Paclitaxel or docetaxel combined with platinum in advanced ovarian cancer?

Epithelial carcinoma of the ovary is one of the most common gynecologic malignancies and ranks 5th as a cause of cancer death in women, with half of all cases occurring in women aged over 65. Because ovarian cancer is often asymptomatic in its early stages, most patients have widespread disease at the time of diagnosis. Surgery is required for correct diagnosis and accurate staging, representing also the main form of treatment for early-stage disease which is confined to the ovaries. In advanced stages (III and IV) where the tumor has spread beyond the pelvis, the initial surgical treatment is followed by chemotherapy. Ovarian tumors are sensitive to chemotherapy, and most stage III and IV patients receive chemotherapy to increase survival, disease-free interval and improve quality of life (QoL). Until the mid 1990s standard chemotherapy of advanced ovarian cancer involved a platinum compound, either cisplatin or carboplatin, administered either alone or in combination with cyclophosphamide. New therapy standards emerged after the publication of a trial by the Gynecologic Oncology Group ( GOG) in 1996 and the first reports of an intergroup trial in 1998 that confirmed the GOG results. These studies demonstrated that patients treated with cisplatin/paclitaxel had significantly higher response rates, progression-free survival and overall survival compared with the previous standard treatment of cisplatin plus cyclophosphamide.