B59: Re-challenge with weekly paclitaxel in patients with advanced epithelial ovarian cancer, fallopian tube and primary peritoneal cancer (PPC).
1The Royal Marsden NHS Foundation Trust, London & Surrey, UK
3-weekly carboplatin with paclitaxel is the standard first-line therapy for advanced epithelial ovarian, fallopian tube and PPC. Evidence suggests that giving these agents weekly may be more effective. The ICON8 trial compares 3-weekly with dose-fractionated regimens using weekly paclitaxel. Weekly paclitaxel is commonly used to treat platinum-resistant relapse. To date, rechallenging patients with weekly paclitaxel is rare and the efficacy of this approach is unknown.
In this retrospective study, patients with ovarian, fallopian tube and PPC rechallenged with weekly paclitaxel between 2004-2014 at a single centre were identified and clinical information collected using Electronic Patient Records.
26 patients received weekly paclitaxel (alone or in combination) as a line of therapy more than once (rechallenge). (median age 60: range 40-86; 69% high grade serous). 16/26 (61%) had prior 3-weekly paclitaxel. At initial weekly paclitaxel (23% monotherapy), 23% were platinum-resistant, 42% platinum sensitive, 35% first line. At re-challenge, 81% were platinum-resistant and 65% of patients received weekly paclitaxel rechallenge as monotherapy. The median interval between initial and re-challenge weekly paclitaxel was 24 months (range 4-84 months). Grade ?2 peripheral neuropathy developed in 5/26 patients during paclitaxel rechallenge (4/26 with initial weekly paclitaxel). Radiological response rate was 34.6%; median PFS 3.7 (95% CI (2.3-6.7) months (range 0.5-49.5 months) and median survival from re-challenge was 18.1 (95%CI 9.6-28.6) months (range 2.5-72.6 months). Three patients received weekly paclitaxel for a 3rd time and 2/3 achieved stable disease.
In a selected population of patients, rechallenge with weekly paclitaxel was feasible and some patients derived clinical benefit comparable to those expected in weekly paclitaxel-naive patients. This information is of increasing clinical relevance as more women are receiving weekly paclitaxel as part of first-line treatment and suggests that they can be treated with this schedule again at relapse. It is important to identify the sub-population that benefit from weekly paclitaxel rechallenge.