Chemotherapy for advanced, recurrent or metastatic endometrial carcinoma

Caroline E Humber; Jayne Tierney; Paul R Symonds; Mandy Collingwood; John J Kirwan; Chris Williams; John A Green

doi:10.1002/14651858.CD003915.pub3

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Guías
Temas

Revisiones y protocolos relacionados

Topics

Temas

Analysis 1.1

Comparison 1 More versus less chemotherapy, Outcome 1 Survival.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 More versus less chemotherapy, Outcome 2 Progression‐free survival.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1 More versus less chemotherapy, Outcome 3 G3‐4 Nausea/vomiting.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1 More versus less chemotherapy, Outcome 4 G3‐4 Diarrhoea/Other GI.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1 More versus less chemotherapy, Outcome 5 G3‐4 Leukopenia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

Comparison 1 More versus less chemotherapy, Outcome 6 G3‐4 Thrombocytopenia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.7

Comparison 1 More versus less chemotherapy, Outcome 7 G3‐4 Anaemia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.8

Comparison 1 More versus less chemotherapy, Outcome 8 G3‐4 Alopecia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.9

Comparison 1 More versus less chemotherapy, Outcome 9 G3‐4 Cardiotoxicity.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.10

Comparison 1 More versus less chemotherapy, Outcome 10 G3‐4 Fever/infection.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.11

Comparison 1 More versus less chemotherapy, Outcome 11 G3‐4 Stomatitis/mucositis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.12

Comparison 1 More versus less chemotherapy, Outcome 12 G3‐4 Neurological toxicity.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.13

Comparison 1 More versus less chemotherapy, Outcome 13 G3‐4 Renal/GU.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Table 1. RCTs: Response rates, progression‐free survival and overall survival

Study	No. randomised	No. evaluable	Complete response	Partial reponse	Stable disease	Progressive disease	ORR (%)	Median PFS	Median OS
EDMONDSON 1987
Cisplatin	14	14	1	2	6	5	21%	56 days	226 days
Cisplatin, doxorubicin, cyclophosphamide	16	16	0	5	6	5	31%	88 days	202 days
AAPRO 2003
Doxorubicin	87	87	8	7	20	32	17%	7 mths	7 mths
Doxorubicin & cisplatin	90	90	13	26	21	13	43%	8 mths	9 mths
THIGPEN 1994
Doxorubicin	169	132	7	22	73	30	22%	3.2 mths	6.9 mths
Doxorubicin & cyclophosphamide	90	90	18	25	75	26	30%	3.9 mths	7.3 mths
THIGPEN 2004
Doxorubicin	NS	150	12	26	NS	NS	25%	5.7 mths	9.0 mths
Doxorubicin & cisplatin	NS	131	25	30	NS	NS	42%	3.8 mths	9.2 nths
LONG 1995
Doxorubicin & cyclophosphamide	15	15	2	2	NS	NS	26%	6.2 mths	15 mths
Doxorubicin, cyclophosphamide, methotrexate & vinblastine,	13	13	4	5	NS	NS	69%	6.9 mths	15 mths
FLEMING 2004A
Doxorubicin & cisplatin	136	129	7%	26%	NS	NS	34%	5.3 mths	12.3 mths
Doxorubicin, cisplatin & paclitaxel	137	134	22%	35%	NS	NS	57%	8.3 mths	15.3 mths
HORTON 1978
Doxorubicin	21	21	1	3	6	11	19%	NS	NS
Cyclophosphamide	19	19	0	0	7	12	0%	NS	NS
PAWINSKI 1999
Cyclophosphamide	29	28	0	2	6	20	7%	7 wks	NS
Ifosfamide	32	31	2	2	10	17	12%	8 wks	NS
FLEMMING 2004B
Doxorubicin & cisplatin	160	157	NS	NS	NS	NS	40%	7.2 mths	12.6 mths
Doxorubicin, paclitaxel & filgrastim	168	160	NS	NS	NS	NS	43%	6.0 mths	13.6 mths
GALLION 2003
Standard timed doxorubicin	175	169	25	52	NS	NS	46%	6.5 mths	11.2 mths
Circadian timed doxorubicin	177	173	30	55	NS	NS	49%	5.9 mths	13.2 mths
COHEN 1984
Melphalan, 5‐FU, megestrol acetate	146	77	12	17	27	21	37.7%	6.1m	10.6m
Doxorubicin, cyclophosphamide, 5‐FU, megestrol acetate	149	78	13	15	30	20	35.9%	5.2m	10.1m
ORR= Objective response rate, PFS= Progression‐free survival, OS=overall survival

