[Experience in first-line chemotherapy with paclitaxel for the treatment of ovarian carcinomas]

The purpose of this study was to investigate the possible benefit of the paclitaxel based combined chemotherapy introduced as an "up front" chemotherapy in Hungary for the treatment of ovary cancer.

Data of four Hungarian Ovary Cancer Treatment Center was collected, evaluated and presented here as a preliminary retrospective study. Data of 67 patients was included into the investigation who underwent laparatomy followed with paclitaxel/carboplatin or paclitaxel/cisplatin combined chemotherapy between 1st of July 1999 and 31st of December 2000. The paclitaxel was administered as 135 mg/m2 i.v. infusion for 3 hours. The main attention was pay on the response rate and the side effect occurred during the administration of the anticancer drugs.

34 out of 67 patients underwent optimal surgery, and 33 out of 67 had got suboptimal procedure only. The chemotherapy was started at the 7th postoperative day. 430 cycles of chemotherapy was evaluated. The overall response rate (RR) at the end of the treatment was 76.1% (CR 68.65%. PR 7.46%). At the end of the follow-up there was 41 patients free of disease (61.19%), 12 patients alive with residual disease (17.91%), 10 patients (14.9%) died of disease, and there was 4 (6%) patients lost. The overall survival (OS) during the follow up period was 16.82 months. In the suboptimally operated group, 36.3% of the patients (12/33) underwent second laparotomy after the 3rd cycle of chemotherapy. Optimal operation was done in 8 out of this 12 patients and all of optimally operated patients remained free of disease at the and of the follow up. Three treatment out of 67 was interrupted because of major side effect, and 13 patients needed supportive treatment. Eleven blood transfusions was performed during the chemotherapy and erythropoetin (EPO) was administered in two patients.

The outcome of patients during of follow up period was better in the optimally operated group. There was 2 death compared to 8 in suboptimally operated group, the progression free survival (PFS) was longer (8 vs. 6.54 months), and so was the OS (17.11 vs. 16.54 months). More disease free patients was registered at the end of follow-up in the optimally operated group (29 vs. 12). The haematological side effect was also more frequent in the suboptimally operated group (12 vs 1). The data suggest that the quality of initial surgical procedure remains the main prognostic factor even if paclitaxel based combine chemotherapy is administered. On the other hand due to the paclitaxel based chemotherapy seems to be a promising "up front" treatment in patients with ovary cancer with few major side effect generally, and quite a lot haematological side effect in the suboptimally operated group only.