Dose-dense chemotherapy: A possible high cost-effectiveness treatment for ovarian cancer

Abstract Background Benefit of carboplatin and dose-dense weekly paclitaxel (ddCT) in first line treatment of ovarian cancer patients has been different in Western and Asian studies. In the present study we compare progression-free survival (PFS) of ddCT to three-weekly carboplatin and paclitaxel (CT) in first-line treatment of ovarian carcinoma in a single institution in a Western population. Materials and methods We conducted a retrospective review of medical records from patients with ovarian carcinoma treated in a tertiary cancer center from 2007 to 2018. All patients treated with ddCT or CT in the first-line setting were included. Patients who received first-line bevacizumab were not included. PFS and overall survival (OS) were compared in a propensity score-matched cohort to address selection bias. Patients were matched according to age, ECOG performance status, CA 125, FIGO stage, residual disease, and histological subtype, in a 1:2 ratio. Results Five hundred eighty-eight patients were eligible for propensity score matching, the final cohort consisted of 69 patients treated with ddCT and 138 CT group. Baseline characteristics were well-balanced. After a median follow-up of 65.1 months, median PFS was 29.3 vs 20.0 months, favouring ddCT treatment (p = 0.035). In the multivariate cox regression ddCT showed a 18% lower risk of progression (HR 0.82, 95% CI 0.68–0.99, p = 0.04). Overall survival data is immature, but suggested better outcomes for ddCT (not reached versus 78.8 months; p = 0.07). Conclusion Our retrospective study has shown superior PFS of ddCT over CT regimen in first-line treatment of ovarian carcinoma in a Western population not treated with bevacizumab.

Download Full-text

408 Dose-dense paclitaxel and carboplatin plus bevacizumab is an effective and a tolerable first-line regimen for advanced ovarian cancer

10.1136/ijgc-2020-igcs.353 ◽

2020 ◽

Author(s):

H Komazaki ◽

K Takahashi ◽

H Tanabe ◽

Y Shoburu ◽

A Izumi ◽

...

Keyword(s):

Ovarian Cancer ◽

Advanced Ovarian Cancer ◽

First Line ◽

Dose Dense

Download Full-text

Cost-effectiveness of maintenance hormonal therapy in patients with advanced low grade serous ovarian cancer

Gynecologic Oncology ◽

10.1016/j.ygyno.2020.09.051 ◽

2021 ◽

Vol 160 (1) ◽

pp. 206-213

Author(s):

Andra Nica ◽

Ji Young Jennifer Lee ◽

Nicole Look Hong ◽

Taymaa May

Keyword(s):

Ovarian Cancer ◽

Cost Effectiveness ◽

Hormonal Therapy ◽

Low Grade ◽

Serous Ovarian Cancer

Download Full-text

The Cost-Effectiveness of Multigene Panel Testing for Hereditary Breast and Ovarian Cancer in Norway

MDM Policy & Practice ◽

10.1177/2381468318821103 ◽

2019 ◽

Vol 4 (1) ◽

pp. 238146831882110 ◽

Cited By ~ 4

Author(s):

Lars Asphaug ◽

Hans Olav Melberg

Keyword(s):

Breast Cancer ◽

Ovarian Cancer ◽

Cost Effectiveness ◽

Gene Panel ◽

Breast Cancer Patients ◽

Brca Testing ◽

Early Onset Breast Cancer ◽

Breast And Ovarian Cancer ◽

Quality Adjusted Life ◽

Multigene Panel

Background. Expansion of routine genetic testing for hereditary breast and ovarian cancer from conventional BRCA testing to a multigene test could improve diagnostic yield and increase the opportunity for cancer prevention in both identified carriers and their relatives. We use an economic decision model to assess whether the current knowledge on non- BRCA mutation prevalence, cancer risk, and patient preferences justifies switching to a multigene panel for testing of early-onset breast cancer patients. Methods. We evaluated routine testing by BRCA testing, a 7-gene panel, and a 14-gene panel using individual-level simulations of annual health state transitions over a lifetime perspective. Breast and ovarian cancer incidence is reduced and posttreatment survival is improved when high-risk mutations are detected and risk-reducing treatment offered. Most model inputs were synthesized from published literature. Intermediate health outcomes included breast and ovarian cancer incidence rates, along with organ-specific cancer mortality. Cost-effectiveness outcomes were health sector costs and quality-adjusted life years. Results. Intermediate health outcomes improved by testing with multigene panels. At a cost-effectiveness threshold of $77,000, a 7-gene panel test with five non- BRCA genes was the optimal strategy with an incremental cost-effectiveness ratio of $53,310 per quality-adjusted life year compared to BRCA-only testing. Limitations. Unable to stratify carriers to specific mutations within genes, we can only make predictions on the gene level, with combined risk estimates for known variants. As mutation prevalence is the absolute upper bound of returns to more expansive testing, the rarity of modelled mutations makes analysis outcomes sensitive to model implementation. Conclusions. A 7-gene panel to diagnose hereditary breast and ovarian cancer in early-onset breast cancer patients can be a cost-effective alternative to current BRCA-only testing in Norway.

Download Full-text