Table 1. RCTs: Response rates, progression‐free survival and overall survival

Ir a la tabla de la revisión

Table 2. Phase II studies: Cisplatin containing combinations

Study	Year	Drug name	Dose	Number in Study	Prior chemo (No.)	ORR (%)	Median PFS	Median OS
Seski	1982	cisplatin	50‐100mg/m2	26	yes (5)	42.3	5m	NS
Thigpen	1984	cisplatin	50mg/m2	31	yes (24)	4	NS	NS
Thigpen	1989	cisplatin	50mg/m2	56	no	20.4	2.9m	8.2m
Barrett	1993	cisplatin	60mg/m2	33	no	60	7.5m	14m
		doxorubicin	60mg/m2
Deppe	1994	cisplatin	50mg/m2	19	NS	36.8	NS	NS
		doxorubicin	50mg/m2
Trope	1984	cisplatin	50mg/m2	19	no	60	ns	ns
		doxorubicin	50mg/m2
Pasmantier	1985	cisplatin	60mg/m2	16	yes (4)	81.2	ns	10m
		doxorubicin	60mg/m2
Lovecchio	1984	cisplatin	50mg/m2	15	no	60	ns	ns
		doxorubicin	30mg/m2
		cyclophosphamide	300mg/m2
		megace	120mg/day
Turbow	1995	cisplatin	60mg/m2	21	no	47.3	ns	10m
		doxorubicin	50mg/m2
		cyclophosphamide	600mg/m2
Hancock	1986	cisplatin	50mg/m2	18	no	56	ns	ns
		doxorubicin	50mg/m2
		cyclophosphamide	500mg/m2
Hoffman	1989	cisplatin	50mg/m2	15	ns	33	17wks	38wks
		doxorubicin	30mg/m2
		cyclophosphamide	500mg/m2
		megace	160mg/day
Burke	1991	cisplatin	50mg/m2	102	no	45	ns	ns
		doxorubicin	50mg/m2
		cyclophosphamide	500mg/m2
Pietrzak	1995	cisplatin	50mg/m2	41	ns	12.2	ns	ns
		doxorubicin	50mg/m2
		cyclophosphamide	500mg/m2
Alberts	1987	cisplatin	50mg/m2	64	no	30.9	ns	6.5m
		doxorubicin	30mg/m2
		vinblastine	0.15mg/m2
Piver	1991	cisplatin	60mg/m2	20	yes (2)	75	ns	15m
		doxorubicin	40mg/m2
		etoposide	225mg/m2
		megace	160mg/day
Cornelison	1995	cisplatin	60mg/m2	50	no	54	11.9	16.4
		doxorubicin	40mg/m2
		etoposide	225mg/m2
		megace	160mg/day
Long	1995	cisplatin	70mg/m2	30	no	67	7.2m	9.9m
		doxorubicin	40mg/m2
		vinblastine	9mg/m2
		methotrexate	90mg/m2
Pierga	1997	cisplatin	105mg/m2	20	no	45	8m	17m
		doxorubicin	30mg/m2
		etoposide	240mg/m2
		5‐FU	1800mg/m2
Lissoni	1997	cisplatin	50mg/m2	30	no	73	ns	ns
		paclitaxel	175mg/m2
		epirubicin	70mg/m2
Dimopoulos	2000	cisplatin	75mg/m2	24	no	67	8.4	17.6
		paclitaxel	175mg/m2
Sorbe	1989	cisplatin	60mg/m2	44	ns	52.3	ns	7m
		vincristine	1.5mg/m2
		VM‐26	100mg/m2
		megace	500mg/day
Gebbia	2001	cisplatin	80mg/m2	35	no	57	ns	240days
		vinorelbine	50mg/m2
Pierga	1996	cisplatin	105mg/m2	49	yes (2)	41	ns	14m
		etoposide	240mg/m2
		5‐FU	1800mg/m2

