Intraperitoneal Chemotherapy for Stage III Ovarian Cancer Using the Gynecologic Oncology Group Protocol 172 Intraperitoneal Regimen: Effect of Supportive Care Using Aprepitant and Pegfilgrastim on Treatment Completion Rate

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Abstract

Purpose:

We evaluated the outcomes of patients with optimally debulked stage III ovarian cancer receiving intraperitoneal (IP) chemotherapy according to the Gynecologic Oncology Group (GOG) 172 trial with concurrent administration of aprepitant and pegfilgrastim.

Patients and Methods:

All patients initially treated with GOG 172 IP chemotherapy between March 2005 and August 2006 were retrospectively identified from the tumor registry database. Clinical data pertaining to IP chemotherapy cycle completion, grade 3/4 gastrointestinal (GI) toxicity with relation to aprepitant use, and grade 3/4 neutropenia with relation to pegfilgrastim were abstracted from the medical records. Statistical comparisons were performed using the Χ2 test.

Results:

Twenty patients were identified. In this group, 102 of 120 (85%) prescribed IP chemotherapy cycles were completed. Sixteen of 20 patients (80%) completed 5-6 cycles of GOG 172 IP therapy. Grade 3/4 neutropenia was documented in 81% of cycles (21 of 26) without pegfilgrastim support. This decreased to 24% of cycles (18 of 76) with pegfilgrastim (P < .0001). Pegfilgrastim was usually given on day 8 concurrent with IP paclitaxel. No patient experienced neutropenic fever while on growth factor support. Grade 3/4 GI toxicity was documented in 23% of cycles (3 of 13) without aprepitant. This decreased to 6% of cycles (5 of 89) with aprepitant (P = .0287).

Conclusion:

In this preliminary dataset of optimally debulked patients with ovarian cancer receiving first-line IP chemotherapy, the addition of aprepitant and pegfilgrastim was associated with a statistically significant reduction in GI and hematologic toxicities and 85% successful completion of prescribed treatment cycles. Pegfilgrastim can safely be given on day 8 concurrent with IP paclitaxel. Further study is warranted to confirm these results.

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