The Pharmaceutical Journal
Vol 269 No 7211 p208
17 August 2002

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Trial supports first-line carboplatin monotherapy for ovarian cancer

Single-agent carboplatin could be considered a first-line treatment option for ovarian cancer, a new study suggests. Researchers from the International Collaborative Ovarian Neoplasm Group found that regimens of carboplatin alone or cyclophosphamide, doxorubicin plus cisplatin (CAP) were as effective as paclitaxel plus carboplatin as first-line treatments.

They randomly assigned 2,074 patients from 130 centres in eight countries, including the United Kingdom, to receive either paclitaxel plus carboplatin, or a control regimen — carboplatin alone or CAP. More than 80 per cent of patients in all groups received six cycles of chemotherapy. The researchers found that after a median follow-up of 51 months, 1,256 patients had died, with no evidence of a difference in overall survival between the three groups. Median overall survival was 36.1 months for those in the paclitaxel plus carboplatin group and 35.4 months for the controls (difference 0.7 months, 95 per cent confidence interval -3.6–4.7). Median progression-free survival was 17.3 months for the paclitaxel plus carboplatin group and 16.1 per cent for the controls (difference 1.2 months, -0.5–2.8).

The researchers suggest single-agent carboplatin, CAP and paclitaxel plus carboplatin are all safe and show similar effectiveness as first-line treatments for women requiring chemotherapy for ovarian cancer. "Of these three treatments, carboplatin might be regarded as the preferred treatment because of its better toxicity profile," they say. The study confirmed that paclitaxel plus carboplatin was more toxic than carboplatin alone, in particular causing more alopecia, fever and sensory neuropathy.

The researchers add that the study does not imply that paclitaxel has no role in the treatment of women with advanced ovarian cancer but that specifying the best way to use this drug may be needed. They say about a third of patients on carboplatin alone went on to receive a taxane at some stage and conclude: "The optimum way of using paclitaxel might be to use it after single-agent carboplatin either before or after progressive disease has been identified."

In guidance issued in May 2000, the National Institute for Clinical Excellence recommended that paclitaxel in combination with a platinum therapy (cisplatin or carboplatin) should be the standard initial therapy for women with ovarian cancer following surgery (PJ, 13 May 2000, p716).