Table 2. Phase II studies: Cisplatin containing combinations

Ir a la tabla de la revisión

Table 3. Phase II studies: Carboplatin containing combinations

Study	Year	Drug	Dose	Number in Study	Prior chemo (No.)	ORR (%)	Median PFS	Median OS
Green	1990	carboplatin	400mg/m2	32	no	30	ns	282 days
Burke	1993	carboplatin	360 ‐ 450mg/m2	33	no	33	4 ‐ 5m	8 ‐ 10m
Long	1998	carboplatin	400mg/m2	25	no	28	117 days	215 days
Bafaloukos	1999	carboplatin	300mg/m2	23	no	74	ns	16m
		methotrexate	30mg/m2
		5‐FU	500mg/m2
		megace	300mg/day
Hoskins	2001	carboplatin	AUC 5‐7	67	no	60.9	ns	15‐26m
		paclitaxel	175mg/m2

Table 3. Phase II studies: Carboplatin containing combinations

Ir a la tabla de la revisión

Table 4. Phase II studies: Anthracycline containing combinations

Study	Date	Drug	Dose	Number in study	Prior chemo (No.)	ORR (%)	Median PFS	Median OS
Thigpen	1979	doxorubicin	60mg/m2	55	yes (2)	37.2	ns	6.8m
Seski	1981	doxorubicin	40‐50mg/m2	26	ns	30.7	ns	ns
		cyclophosphamide	500‐600mg/m2
Deppe	1981	doxorubicin	40mg/m2	29	ns	44.9	ns	6.7‐12.5m
		cyclophosphamide	400mg/m2
		5‐FU	400mg/m2
		megace	160mg/day
Muggia	2002	pegylated liposomal doxorubicin	50mg/m2	46	yes (40)	9.5	ns	8.2m
Calero	1991	epirubicin	80mg/m2	27	no	25.9	6m	9.5m

Table 4. Phase II studies: Anthracycline containing combinations

Ir a la tabla de la revisión

Table 5. Phase II studies: Taxane containing combinations

Study	Date	Drug	Dose	Number in study	Prior chemo (No.)	ORR (%)	Median PFS	Median OS
Ball	1996	Paclitaxel	250mg/m2	30	no	35.7	3.8m	9.5m
Lissoni	1996	Paclitaxel	175mg/m2	19	yes (19)	37	ns	ns
Ramondetta	2001	Paclitaxel	200mg/m2	13	no	77	ns	ns
Hornreich	2000	Paclitaxel	225mg/m2	27	no	40.7	ns	ns
		Liposomal Doxorubicin	30mg/m2

