The taxanes: toxicity and quality of life considerations in advanced ovarian cancer

Abstract

The taxanes paclitaxel and docetaxel show good activity in the management of advanced ovarian cancer when used in conjunction with platinum agents. Accumulating evidence from clinical studies, particularly the latest results from the phase III comparative SCOTROC study, indicates that the two drugs confer similar rates of tumour response and survival in women with this condition. However, it is clear that paclitaxel and docetaxel differ in their tolerability profiles and in other respects, and cannot be regarded as directly equivalent drugs. In particular, paclitaxel is associated with significant neurotoxicity; peripheral neuropathy has also been reported with docetaxel, but to a lesser extent. Neutropenia appears more prevalent with docetaxel than with paclitaxel, although clinical trial data show that this adverse effect is manageable and need not compromise dose delivery. Docetaxel is also associated with potential benefits accruing from shorter infusion times and lack of need for premedication with intravenous histamine H(1) and H(2) antagonists. Emerging quality of life data are expected to shed further light on the overall benefit of chemotherapy in women with advanced ovarian cancer in general, and on taxane-platinum combinations in particular.

Figure 1

Neurosensory/neuromotor adverse events across all treatment cycles in 675 assessable patients with stage IIb–IV ovarian cancer in a phase III study (Piccart et al, 2000). Patients were randomly assigned to receive (i) paclitaxel 175 mg m⁻² over 3 h followed by cisplatin 75 mg m⁻² or (ii) cyclophosphamide 750 mg m⁻² followed by cisplatin 75 mg m⁻² for six to nine cycles.

Figure 2

Incidences of arthralgic/myalgic symptoms and weakness in arms and legs reported in the multicentre phase III SCOTROC study of 3-weekly carboplatin to AUC 5 with either paclitaxel 175 mg m⁻² infused over 3 h or docetaxel 75 mg m⁻² over 1 h (Vasey and the Scottish Gynaecological Cancer Trials Group, 2002). Chemotherapy was given for up to six cycles as first-line treatment in women with grade Ic–IV ovarian cancer. Patient numbers denote those available for assessment of each adverse event shown.