Intensive chemo for ovarian cancer

Many patients with ovarian cancer are diagnosed at stage III and IV.   Unfortunately, the cure rate is around 30-40%.   The standard chemo is usually carboplatin and paclitaxel (Taxol) every 3 weeks intravenously.   Some selected patients may receive cisplatin and paclitaxel intraperiteneally (inside abdomen).

A Japanese randomized trial compared the standard carbo+taxol every 3 weeks with an intensive dose regimen and showed a better cure rate.  The Dose-dense treatment: Carboplatin (AUC 6 on day 1) and weekly paclitaxel (80 mg/m² days 1, 8, and 15) every three weeks for six cycles.  This Japanese study was summarized from Uptodate article:

1.       Improvement in median progression free survival (28 versus 17 months; hazard ratio for recurrence [HR] 0.71, 95% CI 0.58-0.88).  PFS means the duration of time from completion of chemo to the recurrence of cancer.

2. Significant improvement in overall survival at three years (HR for mortality 0.75, 95% CI 0.57-0.98).
3. A higher rate of treatment discontinuation for toxicity (52 versus 37 percent) and higher proportion of patients who had at least one treatment cycle delayed because of toxicity (76 versus 67 percent).
4. Similar frequency of severe (grade 3 or 4) nonhematologic toxicity (including neurotoxicity).
5. No difference in rate of febrile neutropenia between groups (9 percent).  Febrile neutropenia means fever due to suppressed immune system.

This new regimen seems to be effective but with higher toxicities.  Do discuss risks and benefits with your oncologist.

REFERENCE

1.      Katsumata N, et al. Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial. Lancet. 2009;374(9698):1331.

2.      Uptodate. Herzog T.  accessed 2-24-2013