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Abstract & Commentary
Synopsis: Paclitaxel appears to have excellent activity in the treatment of advanced or recurrent uterine papillary serous carcinoma.
Source: Ramondetta L, et al. Gynecol Oncol. 2001;82:
Ramondetta and colleagues treated 20 pat-ients with histologically confirmed advanced or recurrent uterine papillary serous carcinoma (UPSC) with a 24-hour infusion of paclitaxel 200 mg/m2 every 3 weeks. Patients received from 1 to 11 cycles of therapy. Among 13 women with measurable disease receiving 2 or more cycles of therapy, 4 had a complete clinical response and 6 had a partial response. The objective response rate was 77%. The median time to progression was 7.3 months (range, 2-21 months). The other 3 patients with measurable disease had stable disease for a median of 6 months. The 5 patients without evaluable disease received 5-6 cycles of adjuvant paclitaxel. Three developed recurrence (range, 4-10 months; median, 7.2 months). Neutropenia was the major toxicity. Eleven of the 20 patients required G-CSF support, and 9 were hospitalized for neutropenic fever. At the time of analysis, 13 women had died of disease, 4 were alive with disease, and 2 were disease-free. Both disease-free patients had been treated for nonmeasurable advanced stage disease. Ramondetta et al concluded that paclitaxel appears to have excellent activity in the treatment of advanced or recurrent UPSC, an uncommon but aggressive malignancy.
Comment by David M. Gershenson, MD
UPSC remains an aggressive form of endometrial cancer that is associated with a relatively high recurrence rate. Unfortunately, once relapse of UPSC occurs, the disease is essentially incurable. In general, any modality of therapy has been ineffective in achieving an objective response of significantly prolonging survival. Response to platinum-based chemotherapy has generally been reported to be no greater than about 30%. A previous report by Zanotti and colleagues noted a response rate of 89% UPSC patients treated with single-agent paclitaxel or the combination of paclitaxel and a platinum drug; however, this study included a heterogeneous group of patients, including those with advanced stage primary tumors and those with recurrent tumors.1 The optimal treatment of metastatic UPSC—either primary advanced or recurrent—remains uncertain. Others have reported the use of whole abdominopelvic radiotherapy in the treatment of metastatic UPSC; however, the numbers of patients studied have been small. The results from the present study and that by Zanotti et al suggest that the combination of paclitaxel and a platinum drug (either carboplatin or cisplatin) is a reasonable choice for patients with metastatic UPSC. Obviously, because of the poor prognosis associated with this disease, we need to continue our search for new effective agents. Hopefully, the new era of "targeted therapies" will produce more active treatments.
1. Zanotti K, et al. Gynecol Oncol. 1999;74:272-277.