Increased Incidence of Severe Gastrointestinal Events With First-Line Paclitaxel, Carboplatin, and Vorinostat Chemotherapy for Advanced-Stage Epithelial Ovarian, Primary Peritoneal, and Fallopian Tube Cancer

• Published in: International journal of gynecological cancer Vol. 23; no. 3; pp. 533 - 539
• Main Authors: Mendivil, Alberto A., Micha, John P., Brown, John V., Rettenmaier, Mark A., Abaid, Lisa N., Lopez, Katrina L., Goldstein, Bram H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2013; Copyright by IGCS and ESGO; Elsevier Limited
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Carboplatin; Carboplatin - administration & dosage; Chemotherapy; Cystadenocarcinoma, Serous - drug therapy; Cystadenocarcinoma, Serous - mortality; Cystadenocarcinoma, Serous - pathology; Endometrial Neoplasms - drug therapy; Endometrial Neoplasms - mortality; Endometrial Neoplasms - pathology; Fallopian Tube Neoplasms - drug therapy; Fallopian Tube Neoplasms - mortality; Fallopian Tube Neoplasms - pathology; Female; Follow-Up Studies; Gastrointestinal Diseases - chemically induced; Gastrointestinal Diseases - epidemiology; Genital cancers; Gynecologic oncology; Gynecological cancer; Humans; Hydroxamic Acids - administration & dosage; Incidence; Middle Aged; Neoadjuvant Therapy; Neoplasm Grading; Neoplasm Staging; Ovarian cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - mortality; Ovarian Neoplasms - pathology; Ovaries; Paclitaxel; Paclitaxel - administration & dosage; Peritoneal Neoplasms - drug therapy; Peritoneal Neoplasms - mortality; Peritoneal Neoplasms - pathology; Prognosis; Prospective Studies; Response rates; Survival Rate; Vorinostat; Carboplatin; Gynecologic oncology; Chemotherapy; Vorinostat; Paclitaxel; Ovarian cancer
• ISSN: 1048-891X; 1525-1438; 1525-1438
• DOI: 10.1097/IGC.0b013e31828566f1

We sought to assess the response rate and toxicity of paclitaxel, carboplatin, and vorinostat primary induction therapy for the treatment of advanced-stage ovarian carcinoma. Methods: Patients were treated with 6 cycles of weekly paclitaxel (80 mg/m2), carboplatin (6 times area under the curve), and vorinostat (200 mg) every 28 days according to an institutional review board-approved protocol. The subjects were eligible for response evaluation; in patients who achieved stable disease or better following the conclusion of primary induction chemotherapy, they were subsequently treated with a planned 12 cycles of paclitaxel (135 mg/m2) and vorinostat (400 mg) maintenance chemotherapy every 28 days. Eighteen patients received a combined 90 cycles (median, 6 cycles; range, 1-6cycles) of primary induction chemotherapy. Of the 18 subjects, 7 demonstrated a complete response, and2 subjects exhibited a partial response (a total response rate of 50.0%). Eight patients also received a combined total of 50 cycles (median, 5 cycles; range, 1-12 cycles) of consolidation therapy. Grade 3/4 neutropenia and thrombocytopenia were observed in 9 (56.3%) and 2 (12.5%) patients. One patient (6.3%) developed grade 3 anemia, and another (6.3%) manifested a grade 3 neuropathy. Remarkably, we observed a significant gastrointestinal event (eg, bowel anastomotic perforation) in 3 patients, which effectuated the study’s closure. Because the current study was prematurely terminated, we cannot derive a conclusive assessment regarding the efficacy of this treatment. Nevertheless, the high incidence of severe gastrointestinal toxicity warrants further consideration when using vorinostat in the adjuvant setting for patients who have undergone a bowel resection as part of their initial tumor debulking.