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989P PHASE II STUDY OF COMBINATION CHEMOTHERAPY WITH
ORAL S-1 AND OXALIPLATIN (SOX) IN PATIENTS WITH
MUCINOUS ADENOCARCINOMA OF THE OVARY
S. Nishio 1 , M. Shimada 2 , T. Kamura 1 , K. Ishitani 3 , K. Ochiai 4 , N. Takeshima 5 ,
Y. Yokoyama 6 , H. Furumoto 7 , T. Sugiyama 8 , J. Kigawa 2
1 Obstetrics and Gynecology, Kurume University School of Medicine, Kurume,
JAPAN, 2 Obstetrics and Gynecology, Tottori University, Yonago, JAPAN,
3 Obstetrics and Gynecology, Tokyo Women’s Medical University, Tokyo, JAPAN,
4 Obstetrics and Gynecology, Jikei University School of Medicine, Tokyo, JAPAN,
5 Gynecology, Cancer Institute Hospital, Tokyo, JAPAN, 6 Obstetrics and
Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, JAPAN,
7 Obstetrics and Gynecology, The University of Tokushima Graduate School,
Tokushima, JAPAN, 8 Obstetrics and Gynecology, Iwate Medical University
School of Medicine, Morioka, JAPAN
We previously reported that patients with advanced or recurrent ovarian mucinous
adenocarcinoma (MAC) had poor outcomes. Owing to similar biologic
characteristics, chemotherapy for MAC has been based on standard
chemotherapeutic regimens for colorectal cancer. Our basic studies also showed that
a combination of oxaliplatin (L-OHP) and 5-fluorouracil was effective against MAC
cells. This is the first phase II study of combination chemotherapy with oral S-1 and
L-OHP (SOX) in patients with advanced or recurrent MAC. From July 2008 through
December 2011, 40 patients, including 16 with recurrent disease, were enrolled. Two
patients could not receive SOX chemotherapy because their performance status
suddenly deteriorated after enrollment. L-OHP was administered at a dose of 100
mg/m2 on day 1, and S-1 (80-120 mg/day) was given in 2 divided doses daily for 2
weeks followed by a 1-week rest. This treatment schedule was repeated every 3 weeks
until progressive disease. Tumor responses were evaluated according to the Response
Evaluation Criteria in Solid Tumors, and toxicity was assessed with the Common
Terminology Criteria for Adverse Events (version 3.0). Central pathological review
(CPR) was also performed. On CPR, primary MAC was diagnosed in 13 patients,
metastatic MAC in 15, endometrioid adenocarcinoma in 7, and other histological
subtypes in 5. Of the 28 patients with a diagnosis of MAC, the objective response
rate (RR) as assessed by an independent response review committee was 18%
(complete response: 0, partial response: 5), and the disease control rate (CDR),
including 14 patients with stable disease, was 68%. Among the 13 patients with
primary MAC, the objective RR was 31%. Among the 38 patients who received SOX
therapy, 2 discontinued the regimen because of toxicity. Grade 3 or 4 hematologic
toxicities were neutropenia (28%), anemia (21%), and thrombocytopenia (10%). The
most common grade 3 or 4 nonhematologic toxicities were anorexia (8%) and
hyponatremia (8%). The present study showed a promising RR and good tolerance,
suggesting that SOX therapy might contribute to prolonging survival.
Disclosure: All authors have declared no conflicts of interest.
990P ERCC1 EXPRESSION AS PREDICTIVE BIOMARKER FOR
PLATINUM CONTAINING CHEMOTHERAPY REGIMENS IN
OVARIAN CARCINOMA
M. Ulker 1 , B.B. Duman 2 , B. Sahin 3 , D. Gumurdulu 4
1 Intenal Medicine, Cukurova University Medical Faculty, Adana, TURKEY,
2 Medical Oncology, Adana Numune Education and Research Hospital, Adana,
TURKEY, 3 Medical Oncology, Cukurova University Medical Faculty, Adana,
TURKEY, 4 Pathology, Cukurova University Medical Faculty, Adana, TURKEY
Background and aims: Platin based chemotherapy regimens are most important
treatment choices for ovarian carcinoma. Significant numbers of patients develop
resistance to platinum combination therapies. We aimed to show the role of ERCC1
expression in the resistance to therapy in ovarian carcinoma.
