OBJECTIVE To evaluate the efficacy and adverse effects ofgemcitabine versus pegylated liposomal doxorubicin in patientswith progressive or recurrent ovarian cancer.METHODS We conducted a systematic literature search t...OBJECTIVE To evaluate the efficacy and adverse effects ofgemcitabine versus pegylated liposomal doxorubicin in patientswith progressive or recurrent ovarian cancer.METHODS We conducted a systematic literature search toidentify all randomized controlled trials comparing gemcitabineand pegylated liposomal doxorubicin for progressive orrecurrent ovarian cancer. Trial data were reviewed and extractedindependently by 2 reviewers. We evaluated the quality of theincluded studies using the Handbook 5.0 recommend standardsand then analyzed data by Cochrane Collaboration's RevMan 5.0.RESULTS Two trials which included a total of 348 patients wereanalyzed. The results of meta-analysis showed that gemcitabineimproved disease control rates significantly better than pegylatedliposomal doxorubicin. A greater number of patients receivinggemcitabine experienced neutropenia compared with patientsreceiving pegylated liposomal doxorubicin; however, hand-footsyndrome and mucositis were more severe in patients receivingpegylated liposomal doxorubicin.CONCLUSION Gemcitabine provided a limited advantagecompared with pegylated liposomal doxorubicin. There existsan urgent need for more high-quality, multicenter, adequaterandomized, controlled clinical trials for comparing gemcitabinewith pegylated liposomal doxorubicin in patients withprogressive/recurrent ovarian cancer.展开更多
AIM: To assess the efficacy and safety of the combination of pegylated liposomal doxorubicin(PLD) and carboplatin in patients with recurrent epithelial ovarian carcinoma(ROC), following disease progression on single a...AIM: To assess the efficacy and safety of the combination of pegylated liposomal doxorubicin(PLD) and carboplatin in patients with recurrent epithelial ovarian carcinoma(ROC), following disease progression on single agent PLD. METHODS: An analysis of the medical records of 10 patients with ROC, treated in our institution with a combination of PLD and carboplatin following progression on single-agent PLD therapy was performed. The median age was 59.1 years(range, 45 to 77 years). All diagnoses were histological-proven. Eight of the 10 patients were platinum-resistant. Following disease progression on single-agent PLD treatment, carboplatin area under the curve(AUC)-5 was added to PLD in all 10 patients. In order to assess disease status, Ca-125 was assessed before each PLD/carboplatin treatment. Relative changes in Ca-125 values were calculated, and response defined as a greater than 50% reduction in Ca-125 from baseline. Radiographic studies were reevaluated and responses to therapy based on com-puter tomography(CT) scans carried out on a regular basis every 2-3 mo in each patient. Statistical analysis was performed using SPSS(V19).RESULTS: A median of 10 cycles(range, 2-26) of the carboplatin-PLD combination was given. Of the 10 treated patients, 6 had > 50% reduction in Ca-125 levels from baseline, 4 of these had a partial response according to Response Evaluation Criteria in Solid Tumors(RECIST) criteria, and the other 2 patients had no measurable disease. In a further 2 patients with a best response of disease stabilization and < 50% reduction of Ca-125 levels, one had progression of disease after 26 cycles, and the second progressed with brain metastases following 12 cycles. Seven of the eight patients who were platinum-resistant showed evidence of clinical benefit on carboplatin-PLD combination therapy; 5 of these had > 50% reduction in Ca-125 level, 4 also showed a partial response on CT scan. The treatment was generally well-tolerated by the patients. CONCLUSION: Addition of carboplatin to PLD, after disease progression on single-agent PLD therapy, is both effective and safe in patients with ROC, even in those with Platinum-resistant disease.展开更多
