Does the progression-free interval after primary chemotherapy predict survival after salvage chemotherapy in advanced and recurrent endometrial cancer?

A Gynecologic Oncology Group ancillary data analysis

Authors


  • Presented at the Gynecologic Oncology Group Meeting, Garden Grove, California, January 22-25, 2009, and as a plenary presentation at the Society of Gynecologic Oncologists Annual Meeting, San Antonio, Texas, February 5-8, 2009.

  • The following Gynecologic Oncology Group member institutions participated in the primary treatment studies: Wake Forest University School of Medicine, Columbus Cancer Council, University of California Medical Center at Irvine, Duke University Medical Center, Wayne State University, Indiana University Medical Center, University of Kentucky, Washington University School of Medicine, Abington Memorial Hospital, University of Iowa Hospitals and Clinics, Tufts-New England Medical Center, University of Mississippi Medical Center, Milton S. Hershey Medical Center, Rush-Presbyterian-St. Luke's Medical Center, Albany Medical College, University of Texas Southwestern Medical Center at Dallas, Community Clinical Oncology Program, University of Oklahoma, University of Minnesota Medical School, University of Virginia, Cleveland Clinic Foundation, University of Alabama at Birmingham, Colorado Gynecologic Oncology Group, University of North Carolina School of Medicine, University of Massachusetts Medical School, Fox Chase Cancer Center, Women's Cancer Center, State University of New York at Stony Brook, Medical University of South Carolina, Johns Hopkins Oncology Center, Cooper Hospital/University Medical Center, University of Chicago, Walter Reed Army Medical Center, Tampa Bay Cancer Consortium, University of Rochester Medical Center, Eastern Pennsylvania Gynecology/Oncology Center, Tacoma General Hospital, Thomas Jefferson University Hospital, Case Western Reserve University, University of Cincinnati, University of Pennsylvania Cancer Center, Gynecologic Oncology Network, Georgetown University Hospital, Mayo Clinic, Oregon Health Sciences University, University of Miami School of Medicine, University of California at Los Angeles, State University of New York Upstate Medical Center, Eastern Virginia Medical School, The University of Texas M. D. Anderson Cancer Center, Ellis Fischel Cancer Center, State University of New York Downstate Medical Center, Emory University Clinic, University of Southern California at Los Angeles, Stanford University Medical Center, Memorial Sloan-Kettering Cancer Center, University of Washington, North Shore University Hospital, and Long Island Jewish Medical Center.

Abstract

BACKGROUND:

This study evaluated whether progression-free interval (PFI) following primary chemotherapy (PCT) was predictive of overall survival (OS) after second-line chemotherapy in advanced/recurrent endometrial cancer (EC).

METHODS:

This is a pooled analysis of patients who recurred after PCT and were treated with second-line chemotherapy on Gynecologic Oncology Group trials. PFI-1 measured from initiation of PCT to recurrence or treatment-free interval (TFI) measured from completion of PCT to initiation of second-line chemotherapy was evaluated in relation to clinical outcomes.

RESULTS:

A total of 586 patients treated on 5 phase 3 PCT protocols were included. Baseline factors in primary setting associated with clinical outcome after PCT were also predictive of OS after second-line chemotherapy, including race, Gynecologic Oncology Group performance status, grade, and prior radiation therapy (P < .01). PFI-1 was the most significant factor predictive of survival after second-line chemotherapy, with a 30% reduction in the risk of death for PFI-1 >6 months compared with ≤6 months (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.59-0.84 [P < .0001]) and median OS after second-line chemotherapy of 10 versus 5 months. A total of 275 patients treated on 9 phase 2 second-line chemotherapy protocols were also evaluated, and TFI >3 months was associated with a 25% reduction in the risk of death (HR, 0.75; 95% CI, 0.57-0.97 [P = .030]) and median OS after second-line chemotherapy of 10 versus 7 months compared with TFI ≤3 months. The tumor response to second-line chemotherapy was 9.6% versus 5.8%; the difference was not statistically significant.

CONCLUSIONS:

Time to recurrence after PCT is predictive of survival after recurrence in advanced/recurrent EC. However, there is no evidence that this variable can be used in selecting salvage chemotherapy. Cancer 2010. © 2010 American Cancer Society.

Ancillary