Carboplatin in the treatment of ovarian cancer

Carboplatin, a new cisplatin analogue, appears as active as cisplatin in patients with advanced ovarian cancer, but in phase I and II trials has proven significantly less toxic. In single-agent phase II trials, carboplatin has been associated with clinical complete response (CR) rates of up to 13% and overall objective response rates of up to 32% in patients with prior cisplatin exposure. As first-line treatment in phase II trials, single-agent carboplatin has produced clinical CR rates ranging from 9% to 62% and overall objective response rates of 45% to 85%. In phase III trials in this patient population, single-agent carboplatin has been associated with clinical CR rates comparable with or exceeding those of single-agent cisplatin. Phase I/II trials of combination chemotherapy have yielded overall objective response rates of 44% to 75% when carboplatin was combined with either cyclophosphamide or chlorambucil. In randomized phase III trials of combination chemotherapy, response rates similar to those of cisplatin have been achieved. However, toxicities were greatly reduced in the carboplatin-treated patients. The data from these phase I, II, and III trials document that carboplatin is as active as cisplatin in patients with advanced ovarian cancer and is associated with a significantly lower incidence of emesis, ototoxicity, peripheral neuropathy, and renal dysfunction. Thus, carboplatin may become the platinum compound of choice in the first-line treatment of advanced ovarian cancer.