Dear OncoLink "Ask The Experts,"
My wife has epithelial ovarian cancer stage III C. She underwent surgery in January 2001 and chemotherapy with the standard Carboplatin/Taxol (paclitaxel) treatment. She had a recurrence within 18 months and again underwent treatment with the same Carboplatin/Taxol combination beginning in December 2002. She again had a period of remission of approximately 18 months and it has just this week been determined via a CT scan that the cancer has reappeared. Our oncologist is recommending two options for treatment, Carboplatin as a single agent or the combination of Carboplatin and Taxol as previously. These options are being recommended because of her very good response in the past. My wife's concern is the potential cumulative toxicity particularly of Taxol. My question is "What are the benefits and potential negative impacts of each of the two options, that is, Carboplatin on its own versus Carboplatin and Taxol in combination as a third line treatment."
Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health System, responds:
Women with ovarian cancer who have a good initial response to platinum-based chemotherapy and a long period of remission, such as your wife had, have a very good chance of responding again to platinum. A recent study showed improved results when such patients were again treated with the combination of carboplatin and paclitaxel, as your wife was the second time, as compared with carboplatin alone. Your wife has again had an 18 month remission after the second chemotherapy regimen, which suggests her tumor will still respond to platinum.
There is little experience with combination chemotherapy in the third line setting, but most oncologists would probably use carboplatin as a single agent to limit toxicity. If additional chemotherapy is needed in the future, paclitaxel could be used as a single agent at that time. You and your wife should discuss these issues in detail with the treating oncologist.
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