Taxol as second-line treatment in patients with advanced ovarian cancer after platinum-based first-line chemotherapy

Salvage chemotherapy in platin-resistant patients typically results in low response rates and short survival, therefore new active cytotoxic agents must be found. One of these agents is paclitaxel (Taxol), isolated from the bark of the western yew which acts as an antimicrotubule agent. In our study 28 patients were treated with Taxol, 20 of whom had platinum-resistant tumors. Taxol was administered at a starting dose of 175 mg/m2, infused over 3 hr every 21 days. A total of 145 courses of Taxol was infused. Dexamethasone, diphenhydramine, and ranitidine were given as premedication. The response rate was 25% (3 complete and 4 partial remissions), the median survival duration was 15 months. In contrast to other studies we found a lower response rate in patients resistant to platinum-based therapy: 15% (no complete, 3 partial remissions). The most common severe toxicity was leukopenia, with grade 3 toxicity occurring in 10% of the courses; no grade 4 leukopenia or neutropenia was noted. Neurologic toxicity was a clinically significant adverse effect, with 1% of patients experiencing grade 3, 9% experiencing grade 2, and 3% experiencing grade 1 toxicity. Other adverse effects were less frequent and less severe. We conclude that paclitaxel, which in a prospective randomized trial has been shown to be the most active treatment of advanced ovarian cancer, yields low response rates in platinum-resistant patients. Only a few of them profited from second-line treatment with Taxol. This could be a new aspect in the treatment of platinum-resistant ovarian cancer with Taxol.