Primary ovarian cancer chemotherapy: current standards of care

Abstract

Chemotherapy has been regarded as standard therapy for the majority of women with advanced epithelial ovarian cancer for several decades, with this role filled largely by the alkylating agents - used as monotherapy - until the mid-1980s. The activity of cisplatin in this disorder was established during the 1970s, and combinations of cisplatin and an alkylating agent were widely used during the late 1980s. However, further research prompted by continuing concerns over poor survival and tolerability led to the adoption of paclitaxel in combination with either cisplatin or carboplatin as first-line therapy in ovarian cancer during the 1990s. Most recent research has focused on further optimisation of these regimens to maximise clinical benefit while minimising toxicity, and investigations into alternative taxanes (e.g. docetaxel), other novel agents and new treatment schedules are ongoing.

Figure 1

Evolution of chemotherapy for advanced ovarian cancer from the mid-1980s.

Figure 2

Incidence of adverse events showing differences between treatment arms in the Dutch/Danish study of 3-weekly paclitaxel 175 mg m⁻² infused over 3 h plus either cisplatin 75 mg m⁻² or carboplatin infused to achieve AUC 5 (Neijt et al, 2000).

Figure 3

Grade III and IV toxicities reported with >5% incidence in 885 Italian patients participating in the ICON-2 comparison of 3-weekly carboplatin monotherapy (to achieve AUC 5) with cyclophosphamide 500 mg m⁻², doxorubicin 50 mg m⁻² and cisplatin 50 mg m⁻² (CAP), both for six cycles, in 1526 patients from 132 hospitals (ICON Collaborators, 1998).