***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE On the basis of the activity of paclitaxel as a single agent in chemotherapy-naive squamous cell carcinoma of the cervix in a prior Gynecologic Oncology Group ( GOG ) trial , a phase II study of paclitaxel and cisplatin as first-line therapy was conducted by the GOG . PATIENTS AND METHODS Eligibility included squamous cell cancer of the cervix not curable by surgery or radiation , measurable disease , WBC count > or = 3,000/microL , platelet count > or = 100 , 000/microL , serum creatinine > or = 2 mg/100 mL , and adequate hepatic function . The starting dose was paclitaxel 135 mg/m(2 ) infused over 24 hours followed by cisplatin 75 mg/m(2 ) every 21 days . On the basis of toxicity , a dose escalation of paclitaxel to a maximum dose of 170 mg/m(2)/d was prescribed . RESULTS Forty-seven patients were enrolled onto this study ; 44 patients were assessable for toxicity and 41 for response . Forty ( 90.9 % ) had received prior radiation therapy . A median of six courses of chemotherapy was given ( range , one to 10 courses ) . Neutropenia grade 3 ( 15.9 % ) and 4 ( 61.4 % ) was the most frequent severe adverse effect and was associated with fever in 13 patients ( 27.7 % ) . Two patients ( 4.5 % ) died from neutropenic sepsis . Grade 4 thrombocytopenia occurred in 6.8 % of patients . Of 41 assessable patients , five ( 12.2 % ) had complete responses and 14 ( 34.1 % ) had partial responses for an overall response rate of 46.3 % ( 95 % confidence interval , 30.7 % to 62.6 % ) . The median progression-free interval , was 5.4 + months ( range , 0.3 to 22 + months ) with a median survival of 10.0 + months ( range , 0.9 to 22 . 2 months ) . Response was more frequent in patients with disease in nonirradiated sites ( 70 % v 23 % , P = .008 ) . CONCLUSION This regimen seems highly active in advanced and recurrent squamous cell carcinoma of the cervix and is currently being evaluated by the GOG in a phase III r and omized study comparing the combination of paclitaxel and cisplatin with cisplatin alone PURPOSE In r and omized trials the combination of cisplatin and paclitaxel was superior to cisplatin and cyclophosphamide in advanced-stage epithelial ovarian cancer . Although in nonr and omized trials , carboplatin and paclitaxel was a less toxic and highly active combination regimen , there remained concern regarding its efficacy in patients with small-volume , resected , stage III disease . Thus , we conducted a noninferiority trial of cisplatin and paclitaxel versus carboplatin and paclitaxel in this population . PATIENTS AND METHODS Patients with advanced ovarian cancer and no residual mass greater than 1.0 cm after surgery were r and omly assigned to receive cisplatin 75 mg/m2 plus a 24-hour infusion of paclitaxel 135 mg/m2 ( arm I ) , or carboplatin area under the curve 7.5 intravenously plus paclitaxel 175 mg/m2 over 3 hours ( arm II ) . RESULTS Seven hundred ninety-two eligible patients were enrolled onto the study . Prognostic factors were similar in the two treatment groups . Gastrointestinal , renal , and metabolic toxicity , as well as grade 4 leukopenia , were significantly more frequent in arm I. Grade 2 or greater thrombocytopenia was more common in arm II . Neurologic toxicity was similar in both regimens . Median progression-free survival and overall survival were 19.4 and 48.7 months , respectively , for arm I compared with 20.7 and 57.4 months , respectively , for arm II . The relative risk ( RR ) of progression for the carboplatin plus paclitaxel group was 0.88 ( 95 % confidence interval [ CI ] , 0.75 to 1.03 ) and the RR of death was 0.84 ( 95 % CI , 0.70 to 1.02 ) . CONCLUSION In patients with advanced ovarian cancer , a chemotherapy regimen consisting of carboplatin plus paclitaxel results in less toxicity , is easier to administer , and is not inferior , when compared with cisplatin plus paclitaxel A total of 394 patients with advanced , measurable squamous carcinoma of the uterine cervix and no prior chemotherapy were r and omized to therapy with either carboplatin or iproplatin . There were 23 patients ineligible for the study and 10 patients who were not evaluable ; the remaining 361 patients were evaluable for response and adverse effects . R and omization was well balanced for age , performance status , and prior therapy . Both platinum analogs were given every 28 days with starting doses of 400 mg/m2 for carboplatin ( 340 mg/m2 if the patient underwent prior radiation ) and 270 mg/m2 for iproplatin ( 230 mg/m2 if the patient underwent prior radiation ) . These doses are equivalent to cisplatin doses of 75 to 100 mg/m2 . Hematologic toxicity was dose-limiting , among which thrombocytopenia was slightly more common than leukopenia . Gastrointestinal toxicity was also prominent with both agents ; however , iproplatin was significantly more toxic than carboplatin ( P less than .001 ) . Renal , otic , and peripheral nervous system toxicities were absent or infrequent with both analogs . No electrolyte abnormalities were observed . The percentage of planned dosages that were actually administered was 100 % of carboplatin doses and 85 % of iproplatin doses ( P less than .0001 ) . The reduction in  iproplatin dose was apparently due to gastrointestinal toxicity . Response rates were similar for both agents ( 15 % for carboplatin , 11 % for iproplatin ) and appear to be inferior to those noted with the parent compound , cisplatin PURPOSE The results of salvage chemotherapy for recurrent or persistent squamous-cell cervical cancer are unsatisfactory . Cisplatin and Ifosfamide are effective compounds in cervical cancer . Paclitaxel has recently been tested with promising results . The aim of this study was to assess the efficacy of a combination of paclitaxel , ifosfamide and cisplatin ( TIP ) for persistent/recurrent squamous-cell cervical carcinoma in a phase II trial . PATIENTS AND METHODS Forty-five women were treated with the TIP regimen . Thirty-one had received prior irradiation .  