Patients and methods: Among all patients treated with platinum containing
chemotherapy regimens, 27 eligible ovarian cancer patients were selected. Tissue
samples were obtained from paraffin blocks and evaluated ERCC1 expression with
immunohistochemical method in the pathology department. Expression level 0, 1(+),
2(+) was assessed as low expression, 3(+) was assessed as high expression. The results
were correlated with clinical findings and therapy response. Therapy response was
assessed for RECIST criteria.
Results: In this study 27 patients with pathologically proven ovarian cancer were
enrolled to this study. Sixteen (59%) patients were stage III, and 11(41%) patients
were stage IV. Complete response was determined in 18 (67%) patients, stable disease
was determined in 3 (11%) patients and progressive disease was determined in 6
(22%) patients. Median overall survival was 23 months. Treatment response rates
were 50% in high ERCC1 expression group and 90% in low expression group.
Statistically significant difference was found between two groups (p = 0.04). The
median overall survival was 30 months(95% CI 23-37 months) in low ERCC1
expression group and 15.8 months (95% CI 23-37 months) in high expression group
(p = 0.183).
Conclusion: Some primary tumors and most recurrent tumors develop drug
resistance that lead to treatment failure. High ERCC1 expression levels are associated
with the mechanism of cisplatin resistance in ovarian cancer. ERCC1 expression can
be used as a predictive biomarker for the platin containing regimens in ovarian
carcinoma.
Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology
991P PATTERNS AND OUTCOMES OF TREATMENT IN ELDERLY
PATIENTS WITH OVARIAN CANCER: A RETROSPECTIVE
MONO-ISTITUTIONAL STUDY
M.O. Nicoletto 1 , L. Furini 1 , M. Dalla Palma 1 , L. Borgato 1 , P. Fiduccia 1 ,
M. Rocchetto 2 , G.B. Nardelli 3 , M.T. Gervasi 4 , V. Zagonel 1
1 Medical Oncology Unit 1, Istituto Oncologico Veneto, Padua, ITALY, 2 School of
Medicine, University of Padua, School of Medicine, Padua, ITALY, 3 Deapartment
of Gynecological Sciences and Human Reproduction, University of Padua,
Padua, ITALY, 4 Ob/Gyn Unit Department for Health of Mothers and Children,
Azienda Ospedaliera, Padua, ITALY
Introduction: Ovarian cancer incidence is increasing in the elderly. We studied
clinical and biological features of ovarian cancer in patients (OCP) aged >or = 70y.
Methods: We conducted a retrospective analysis in 100 elderly OCP observed from
1995 to 2011. We considered overall survival, comorbidities, surgery, hystotype and
grading, chemotherapy (monochemotherapy vs polychemotherapy), response to
treatment, and toxicities.
Results: Median age was 75y (range 70-88y). Most of the pts (82%) had advanced
stage at diagnosis (stage III, 70.2%), serous ovarian cancer histotype (67%), and grade
3 (74 pts, 78.7%). Most pts had at least one comorbidity (84%) and more than half
(53.2%) two or more. 29.8% of pts received an optimal debulking ( 5cm) tumour burden at multiple sites, radiological evidence
of serosal disease and half developed bowel obstruction whilst receiving
chemotherapy. Approximately 50% of patients presented with obstructive symptoms,
but 25% presented with erratic bowel habit. Median survival following the first
episode of bowel obstruction was 87 days (range 3-1754). Survival was similar
between patients who underwent palliative surgery or chemotherapy (p = 0.89).
Median survival for patients presenting in bowel obstruction with platinum-sensitive
(PS) and platinum-resistant (PR) disease (but not chemonaïve patients) who
proceeded to chemotherapy was prolonged compared with patients unsuitable for
further treatment (PS 191 vs. 24 days, p < 0.0001; PR 149 vs. 50 days, p = 0.06). A
feasibility trial investigating the efficacy of low residue diet and intravenous
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