OBJECTIVE Pegylated liposomal doxorubicin (PLD;CAELYX^(?)), a novel formulation of doxorubicin with enhancedtherapeutic efficacy and reduced toxicity, has demonstratedimproved progression-free survival in recurrent or...OBJECTIVE Pegylated liposomal doxorubicin (PLD;CAELYX^(?)), a novel formulation of doxorubicin with enhancedtherapeutic efficacy and reduced toxicity, has demonstratedimproved progression-free survival in recurrent or refractoryovarian cancer. The objective of this open-label, noncomparative,observational study was to determine the efficacyand safety of PLD monotherapy or combination therapy withcarboplatin for patients with recurrent or refractory ovariancancer.METHODS Sixty-two patients with recurrent or refractoryovarian cancer who completed a platinum-based chemotherapyregimen and demonstrated platinum sensitivity for first-linetreatment at least 6 months prior to study entry were enrolledin 20 centers in China. PLD was given as monotherapy (50mg/m^2 infused over 60 minutes) or as combination therapy(30 mg/m^2 1-hour infusion) with carboplatin (area under thecurve 5 mg.min/mL 1-hour infusion) on day 1 every 28 daysfor 4 cycles. The primary endpoint was objective response (OR)rate or CA-125 level. Secondary endpoints included time toresponse, time-to-progression, health-related quality of life, andsafety.RESULTS Overall, 48% of the 62 evaluable patients achieveda confirmed OR. More patients receiving PLD and carboplatinachieved an OR vs the PLD monotherapy group (63% vs. 37%).The median time to response and disease progression was58.5 days and 56.0 days, respectively. Overall and drug-relatedadverse events were reported for 39% and 34%, respectively.The most commonly reported adverse events were stomatitis(22.6%) and palmar-plantar erythroderma (9.7%). Two deathswere reported.CONCLUSION PLD is an effective and well tolerated agentin women with recurrent or refractory epithelial ovarian cancer.展开更多
目的：系统评价脂质体多柔比星联合卡铂治疗卵巢癌的疗效及安全性。方法：计算机检索Cochrane Library、Pubmed、EMbase、Web of Science、中国CNKI学术总库、万方数据库、维普中文科技期刊数据库和中国生物医学文献数据库，检索时间从...目的：系统评价脂质体多柔比星联合卡铂治疗卵巢癌的疗效及安全性。方法：计算机检索Cochrane Library、Pubmed、EMbase、Web of Science、中国CNKI学术总库、万方数据库、维普中文科技期刊数据库和中国生物医学文献数据库，检索时间从建库截至2013年3月，同时追索纳入文献的参考文献，查找脂质体多柔比星联合卡铂及紫杉醇联合卡铂治疗卵巢癌的随机对照试验（RCT）。由2位研究者按照纳入、排除标准筛选文献，提取资料并依据CochraneHand—book5．0．1质量评价标准评价纳入文献后，采用RevMan5．1软件进行Meta分析。结果：纳入3个临床RCT，共1985例患者。Meta分析结果显示：总生存率两组差异无统计学意义（OR=0．85，95％C10．71～1．02，P=0．090），与紫杉醇联合卡铂相比，脂质体多柔比星联合卡铂治疗改善患者的中位无进展生存率（OR=1．15，95％CI1．03～1．30，P=0．020）效果更好，过敏反应（OR=0．28，95％C10．19—0．41，P=0．000）、脱发（0R=0．08，95％C10．06～0．10，P=0．000）、中性白细胞减少（OR=0．70，95％C10．58—0．84，P=0．000）和神经毒性（OR=0．17，95％C10．14～0．21，P=0．000）发生较少，但用药期间掌跖红斑（OR=3．82，95％CI2．85～5．13，P=0．000）和血小板减少症（OR=4．31，95％CI3．00～6．17，P=0．000）的发生却明显增加。结论：脂质体多柔比星联合卡铂与紫杉醇联合卡铂治疗卵巢癌的总体生存率相当，而中位无进展生存情况脂质体多柔比星联合卡铂有明显优势，且部分毒副反应明显减轻。展开更多
文摘OBJECTIVE To evaluate the efficacy and adverse effects ofgemcitabine versus pegylated liposomal doxorubicin in patientswith progressive or recurrent ovarian cancer.METHODS We conducted a systematic literature search toidentify all randomized controlled trials comparing gemcitabineand pegylated liposomal doxorubicin for progressive orrecurrent ovarian cancer. Trial data were reviewed and extractedindependently by 2 reviewers. We evaluated the quality of theincluded studies using the Handbook 5.0 recommend standardsand then analyzed data by Cochrane Collaboration's RevMan 5.0.RESULTS Two trials which included a total of 348 patients wereanalyzed. The results of meta-analysis showed that gemcitabineimproved disease control rates significantly better than pegylatedliposomal doxorubicin. A greater number of patients receivinggemcitabine experienced neutropenia compared with patientsreceiving pegylated liposomal doxorubicin; however, hand-footsyndrome and mucositis were more severe in patients receivingpegylated liposomal doxorubicin.CONCLUSION Gemcitabine provided a limited advantagecompared with pegylated liposomal doxorubicin. There existsan urgent need for more high-quality, multicenter, adequaterandomized, controlled clinical trials for comparing gemcitabinewith pegylated liposomal doxorubicin in patients withprogressive/recurrent ovarian cancer.
