Rationale for examining the combination of paclitaxel and ifosfamide in the treatment of advanced ovarian cancer.

Both paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) and ifosfamide have been demonstrated to be active agents in patients with clinically defined platinum-refractory ovarian cancer. While there might be interest in combining these two drugs as salvage therapy for this disease, the recent inclusion of paclitaxel as initial therapy for advanced ovarian cancer, along with a platinum agent (cisplatin or carboplatin), makes it unlikely that paclitaxel and ifosfamide will be used clinically in this malignancy. However, if alkylating agents are not to be used as part of the initial chemotherapy strategy for women with advanced ovarian cancer, it will be important to evaluate the activity of ifosfamide as salvage therapy in individuals treated only with, and demonstrated to be refractory to, a platinum agent and paclitaxel. If significant activity for ifosfamide is observed in this clinical setting, evaluation of the potential utility of a three-drug combination regimen comprising ifosfamide, paclitaxel, and cisplatin or carboplatin may be quite relevant.