Paclitaxel/carboplatin for the initial treatment of advanced ovarian cancer

In 1996, the combination of cisplatin 75 mg/m2 plus 24-hour infusion of 135 mg/m2 paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) was proved to prolong survival in comparison with cyclophosphamide/cisplatin in women with advanced ovarian cancer. As a result, the paclitaxel/cisplatin combination was recommended to serve as the new standard of care. One year later, a European-Canadian group confirmed the efficacy of paclitaxel/cisplatin in a study in which the infusion period of paclitaxel was reduced from 24 to 3 hours and the dose of paclitaxel escalated to 175 mg/m2. These changes resulted in a lower incidence of myelosuppression but a higher rate of neurotoxicity. Replacing cisplatin with carboplatin, a platinum analogue without the neurotoxic effects, proved feasible, and several trials were initiated to compare the safety and efficacy of paclitaxel/carboplatin with paclitaxel/cisplatin. The results of two of these studies that have completed accrual and reported preliminary data have shown that paclitaxel/carboplatin can be administered safely to outpatients, is better tolerated than paclitaxel/cisplatin, and results in a better quality of life. So far, the larger study (accrual, 800 patients) has yielded equal durations of progression-free survival for both the carboplatin and cisplatin combinations. If future updates of these studies confirm the current results and show similar long-term survival, the combination of carboplatin area under the concentration-time curve 5 or 6 plus paclitaxel 175 mg/m2 given over 3 hours is an attractive regimen for the treatment of newly diagnosed epithelial ovarian cancer.