文摘AIM: To assess the efficacy and safety of the combination of pegylated liposomal doxorubicin(PLD) and carboplatin in patients with recurrent epithelial ovarian carcinoma(ROC), following disease progression on single agent PLD. METHODS: An analysis of the medical records of 10 patients with ROC, treated in our institution with a combination of PLD and carboplatin following progression on single-agent PLD therapy was performed. The median age was 59.1 years(range, 45 to 77 years). All diagnoses were histological-proven. Eight of the 10 patients were platinum-resistant. Following disease progression on single-agent PLD treatment, carboplatin area under the curve(AUC)-5 was added to PLD in all 10 patients. In order to assess disease status, Ca-125 was assessed before each PLD/carboplatin treatment. Relative changes in Ca-125 values were calculated, and response defined as a greater than 50% reduction in Ca-125 from baseline. Radiographic studies were reevaluated and responses to therapy based on com-puter tomography(CT) scans carried out on a regular basis every 2-3 mo in each patient. Statistical analysis was performed using SPSS(V19).RESULTS: A median of 10 cycles(range, 2-26) of the carboplatin-PLD combination was given. Of the 10 treated patients, 6 had > 50% reduction in Ca-125 levels from baseline, 4 of these had a partial response according to Response Evaluation Criteria in Solid Tumors(RECIST) criteria, and the other 2 patients had no measurable disease. In a further 2 patients with a best response of disease stabilization and < 50% reduction of Ca-125 levels, one had progression of disease after 26 cycles, and the second progressed with brain metastases following 12 cycles. Seven of the eight patients who were platinum-resistant showed evidence of clinical benefit on carboplatin-PLD combination therapy; 5 of these had > 50% reduction in Ca-125 level, 4 also showed a partial response on CT scan. The treatment was generally well-tolerated by the patients. CONCLUSION: Addition of carboplatin to PLD, after disease progression on single-agent PLD therapy, is both effective and safe in patients with ROC, even in those with Platinum-resistant disease.
文摘OBJECTIVE Pegylated liposomal doxorubicin (PLD;CAELYX^(?)), a novel formulation of doxorubicin with enhancedtherapeutic efficacy and reduced toxicity, has demonstratedimproved progression-free survival in recurrent or refractoryovarian cancer. The objective of this open-label, noncomparative,observational study was to determine the efficacyand safety of PLD monotherapy or combination therapy withcarboplatin for patients with recurrent or refractory ovariancancer.METHODS Sixty-two patients with recurrent or refractoryovarian cancer who completed a platinum-based chemotherapyregimen and demonstrated platinum sensitivity for first-linetreatment at least 6 months prior to study entry were enrolledin 20 centers in China. PLD was given as monotherapy (50mg/m^2 infused over 60 minutes) or as combination therapy(30 mg/m^2 1-hour infusion) with carboplatin (area under thecurve 5 mg.min/mL 1-hour infusion) on day 1 every 28 daysfor 4 cycles. The primary endpoint was objective response (OR)rate or CA-125 level. Secondary endpoints included time toresponse, time-to-progression, health-related quality of life, andsafety.RESULTS Overall, 48% of the 62 evaluable patients achieveda confirmed OR. More patients receiving PLD and carboplatinachieved an OR vs the PLD monotherapy group (63% vs. 37%).The median time to response and disease progression was58.5 days and 56.0 days, respectively. Overall and drug-relatedadverse events were reported for 39% and 34%, respectively.The most commonly reported adverse events were stomatitis(22.6%) and palmar-plantar erythroderma (9.7%). Two deathswere reported.CONCLUSION PLD is an effective and well tolerated agentin women with recurrent or refractory epithelial ovarian cancer.
