Chemotherapy of advanced ovarian cancer: current status and future directions

The identification of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) activity in previously treated patients with ovarian cancer has led to its incorporation into primary chemotherapy regimens for newly diagnosed patients. Based on prospective trials by the Gynecologic Oncology Group, paclitaxel/cisplatin has become the new standard regimen in the United States. A confirmatory trial has been performed by Canadian-European investigators. Clinical trials are in progress evaluating strategies to optimize paclitaxel-based chemotherapy. Randomized trials also are in progress, both in the United States and in Europe, comparing cisplatin/paclitaxel versus carboplatin/paclitaxel. Other trials are evaluating the role of paclitaxel dose intensity, the schedule of infusion, and the role of interval debulking surgery. In addition, pilot studies are under way to evaluate high-dose therapy together with peripheral blood stem cell support. Intraperitoneal cisplatin has been shown to be superior to intravenous cisplatin when administered together with intravenous cyclophosphamide. A combination of intravenous paclitaxel and intraperitoneal cisplatin has been compared with intravenous cisplatin and paclitaxel.