Paclitaxel Matches Cisplatin HIPEC in Ovarian Cancer

TOPLINE:

Patients with advanced ovarian cancer undergoing interval cytoreductive surgery who received paclitaxel-based hyperthermic intraperitoneal chemotherapy (HIPEC) during surgery appeared to have comparable overall survival and disease-free survival rates to those who received cisplatin-based HIPEC.

METHODOLOGY:

• Although the use of HIPEC remains controversial, cisplatin-based HIPEC during cytoreductive surgery may benefit patients with advanced ovarian cancer; however, there is less evidence for paclitaxel-based HIPEC, typically used in patients who are frail or intolerant to platinum agents.
• To compare the two regimens, researchers analyzed data from the National Registry of Peritoneal Carcinomatosis, which included 846 patients (mean age, 59 years) who underwent interval cytoreductive surgery with either cisplatin-based HIPEC (n = 325) or paclitaxel-based HIPEC (n = 521). After propensity score matching, there were 199 patients per group (total = 398).
• HIPEC was administered post-surgery with cisplatin (75-100 mg/m² for 90 minutes) or paclitaxel (120 mg/m² for 60 minutes), both at 42-43 °C.

TAKEAWAY:

• Using cisplatin as the reference group, the median overall survival was not significantly different between the two options (hazard ratio [HR], 0.74; P = .16); however, the median overall survival was 82 months in the paclitaxel group vs 58 months in the cisplatin group.
• Disease-free survival was also not significantly different between the two groups, with a median of 20 months in the cisplatin group and 21 months in the paclitaxel groups (HR, 0.95; 95% CI, 0.72-1.25; P = .70).
• Overall survival was comparable during the first 20 months of follow-up and disease-free survival was equivalent during the first 15 months of follow-up, based on a predefined equivalence margin of 0.1.
• Paclitaxel-based HIPEC was not associated with increased morbidity (odds ratio, 1.32; P = .06).

IN PRACTICE:

“Our study suggests that cisplatin and paclitaxel are two safe and effective drugs to be used for HIPEC in [interval cytoreductive surgery] for advanced ovarian cancer. As cisplatin is the preferred drug according to strong evidence, paclitaxel could be a valuable alternative for patients with any contraindication to cisplatin, with similar oncological and perioperative outcomes,” the authors wrote.

SOURCE:

This study, led by Salud González Sánchez, MD, Reina Sofía University Hospital in Córdoba, Spain, was published online in JAMA Network Open.

LIMITATIONS:

The retrospective design of this study limited causal inference. The BRCA mutation status was not captured in the national registry. Additionally, the matching procedure resulted in a moderate sample size, which could have led to residual confounding.

DISCLOSURES:

The authors did not declare any funding information and reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.