Ray-Coquard Isabelle
Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon.
Bull Cancer. 2004 Feb;91(2):159-65.
Docetaxel has exhibited substantial clinical activity against platinum, refrac- tory, paclitaxel resistant and previously untreated advanced ovarian cancer. As single agent, in advanced ovarian cancer patients previously treated with platinum agents, docetaxel 100 mg/m(2) every 3 weeks yields a 30% overall response rate and 6 months duration of response. In vitro data demonstrate a lack of complete cross-resistance bet- ween docetaxel and paclitaxel. In both platinum- and paclitaxel-pretreated patients, the highest response rates were obtained in patients with the longest interval of time since receipt of prior chemotherapy. Docetaxel currently is being intensively evaluated as a component of first line combination chemotherapy for ovarian cancer. Phase I-II have shown that docetaxel-platinum doublets are feasible and highly effective in the treatment of ovarian cancer, with docetaxel-carboplatin providing a more favorable safety profile compared with docetaxel-cisplatin, particularly with respect to neurotoxicity. The preliminary results of a phase III comparison of docetaxel-carboplatin versus paclitaxel-carboplatin support the clinical use of docetaxel-carboplatin as first line chemotherapy for stage IC to IV ovarian cancer, as it was shown to reduce the incidence of grade > 2 neurosensory toxicity compared to paclitaxel-carboplatin. Comparative overall survival and quality of life and more mature progression free survival data will be instrumental in determining the relative merits of docetaxel-carboplatin and paclitaxel-carboplatin as first line adjuvant therapy for ovarian cancer. The positive clinical experiences with docetaxel-provide a strong basis for continued investigation of docetaxel-carboplatin-based chemotherapy as component of advanced ovarian cancer management.
多西他赛已显示出对铂类耐药、难治性、对紫杉醇耐药及既往未治疗的晚期卵巢癌具有显著的临床活性。作为单药,在先前接受铂类药物治疗的晚期卵巢癌患者中,每3周给予多西他赛100mg/m²,总缓解率为30%,缓解持续时间为6个月。体外数据表明多西他赛与紫杉醇之间不存在完全交叉耐药。在铂类和紫杉醇预处理的患者中,自上次化疗后间隔时间最长的患者缓解率最高。多西他赛目前正作为卵巢癌一线联合化疗的组成部分进行深入评估。I-II期研究表明,多西他赛-铂类双联疗法在治疗卵巢癌方面可行且高效,与多西他赛-顺铂相比,多西他赛-卡铂具有更良好的安全性,尤其是在神经毒性方面。多西他赛-卡铂与紫杉醇-卡铂的III期比较的初步结果支持将多西他赛-卡铂作为IC至IV期卵巢癌的一线化疗药物,因为与紫杉醇-卡铂相比,它可降低2级以上神经感觉毒性的发生率。比较总体生存率、生活质量以及更成熟的无进展生存数据,将有助于确定多西他赛-卡铂和紫杉醇-卡铂作为卵巢癌一线辅助治疗的相对优势。多西他赛的积极临床经验为继续研究以多西他赛-卡铂为基础的化疗作为晚期卵巢癌治疗的组成部分提供了有力依据。