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Paclitaxel - cisplatin regimen
Abstract: Cyclophosphamide and cisplatin compared with paclitaxel and
cisplatin in patients with stage III and stage IV ovarian cancer.
BACKGROUND. Chemotherapy combinations that include an alkylating agent
and a platinum coordination complex have high response rates in women with
advanced ovarian cancer. Such combinations provide long-term control of
disease in few patients, however. We compared two combinations, cisplatin
and cyclophosphamide and cisplatin and paclitaxel, in women with ovarian
cancer. METHODS. We randomly assigned 410 women with advanced ovarian cancer
and residual masses larger than 1 cm after initial surgery to receive cisplatin
(75 mg per square meter of body-surface area) with either cyclophosphamide
(750 mg per square meter) or paclitaxel (135 mg per square meter over 24
hours). RESULTS. Three hundred eighty-six women met all the eligibility
criteria. Known prognostic factors were similar in the two treatment groups.
Alopecia, neutropenia, fever, and allergic reactions were reported more
frequently in the cisplatin-paclitaxel group. Among 216 women with measurable
disease, 73
percent in the cisplatin-paclitaxel group responded to therapy,
as compared with 60 percent in the cisplatin-cyclophosphamide group (P =
0.01). The frequency of surgically verified complete response was similar
in the two groups. Progression-free survival was significantly longer (P
< 0.001) in the cisplatin-paclitaxel group than in the cisplatin-cyclophosphamide
group (median, 18 vs. 13 months). Survival
was also significantly longer (P < 0.001) in the cisplatin-paclitaxel group
(median, 38 vs. 24 months). CONCLUSIONS.
Incorporating paclitaxel into first-line therapy improves the duration of
progression-free survival and of overall survival in women with incompletely
resected stage III and stage IV ovarian cancer.
References
McGuire WP, Hoskins WJ, Brady MF, Kucera PR, Partridge EE, Look KY, Clarke-Pearson
DL, Davidson M. Cyclophosphamide and cisplatin compared with paclitaxel
and cisplatin in patients with stage III and stage IV ovarian cancer. N
Engl J Med. 1996 Jan 4;334(1):1-6.
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| Regimen |
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| The original dosing as described
in this article: Paclitaxel....... 135 mg / M2 IV (over 24 h)
day 1
Cisplatin....... 75 mg / M2 IV day 1
FREQUENCY every 21 days
The 3 hour regimen (less toxic):
Paclitaxel....... 175 mg / M2 IV (over 3 h) day 1
Cisplatin....... 75 mg / M2 IV day 1
FREQUENCY every 21 days
MJ Piccart et al. Randomized intergroup trial of cisplatin-paclitaxel
versus cisplatin-cyclophosphamide in women with advanced epithelial
ovarian cancer: Three-year results. J Natl Cancer Inst 92:699-708, 2000.
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Summary |
Cyclophosphamide
- cisplatin vs. paclitaxel - cisplatin in stage III & IV ovarian cancer. |
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Overall Response
Rate |
73% vs. 60% |
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Progression
Free Survival |
18m vs. 13m |
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Overall Survival |
38m vs. 24m |
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Toxicity |
Alopecia,
neutropenia, fever, and allergic reactions were reported more frequently
in the cisplatin-paclitaxel group (24 hour infusion). |
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