Abstract

Author(s): Vijayeta Ray*, Shahid Ali Siddiqui and Zehra Mohsin

Most patients with epithelial ovarian cancer have the advanced-stage disease when the diagnosis is established. The survival rates of patients with advanced ovarian cancer have steadily improved as a result of both a more skilled surgical approach and the development of more effective chemotherapy in first-line treatment. Paclitaxel is an important agent in the management of patients with advanced ovarian cancer. Following cytoreductive surgery, the current optimal chemotherapeutic approach consists of a platinum compound together with paclitaxel. This recommendation is supported by level 1 evidence from two large randomized trials, the Gynecologic Oncology Group (GOG) study and the Canadian European Intergroup study that showed the paclitaxel/cisplatin combination to be superior to the cyclophosphamide/ cisplatin combination in terms of survival. Long term follow-up data from the GOG study showed the survival advantage was still maintained at 5 years in patients who received the paclitaxel/cisplatin combination compared with those who received cyclophosphamide/cisplatin (27 vs 16%). However, neurotoxicity was a significant problem, particularly in the Intergroup study, which used a higher paclitaxel dose (175-200 mg/m2 over 3 h) than the GOG study (135 mg/m2 over 24 h). One of a number of approaches to reduce toxicity has included the weekly administration of paclitaxel. The lower doses and shorter infusion times used with weekly dosing appear to minimize bone marrow suppression and other toxicities associated with standard paclitaxel 3-weekly administration. The dose-dense approach of weekly paclitaxel may also achieve greater efficacy than standard doses every 3 weeks, through more sustained exposure of dividing tumor cells to paclitaxel’s cytotoxic and anti-angiogenic effects. Attempts to improve the outcome of chemotherapy in women with advanced ovarian cancer have focused on attenuation of side-effects, improvements in responsiveness, progressive palliation of the disease and improvements in quality of life. The recommended treatment strategy for patients with advanced ovarian cancer is upfront radical cytoreductive surgery followed by combination chemotherapy with a taxane and a platinum compound . In order to increase efficacy further, three-drug regimens have also been used. 
 

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