Salvage Chemotherapy for Patients With Recurrent or Persistent Ovarian Clear Cell Carcinoma: A Retrospective Study of 164 Cases

Abstract

The purpose of this study was to evaluate the effects of salvage chemotherapy on recurrent or persistent ovarian clear cell carcinoma (CCC) with the goal of identifying a more rational treatment regimen for this lethal disease.The medical records of patients with CCC were retrospectively reviewed to select patients that were subsequently treated for recurrent or persistent disease.Of the 164 women with recurrent or persistent CCC, 485 chemotherapy courses with 1766 cycles were administered. Overall, the clinical benefit rate (CBR) was 39.4%, and the mean progression-free survival (PFS) was 4.5 months. Grade 3/4 toxicities occurred in 94 courses (19.4%). The CBR for TC was 45.1%, with a PFS of 3.7 months. Compared to that of TC, the CBRs for PC and CC were significantly lower (P = 0.020 and 0.021, respectively). The CBRs and PFS for PAF-C were slightly higher (P = 0.518 and 0.077, respectively), but showed a significantly higher adverse event rate (AER, P = 0.039). The CBR for bevacizumab was 50% with an extraordinarily long PFS (49.8 months). Gemcitabine and oxaliplatin had similar values for CBRs (44.4% and 44.1%) and PFS (2.5 and 3.4 months), respectively. Docetaxel (weekly) exhibited a notably low AER of 2.7%, and topotecan was associated with a relatively long PFS (7.7 months).For cis/carboplatin-pretreated patients, the existing active agents, such as oxaliplatin, gemcitabine, topotecan, and especially bevacizumab, are promising. Docetaxel (weekly) is well tolerated and might offer a particularly viable option for heavily pretreated patients. However, additional research to identify for a continued search for the optimal combination of chemotherapeutics or novel agents is still warranted.

FIGURE 1

The different activity and toxicity of active agents for recurrent or persistent CCC (clear cell carcinoma). (A) The different CBR (clinical benefit rate) of active agents. (B) The PFS (progression free survival) duration (mean, SD) of active agents. The CBR of TC was 45.1% with a PFS of 3.7 months. The CBRs of PC and CC were both significantly lower than that of TC (P = 0.020 and 0.021, respectively) with a slightly shorter PFS (progression free survival). Compared to TC, the CBR and PFS of PAF-C were slightly higher and longer. The CBR of bevacizumab was 50%, with an extraordinarily long PFS (49.8 months). The CBR of thiotepa was the second highest, but the associated mean PFS was only 1.5 months. Gemcitabine and oxaliplatin had similar CBRs (44.4% and 44.1%, respectively), with durations of 2.5 and 3.4 months, respectively. Docetaxel (weekly) showed a moderate activity and the CBR of topotecan was 38.9%, but was associated with a relatively long PFS (7.7 months). (C) The different adverse event rate (AER) of active agents for recurrent or persistent CCC. The AER of PAF-C (32.1%) was significantly higher than that of TC (P = 0.036). The AERs of gemcitabine, oxaliplatin, and topotecan were similar, 25.9%, 20.6%, and 22.2%, respectively. Docetaxel (weekly) was well tolerated with a 2.7% AER, which was significantly lower than that of gemcitabine (P = 0.004). No serious side effects were identified found related to bevacizumab.

FIGURE 2

The mean OS (overall survival) time was 22.6 months for the entire group. The 5- and 10-year OS rates, respectively, were 41.8% and 23.9%.