Paclitaxel and Platinum Remains Standard Chemotherapy for Initial Treatment

Paclitaxel and Platinum Remains Standard Chemotherapy for Initial Treatment of Advanced Ovarian Cancer.

Women who have advanced cancer of the ovary are commonly treated with surgery, followed by a chemotherapy combination, often cisplatin and cyclophosphamide. However, according to European researchers, cisplatin and paclitaxel has been shown to be more effective and should be considered the new standard therapy for advanced ovarian cancer.

Cancer of the ovary is characterized by the presence of cancer cells in 1 or both ovaries, which are located on either side of the uterus, or womb. Most cancers of the ovary are in the lining, or epithelium, of the ovary and are sometimes referred to as ovarian epithelial cancer. Treatment options for ovarian epithelial cancer depend on the stage of disease (extent of disease at diagnosis).

Stage III ovarian cancer is defined as cancer that is found in 1 or both ovaries and has spread to the nearby lymph nodes or other areas in the abdomen.

Stage IV ovarian cancer consists of cancer that is found in 1 or both ovaries and has spread to other parts of the body outside of the abdomen. Treatment for stage III and stage IV ovarian cancer, often referred to as advanced or metastatic cancer, commonly involves surgery to remove the ovaries, uterus, fallopian tubes, and as much of the cancer as possible. Nearby lymph nodes and other tissues in the abdomen and/or pelvis area may also be removed to determine whether the cancer cells have spread to these areas. After the surgery, many women receive chemotherapy with a cisplatin combination, with cisplatin and cyclophosphamide being considered the standard to which other therapies are compared. However, researchers continue to develop and study new and hopefully more effective drugs and drug combinations to treat this disease. Recently, studies of the combination of cisplatin and paclitaxel have shown promising results.

Researchers for several medical centers in Europe treated 680 women who had undergone surgery for advanced ovarian cancer with either A) cisplatin and cyclophosphamide or B) cisplatin and paclitaxel. When the assigned regimen stopped working for a patient, that individual then received the other therapy. The overall response rates were 59% in the group receiving paclitaxel initially and 45% in the group receiving cyclophosphamide initially, with 41% and 27% (respectively) being complete responses. The time it took for the cancer to begin growing again (called time to progression) was 15.5 months in those receiving paclitaxel and 11.5 months in the those receiving cyclophosphamide. The average overall survival time was 35.6 months in those initially receiving paclitaxel, compared with only 25.8 months in those initially receiving cyclophosphamide.

The researchers concluded that the cisplatin/paclitaxel combination produces higher response rates and longer survival times than the cisplatin/cyclophosphamide regimen, and should be considered the new standard to which new therapies are compared. Other clinical trials have demonstrated that a less toxic platinum chemotherapy compound, carboplatin, may be substituted for cisplatin. Persons who have ovarian cancer may wish to talk with their doctor about the risks and benefits of participating in a clinical trial in which cisplatin/paclitaxel and/or other promising new treatments are being evaluated.

(Journal of the National Cancer Institute, Vol 92, No 9, pp 699-708, 2000)

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