First line chemotherapy with carboplatin plus paclitaxel in advanced ovarian cancer--a new standard of care?

Cisplatin 75 mg/m2 plus paclitaxel 135 mg/m2 administered over 24 hours have been established as the standard treatment for advanced ovarian cancer. This schedule can not be administered in an outpatient setting. A European-Canadian trial confirmed the superiority of cisplatin-paclitaxel, but failed to improve the therapeutic index of this combination by reducing infusion length of paclitaxel from 24 to 3 hours. The reduction of infusion duration combined with a dose escalation of paclitaxel from 135 mg/m2 to 175 mg/m2 induced a high rate of neurotoxicity. A further attempt to improve the therapeutic index of platinum-taxane combinations was started with the substitution of cisplatin by carboplatin. At least 7 phase I/II trials evaluated this combination. The promising results of these studies led to the initiation of 5 randomised phase III trials with carboplatin plus paclitaxel administered in 3-hours. Two of these trials have completed accrual and preliminary data were available for this review. Although long-term survival data are not available, the current results warrant the conclusion that the combination of carboplatin AUC 5-6 plus paclitaxel 175 mg/m2 in a 3-hours infusion can be regarded as an alternative for the first-line treatment in patients with advanced ovarian cancer. Final analysis of the above mentioned phase III trials with longer follow-up is awaited and will define the ultimate role of this combination.