Platinum compounds and paclitaxel in advanced epithelial ovarian cancer

Cisplatin is the most active agent currently employed in epithelial ovarian cancer. A meta-analysis of the Advanced Ovarian Cancer Trialists Group suggested that in terms of immediate survival platinum-based therapy was superior to nonplatinum regimens and that regimens including cisplatin were superior to single agent cisplatin given at the same doses. Intraperitoneal cisplatin seems to offer some clinical benefit when compared to systemic cisplatin in patients with minimal residual disease after initial surgery. An overview on the role of anthracyclines using data from the Advanced Ovarian Cancer Trialists Group and the Ovarian Cancer Meta-Analysis Project suggested that the addition of doxorubicin significantly improves survival and that the size of this benefit is of a similar magnitude to that of platinum. Carboplatin and cisplatin are equiactive, and the different spectrum of toxicities could offer an appropriate criterion for the choice of the platinum analogue to use in the individual patient. At present, there is no conclusive evidence that cisplatin dose intense regimens are beneficial, and the issue of dose intensity must still be considered experimental. The combination of cisplatin + paclitaxel is able to obtain a better progression-free survival and survival than the association cisplatin + cyclophosphamide. Phase I-II trials on regimens including platinum compounds, anthracyclines and paclitaxel are currently ongoing.