Table 5. Phase II studies: Taxane containing combinations

Ir a la tabla de la revisión

Table 6. Phase II studies: Miscellaneous single agents

Study	Date	Drug	Dose	Number in Study	ORR (%)	Median PFS	Median OS
Barton	1990	ifosfamide	5g/m2	16	12.5	ns	5m
Sutton	1994	ifosfamide	6g/m2	52	15	ns	ns
Sutton	1996	ifosfamide	6g/m2	37	24	ns	ns
Seski	1981	hexamethylmelamine	8mg/kg/day	20	30	ns	ns
Thigpen	1988	hexamethylmelamine	3920mg/m2	38	8	ns	ns
Slayton	1982	etoposide	300mg/m2	29	3	ns	ns
Rose	1996	etoposide	1050mg/m2	26	0	ns	ns
Poplin	1999	etoposide	1050mg	47	13.6	4m	11m
Muss	1991	teniposide	160mg/m2	26	9	1.9m	6.4m
Hilgers	1985	mitoxantrone	10‐12mg/m2	15	0	ns	17wks
Muss	1987	mitoxantrone	12mg/m2	19	5	1.8m	2.1m
Veenhof	1990	mitoxantrone	14mg/m2	20	0	ns	ns
Malviya	1996	piroxantrone	150mg/m2	22	6	ns	11m
Thigpen	1987	vinblastine	7.5mg/m2	41	11	ns	4m
Broun	1993	vincristine	1.4mg/m2	36	18	ns	ns
Chauvergne	1993	pirarubicin	25mg/m2	28	9	ns	ns
Green	1991	esorubicin	30mg/m2	31	0	ns	154days
Hakes	1987	idarubicin	12.5mg/m2	25	9	ns	ns
Muss	1990	methotrexate	40mg/m2	33	6	2.9m	6.7m
Von Hoff	1991	fludarabine	90mg/m2	20	0	ns	ns
Malviya	1994	amonafide	1500mg/m2	38	5	ns	8m
Moore	1999	dactinomycin	2mg/m2	27	12	ns	ns
Muss	1993	echinomycin	1.5mg/m2	25	4	ns	ns
Homesley	1986	razoxane	1.5g/m2	24	0	ns	ns
Asbury	1990	aminothiadiazole	125mg/m2	22	0	ns	ns
Stehman	1983	dianhydrogalactitol	60mg/m2	21	5	ns	ns
Plaxe	2002	pyrazoloacridine	560mg/m2	28	4	ns	ns
Thigpen	1986	piperazinedione	9mg/m2	23	5	ns	ns

Table 6. Phase II studies: Miscellaneous single agents

Ir a la tabla de la revisión

Comparison 1. More versus less chemotherapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Survival Show forest plot	6	1135	Peto Odds Ratio (95% CI)	0.91 [0.80, 1.03]

1.1 Cisplatin in combination versus cisplatin	1	30	Peto Odds Ratio (95% CI)	0.76 [0.36, 1.58]
1.2 Doxorubicin in combination versus doxorubicin	3	814	Peto Odds Ratio (95% CI)	0.97 [0.84, 1.11]
1.3 Doxorubicin/cisplatin plus other drugs versus doxorubicin/cisplatin	2	291	Peto Odds Ratio (95% CI)	0.75 [0.58, 0.97]
2 Progression‐free survival Show forest plot	6	1132	Peto Odds Ratio (95% CI)	0.80 [0.71, 0.90]

2.1 Cisplatin in combination versus cisplatin	1	30	Peto Odds Ratio (95% CI)	0.85 [0.37, 1.92]
2.2 Doxorubicin in combination versus doxorubicin	3	811	Peto Odds Ratio (95% CI)	0.86 [0.75, 0.99]
2.3 Doxorubicin/cisplatin plus other drugs versus doxorubicin/cisplatin	2	291	Peto Odds Ratio (95% CI)	0.64 [0.49, 0.82]
3 G3‐4 Nausea/vomiting Show forest plot	5	761	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.73 [1.76, 4.23]

3.1 Cisplatin in combination versus cisplatin	1	30	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.21 [0.23, 6.43]
3.2 Doxorubicin in combination versus doxorubicin	2	443	Peto Odds Ratio (Peto, Fixed, 95% CI)	3.95 [2.27, 6.89]
3.3 Doxorubicin/cisplatin plus other drugs versus doxorubicin/cisplatin	2	288	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.56 [0.71, 3.42]
4 G3‐4 Diarrhoea/Other GI Show forest plot	5	761	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.48 [1.19, 5.17]

4.1 Cisplatin in combination versus cisplatin	1	30	Peto Odds Ratio (Peto, Fixed, 95% CI)	6.52 [0.13, 331.51]
4.2 Doxorubicin in combination versus doxorubicin	2	443	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.36 [0.83, 6.68]
4.3 Doxorubicin/cisplatin plus other drugs versus doxorubicin/cisplatin	2	288	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.44 [0.84, 7.12]
5 G3‐4 Leukopenia Show forest plot	5	761	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.30 [0.98, 1.73]

