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Takashi Motohashi,Akira Yabuno,Hiroshi Michimae,Tetsuro Ohishi,Miwa Nonaka,Masashi Takano,Shin Nishio,Hiroyuki Fujiwara,Keiichi Fujiwara,Eiji Kondo,Toru Sugiyama,Tsutomu Tabata 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.1
Objective: The standard dose for pegylated liposomal doxorubicin (PLD) is 50 mg/m2every 4weeks. While 40 mg/m2has recently been used in clinical practice, evidence supporting thisuse remains lacking. Methods: This phase III randomized, non-inferiority study compared progression free survival (PFS) for patients with platinum-resistant ovarian carcinoma between anexperimental arm (40 mg/m2PLD) and a standard arm (50 mg/m2PLD) until 10 courses,disease progression or unacceptable toxicity. Eligible patients had received ≤2 prior lines. Stratification was by performance status and PFS of prior chemotherapy (<3 months versus ≥3months). The primary endpoint was PFS and secondary endpoints were overall survival (OS),toxicity profile, clinical response and tolerability. The total number of patients was 470. Results: The trial was prematurely closed due to slow recruitment, with 272 patients randomizedto the experimental arm (n=137) and standard arm (n=135). Final analysis was performed with234 deaths and 269 events for PFS. In the experimental arm vs. standard arm, median PFS was4.0 months vs. 4.0 months (hazard ratio [HR]=1.065; 95% confidence interval [CI]=0.830–1.366)and median OS was 14.0 months vs. 14.0 months (HR=1.078; 95% CI=0.831–1.397). Hematologictoxicity and oral cavity mucositis (≥grade 2) were more frequent in the standard arm than in theexperimental arm, but no difference was seen in ≥grade 2 hand-foot skin reaction. Conclusion: Non-inferiority of 2 PLD dosing schedule was not confirmed because the trialwas closed prematurely. However, recommendation of dose reduction of PLD should bebased both on efficacy and safety. Trial Registration: UMIN Clinical Trials Registry Identifier: UMIN000003130