2018; 2020. Disponível em: https://www.drugs.com/drug_interactions. html. Acessado em: 1 Dez 2020.
National Cancer Institute (NCI). Common Terminology Criteria for Adverse Events (CTCAE) - Version 5.0; 2017. Disponível em: https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm. Acessado em: 30 Jun 2019.
Gillen J, Gunderson C, Greenwade M, et al. Contribution of age to clinical trial enrollment and tolerance with ovarian cancer. Gynecol Oncol. 2017;145(1):32-36
Dumas L, Bowen R, Butler J, et al. Under-treatment of older patients with newly diagnosed epithelial ovarian cancer remains an issue. Cancers. 2021;13(5):952.
Hirte H, Poon R, Yao X, et al. Neoadjuvant and Adjuvant Systemic Therapy for Newly Diagnosed Stage II–IV Epithelial Ovary, Fallopian Tube, or Primary Peritoneal Carcinoma: A Practice Guideline. Curr Oncol. 2022;29(1):231–242.
Carrier M, Blais N, Crowther M, et al. Treatment Algorithm in Cancer-Associated Thrombosis: Updated Canadian Expert Consensus. Curr Oncol. 2021;28(6):5434-5451.
Gockley A, Wright A. Living through ovarian cancer treatment: acute and long-term toxicities of chemotherapy for advanced-stage disease. Hematol Oncol Clin North Am. 2018;32(6):1073-1085.
Yahata H, Kobayashi H, Sonoda K, et al. Efficacy of aprepitant for the prevention of chemotherapy-induced nausea and vomiting with a moderately emetogenic chemotherapy regimen: a multicenter, placebo-controlled, double-blind, randomized study in patients with gynecologic cancer receiving paclitaxel and carboplatin. Int J Clin Oncol. 2016;21(3):491-497.
Turner JP, Kantilal K, Holmes HM, et al. Optimising medications for patients with cancer and multimorbidity: the case for deprescribing. Clin Oncol. 2020;32(9):609-617.
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