5.1 Cisplatin in combination versus cisplatin	1	30	Peto Odds Ratio (Peto, Fixed, 95% CI)	3.28 [0.76, 14.19]
5.2 Doxorubicin in combination versus doxorubicin	2	443	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.51 [1.73, 3.65]
5.3 Doxorubicin/cisplatin plus other drugs versus doxorubicin/cisplatin	2	288	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.43 [0.27, 0.68]
6 G3‐4 Thrombocytopenia Show forest plot	5	761	Peto Odds Ratio (Peto, Fixed, 95% CI)	4.44 [2.67, 7.38]

6.1 Cisplatin in combination versus cisplatin	1	30	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.12 [0.00, 5.96]
6.2 Doxorubicin in combination versus doxorubicin	2	443	Peto Odds Ratio (Peto, Fixed, 95% CI)	4.12 [2.08, 8.14]
6.3 Doxorubicin/cisplatin plus other drugs versus doxorubicin/cisplatin	2	288	Peto Odds Ratio (Peto, Fixed, 95% CI)	5.65 [2.60, 12.28]
7 G3‐4 Anaemia Show forest plot	3	336	Peto Odds Ratio (Peto, Fixed, 95% CI)	5.32 [2.62, 10.81]

7.1 Cisplatin in combination versus cisplatin	1	30	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.2 Doxorubicin in combination versus doxorubicin	1	278	Peto Odds Ratio (Peto, Fixed, 95% CI)	5.32 [2.62, 10.81]
7.3 Doxorubicin/cisplatin plus other drugs versus doxorubicin/cisplatin	1	28	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 G3‐4 Alopecia Show forest plot	3	223	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.86 [1.01, 3.42]

8.1 Cisplatin in combination versus cisplatin	1	30	Peto Odds Ratio (Peto, Fixed, 95% CI)	10.63 [2.01, 56.35]
8.2 Doxorubicin in combination versus doxorubicin	1	165	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.42 [0.74, 2.74]
8.3 Doxorubicin/cisplatin plus other drugs versus doxorubicin/cisplatin	1	28	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 G3‐4 Cardiotoxicity Show forest plot	3	471	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.14 [0.42, 3.10]

9.1 Doxorubicin in combination versus doxorubicin	2	443	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.31 [0.46, 3.68]
9.2 Doxorubicin/cisplatin plus other drugs versus doxorubicin/cisplatin	1	28	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.15 [0.00, 7.87]
10 G3‐4 Fever/infection Show forest plot	4	501	Peto Odds Ratio (Peto, Fixed, 95% CI)	4.36 [1.39, 13.71]

10.1 Cisplatin in combination versus cisplatin	1	30	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.2 Doxorubicin in combination versus doxorubicin	2	443	Peto Odds Ratio (Peto, Fixed, 95% CI)	5.95 [1.80, 19.69]
10.3 Doxorubicin/cisplatin plus other drugs versus doxorubicin/cisplatin	1	28	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.15 [0.00, 7.87]
11 G3‐4 Stomatitis/mucositis Show forest plot	3	318	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.92 [0.61, 14.06]

11.1 Cisplatin in combination versus cisplatin	1	30	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.2 Doxorubicin/cisplatin plus other drugs versus doxorubicin/cisplatin	2	288	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.92 [0.61, 14.06]
12 G3‐4 Neurological toxicity Show forest plot	5	761	Peto Odds Ratio (Peto, Fixed, 95% CI)	5.81 [1.91, 17.61]

12.1 Cisplatin in combination versus cisplatin	1	30	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
12.2 Doxorubicin in combination versus doxorubicin	2	443	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.15 [0.00, 7.88]
12.3 Doxorubicin/cisplatin plus other drugs versus doxorubicin/cisplatin	2	288	Peto Odds Ratio (Peto, Fixed, 95% CI)	7.95 [2.50, 25.26]
13 G3‐4 Renal/GU Show forest plot	3	566	Peto Odds Ratio (Peto, Fixed, 95% CI)	3.55 [1.02, 12.40]

13.1 Doxorubicin in combination versus doxorubicin	1	278	Peto Odds Ratio (Peto, Fixed, 95% CI)	8.76 [0.90, 85.46]
13.2 Doxorubicin/cisplatin plus other drugs versus doxorubicin/cisplatin	2	288	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.41 [0.54, 10.74]

Comparison 1. More versus less chemotherapy

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet