Taxol in epithelial ovarian cancer

Epithelial ovarian cancer is the fifth most common cause of cancer death in women. The management of patients with advanced disease involves surgery followed by platinum-based chemotherapy, but most patients will have either residual or recurrent disease. Salvage therapy in these patients is poor, with response rates less than 20%. Taxol, a new antineoplastic agent, was first noted to have activity in platinum-resistant ovarian cancer in a phase I study. Since then, response rates of 20% to 35% have been noted in several phase II studies involving hundreds of patients. Major toxicities include neutropenia and peripheral neuropathy. Taxol dose escalation with granulocyte-colony stimulating factor support, and Taxol in combination with cisplatin, have been tested and shown to be feasible. Intraperitoneal administration of Taxol is possible and appears advantageous from a pharmacokinetic perspective. A phase III study of Taxol and cisplatin in suboptimal disease was completed, and toxicity data show that Taxol administration is safe in a multi-institutional setting. Planned clinical development of Taxol includes use in less bulky stage III disease and dose escalation in platinum-resistant disease. Taxol has already become a major treatment of platinum-resistant disease. Further investigation will determine its role in the overall management of ovarian cancer.