Carboplatin/Paclitaxel Preferable to Cisplatin/Paclitaxel in Optimal Stage III Epithelial Ovarian Cancer
Robert Ozols, M.D. from the Fox Chase Cancer Center presented data from the Gynecologic Oncology Group (GOG) Protocol #158 a randomized Phase III clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel in optimally surgically cytoreduced epithelial ovarian cancer. This important study is the largest reported randomized trial in optimal Stage III ovarian cancer.The regimen for GOG 158 was as follows:
- Regimen 1: Cisplatin 75 mg/m2 IV and paclitaxel 135 mg/m2 IV over 24 hours for six cycles
- Regimen 2: Carboplatin AUC 7.5 and paclitaxel 175 mg/m2 IV over 3 hours for six cycles.
- A total of 840 patients were entered into the study.
- Approximately half of the patients were registered for second-look surgery (SLS). There was no significant difference in disease free survival for the SLS and non-SLS groups.
- Gastrointestinal, leukopenia, fever, and metabolic toxicity were greater in regimen 1.
- Thrombocytopenia and pain were more common in regimen 2.
- Both regimens are equivilent in effacacy at the limit of power for this study.
- Regimen 2 (Carboplatin and 3-hour paclitaxel) is the preferable regimen because of ease of administration and less toxicity.
- Second-look surgery does not influence recurrence free survival in optimal Stage IIIC ovarian cancer