Paclitaxel was given at a dose of 175 mg/m2 , ifosfamide at a dose of 5 g/m2 , and cisplatin at a dose of 75 mg/m2 ( 50 mg/m2 in irradiated patients ) at three-week intervals . RESULTS We observed 15 clinical complete responses , 15 partial responses , 9 stable diseases and 6 progressions . The objective response rate was 67 % ( 95 % confidence interval : 51%-81 % ) . Ten complete responders underwent subsequent surgery and seven had pathology-defined complete responses ( two in irradiated areas ) . The response rate was 52 % in irradiated and 75 % in non-irradiated areas . The median survival for non-responders is 6 months , 9 + month for partial responders and 13 + for complete responders . The most relevant side effect was myelotoxicity , with 91 % of patients experiencing grade 3 - 4 . One woman had life-threatening toxic effects . CONCLUSIONS This combination is highly effective for salvage treatment in non-irradiated patients . For irradiated women the response rate is higher than that observed with other regimens but further investigation is warranted . The toxicity is relevant but adequate hydration and prolonged infusion of ifosfamide make it acceptable Since publication of the results of the Gynecologic Oncology Group III study , the combination of cisplatin/paclitaxel ( Taxol ; Bristol-Myers Squibb Company , Princeton , NJ ) has been widely adopted as st and ard treatment for advanced ovarian cancer . Further attempts to optimize first-line chemotherapy with platinum and taxanes include the substitution of cisplatin with carboplatin , individualization of the carboplatin dose by calculating it according to the area under the concentration-time curve , and reduction of paclitaxel infusion duration . These attempts have led to the initiation of several phase I/II trials evaluating the combination of carboplatin/paclitaxel . The promising results of these small studies have prompted the initiation of three phase III trials comparing carboplatin/paclitaxel with the st and ard combination of cisplatin/paclitaxel . The interim analysis after 15 months ' accrual of the prospect ively r and omized German Arbeitsgemeinschaft Gynäkologische Onkologie ( AGO ) study is presented here . As of January 1997 , 518 of 660 planned patients have been recruited . The interim analysis is based on data from 449 evaluable patients . The preliminary data indicate that hematologic toxicity occurred more frequently in arm A ( carboplatin/paclitaxel ) , whereas nonhematologic toxicity occurred slightly more frequently in arm B ( cisplatin/paclitaxel ) . Dose-intensity analysis did not reveal cumulative dose reductions or an increased need for colony-stimulating factors over subsequent courses in both arms . Forty-four patients with measurable disease following surgery completed chemotherapy and were evaluable for response , which remains blinded at this time and is reported for the group as a whole . So far , there have been 18 complete responses ( 41 % ) and 15 partial responses ( 34 % ) , for an overall response rate of 75 % . Retrospective comparison reveals no significant difference in response rates between patients in the cisplatin/paclitaxel arm of Gynecologic Oncology Group III and those in the Arbeitsgemeinschaft Gynäkologische Onkologie study . Overall , this interim analysis did not reveal any reason for an early termination of this study . Accrual is ongoing and is expected to be completed this year PURPOSE To determine whether cisplatin plus paclitaxel ( C+P ) improved response rate , progression-free survival ( PFS ) , or survival compared with cisplatin alone in patients with stage IVB , recurrent , or persistent squamous cell carcinoma of the cervix . PATIENTS AND METHODS Eligible : patients with measurable disease , performance status ( PS ) 0 to 2 , and adequate hematologic , hepatic , and renal function received either cisplatin 50 mg/m2 or C+P ( cisplatin 50 mg/m2 plus paclitaxel 135 mg/m2 ) every 3 weeks for six cycles . Tumor measurements and quality -of-life ( QOL ) assessment s were obtained before each treatment cycle . RESULTS Of 280 patients entered , 6 % were ineligible . Among 264 eligible patients , 134 received cisplatin and 130 received C+P. Groups were well matched with respect to age , ethnicity , PS , tumor grade , disease site , and number of cycles received . The majority of all patients had prior radiation therapy ( cisplatin , 92 % ; C+P , 91 % ) . Objective responses occurred in 19 % ( 6 % complete plus 13 % partial ) of patients receiving cisplatin versus 36 % ( 15 % complete plus 21 % partial ) receiving C+P ( P = .002 ) . The median PFS was 2.8 and 4.8 months , respectively , for cisplatin versus C+P ( P < .001 ) . There was no difference in median survival ( 8.8 months v 9.7 months ) . Grade 3 to 4 anemia and neutropenia were more common in the combination arm . There was no significant difference in QOL scores , although a disproportionate number of patients ( cisplatin , n = 50 ; C+P , n = 33 ) dropped out of the QOL component , presumably because of increasing disease , deteriorating health status , or early death . CONCLUSION C+P is superior to cisplatin alone with respect to response rate and PFS with sustained QOL The aim of this study was to assess the efficacy and toxicities of a combination of paclitaxel , ifosfamide , and cisplatin ( TIP ) for recurrent carcinoma of the uterine cervix . Fifty-three patients with recurrent cervical carcinoma were treated with ifosfamide 1500 mg/m2 intravenously over 3 h on days 1–3 , paclitaxel 135 mg/m2 as a 3-h intravenous infusion , and cisplatin 50 mg/m2 intravenously over 30 min on day 1 . The chemotherapy was repeated every 3 weeks until there was disease progression or unacceptable toxicity . Forty-five patients received at least three courses of treatment and were evalu 
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DISCUSSION Our study indicates that CBDCA may represent an attractive and valid alternative to the more toxic and equally effective CDDP in the treatment of advanced or recurrent cervical cancer