文摘目的：系统评价脂质体多柔比星联合卡铂治疗卵巢癌的疗效及安全性。方法：计算机检索Cochrane Library、Pubmed、EMbase、Web of Science、中国CNKI学术总库、万方数据库、维普中文科技期刊数据库和中国生物医学文献数据库，检索时间从建库截至2013年3月，同时追索纳入文献的参考文献，查找脂质体多柔比星联合卡铂及紫杉醇联合卡铂治疗卵巢癌的随机对照试验（RCT）。由2位研究者按照纳入、排除标准筛选文献，提取资料并依据CochraneHand—book5．0．1质量评价标准评价纳入文献后，采用RevMan5．1软件进行Meta分析。结果：纳入3个临床RCT，共1985例患者。Meta分析结果显示：总生存率两组差异无统计学意义（OR=0．85，95％C10．71～1．02，P=0．090），与紫杉醇联合卡铂相比，脂质体多柔比星联合卡铂治疗改善患者的中位无进展生存率（OR=1．15，95％CI1．03～1．30，P=0．020）效果更好，过敏反应（OR=0．28，95％C10．19—0．41，P=0．000）、脱发（0R=0．08，95％C10．06～0．10，P=0．000）、中性白细胞减少（OR=0．70，95％C10．58—0．84，P=0．000）和神经毒性（OR=0．17，95％C10．14～0．21，P=0．000）发生较少，但用药期间掌跖红斑（OR=3．82，95％CI2．85～5．13，P=0．000）和血小板减少症（OR=4．31，95％CI3．00～6．17，P=0．000）的发生却明显增加。结论：脂质体多柔比星联合卡铂与紫杉醇联合卡铂治疗卵巢癌的总体生存率相当，而中位无进展生存情况脂质体多柔比星联合卡铂有明显优势，且部分毒副反应明显减轻。
文摘目的评价托泊替康在复发性卵巢癌化疗中的疗效,安全性以及成本效果。方法计算机检索MEDLINE(1966～2005),EMbase(1974～2005), CancerLit(1996～2003),中国生物医学文献数据库(1978-2005)。中国期刊全文数据库(1 994～2005),The Cochrane Central Register of Controlled Trials(CENTRAL),The National Research Register,Health Technology Assessment Database(HTA),Cochrane图书馆(2005年第3期)等数据库。手工检索相关领域的杂志,并用Google等搜索引擎在互联网上查找相关的文献。检索截止至2005年12月。收集有关托泊替康(TPT)与其他药物比较治疗复发性卵巢癌(ROC)的随机对照试验(RcT)文献。由两名研究者独立评价纳入研究的文献质量,并提取有效数据进行Meta分析。结果共纳入4个RCT(9篇文献,1 032例病人)。其中1个多中心RCT(474例,B级),比较TPT与脂质体阿霉素(PLD)治疗ROC的疗效和成本;另1个多中心RCT(226例,A级),比较托泊替康与紫杉醇的疗效。还有1个RCT (266例,B级)为TPT不同用药途径的比较;最后1个RCT(66例,A级)比较了TPT两种用药方案及剂量。结果显示:①TPT与紫杉醇比较:临床受益率TPT大于紫杉醇,两者差异有统计学意义;缓解率、疾病稳定率的差异无统计学意义;3／4级血液学毒性TPT高于紫杉醇,对铂类耐药者TPT的生存时间长于紫杉醇,差异有统计学意义;两者生存质量差异无统计学意义。②TPT与PLD比较:临床受益率、缓解率差异无统计学意义。3／4级血液学毒性,TPT高于PLD,差异有统计学意义。对铂类敏感者TPT组的生存时间短于PLD组:1年生存率差异无统计学意义;2、3年生存率TPT低于PLD,差异有统计学意义。成本效果分析:TPT的治疗总成本高于PLD;二者生活质量差异无统计学意义。③TPT两种用药剂量(方案)的比较:标准方案的缓解率及3／4级中性粒细胞减少的血液学毒性均大于24 h静滴方案;生存时间差异无统计学意义。④TPT口服与静脉两种用药途径相比:总缓解率静脉途径大于口服途径;口服途径的中性粒细胞减少的血液学毒性小于静脉途径,生存时间短于静脉途径。结论在ROC的化疗中,TPT的疗效优于紫杉醇,与PLD相当(TPT的临床受益率大于紫杉醇,缓解率相当于紫杉醇,对铂类耐药ROC患者TPT治疗的生存率大于紫杉醇)。TPT的缓解率和临床受益率与PLD差异无统计学意义,TPT的2、3年生存率低于PLD,铂类敏感的生存时间小于PLD;血液学毒性TPT大于紫杉醇和PLD;治疗成本TPT高于PLD。关于TPT在ROC的二线化疗中的临床应用,推荐用于耐药性、难治性的卵巢癌,选用治疗效果足够、毒性可以耐受的5天静脉滴注的标准治疗方案。
