Dose-dense weekly versus standard three-weekly paclitaxel in combination with carboplatin for resectable stage II-IV epithelial ovarian carcinoma: A retrospective cohort study.

Abstract

5568 Background: Dose-dense weekly paclitaxel combined with carboplatin has demonstrated variable efficacy in first-line treatment of resectable epithelial ovarian cancer across different populations. While Japanese and selected real-world studies suggest improved outcomes, large Western trials have failed to confirm a survival advantage. Data from South Asian populations remains limited. This study compared progression-free survival (PFS), overall survival (OS), and toxicity profiles of dose-dense versus standard three-weekly paclitaxel plus carboplatin in a real-world, resource-constrained setting. Methods: This single-center retrospective cohort study included women aged ≥20 years with resectable, FIGO stage II–IV epithelial ovarian, fallopian tube, or primary peritoneal carcinoma treated between January 2015 and December 2018. Patients received first-line carboplatin at an AUC of 5 (Area Under Curve 5) with either dose-dense weekly paclitaxel (80 mg/m² on days 1, 8, and 15) or standard three-weekly paclitaxel (175 mg/m²). Kaplan–Meier methods were used to estimate PFS and OS, and comparisons were performed using the log-rank test. Cox proportional hazards models were applied for univariate and multivariate analyses. Results: Seventy-two patients were included, 36 in each arm. The majority presented with stage III disease (63.9% in the dose-dense arm vs. 52.8% in the standard arm). High-grade serous carcinoma was the predominant histology in both groups (83% vs. 75%). The distribution of primary versus interval debulking surgery and rates of residual disease were similar between the two arms. The dose-dense regimen was associated with significantly improved PFS compared with the standard schedule (mean PFS 25 vs. 18 months; 95% CI: 23.1-28.4; log-rank p = 0.01); median PFS was 32 months in the dose-dense arm, whereas it could not be estimated in the standard arm. OS favoured the dose-dense group (mean OS of 56 vs. 50 months), although this difference was not statistically significant (p = 0.27). In the multivariate analysis of the dose-dense cohort, elevated baseline Ca-125 (HR = 6.80; 95% CI: 1.38–34.20; p = 0.01) and cytoreduction type (HR = 13.30; 95% CI: 1.90–90.20; p = 0.008) were independent predictors of PFS but not for OS. Rates of grade ≥3 treatment-related adverse events were comparable between arms, while sensory neuropathy occurred more frequently with dose-dense therapy (39% vs. 28%). Conclusions: This real-world analysis supports the use of dose-dense weekly paclitaxel combined with carboplatin for improved PFS, findings consistent with some regional studies. While OS data showed a non-significant trend favouring the dose-dense regimen with some risk of neuropathy, they highlight the need for larger prospective regional studies to better define patient populations most likely to benefit.