***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: BACKGROUND We have continued to monitor the survival of patients r and omised in a previously reported multicentre phase III study of topotecan versus paclitaxel in patients with advanced epithelial ovarian cancer who had failed one prior platinum-based regimen . PATIENTS AND METHODS Patients with bidimensionally measurable disease were r and omised to topotecan  ( 1.5 mg/m(2)/day for 5 days ) or paclitaxel ( 175 mg/m(2)/day as a 3-h infusion ) every 21 days . Patients were eligible for treatment with the alternate therapy at third line . The European Organisation for Research and Treatment of Cancer Quality of Life ( EORTC QOL)-C30 question naire was also used to measure eight symptoms at baseline and during each course ( pain , anorexia , diarrhoea , fatigue , nausea and vomiting , dyspnea , constipation and insomnia ) . RESULTS A total of 226 patients were evaluable for response . Demographic characteristics were similar in both treatment groups , as were results of the EORTC QOL-30 question naire . For the topotecan group , median time to progression was 18.9 weeks ( range < 1 to 92.6 + weeks ; 25 % censored ) , and , for paclitaxel , 14.7 weeks ( range < 1 to 137.3 + weeks ; 12.3 % censored ) ; P = 0.076 . At 4 years post-r and omisation , median survival in the topotecan group was 63.0 weeks ( range < 1 to 238.4 + weeks ; 20.5 % censored ) and , for paclitaxel , 53.0 weeks ( range < 1 to 226.3 + weeks ; 12.3 % censored ) ; P = 0.44 . CONCLUSION Topotecan continues to demonstrate comparable efficacy and survival to paclitaxel with manageable and non-cumulative haematological toxicity . Non-haematological toxicity was generally mild for both groups . The long-term survival rate indicates substantial therapeutic benefit for this group of patients receiving topotecan at relapse of ovarian cancer PURPOSE This was a multicentric , open , r and omized , phase II study of single-agent paclitaxel and oxaliplatin to evaluate the efficacy of oxaliplatin in a relapsing progressive ovarian cancer patient population and to analyze the safety profile and impact of both agents on quality of life , time to progression , and survival . PATIENTS AND METHODS Eighty-six patients with platinum-pretreated advanced ovarian cancer were r and omly assigned to two arms : 41 received paclitaxel at 175 mg/m(2 ) over 3 hours every 3 weeks , and 45 received oxaliplatin at 130 mg/m(2 ) over 2 hours every 3 weeks . For inclusion , patients had to have a performance status of 0 to 2 and to have received at least one and no more than two prior cisplatin- and /or carboplatin-containing chemotherapy regimens within the last 12 months . RESULTS Seven confirmed responses were observed in each arm , for an overall response rate in the total treated population of 17 % ( 95 % confidence interval [ CI ] , 7 % to 32 % ) in the paclitaxel arm and 16 % ( 95 % CI , 7 % to 29 % ) in the oxaliplatin arm . Median time to progression was 14 weeks and 12 weeks , and overall survival was 37 weeks and 42 weeks in the paclitaxel and oxaliplatin arms , respectively . Among 63 patients with a 0- to 6-month progression-free , platinum-free interval , there were five objective responses with paclitaxel in 31 patients and two objective responses with oxaliplatin in 32 patients . Nine patients ( 22 % ) in the paclitaxel arm had grade 3 or 4 neutropenia ( National Cancer Institute of Canada [ NCIC ] Common Toxicity Criteria ) . Two patients ( 4 % ) experienced grade 3 thrombocytopenia in the oxaliplatin arm . Maximum grade ( grade 3 ) NCIC neurosensory toxicity was experienced by three patients ( 7 % ) in the paclitaxel arm and by four patients ( 9 % ) in the oxaliplatin arm . CONCLUSION Single-agent oxaliplatin at 130 mg/m(2 ) every 3 weeks is active with moderate toxicity in patients with cisplatin-/carboplatin-pretreated advanced ovarian cancer BACKGROUND The aim of this study was to determine whether the response rate for the paclitaxel-carboplatin combination is superior to carboplatin alone in the treatment of patients with platinum-sensitive recurrent ovarian carcinoma . PATIENTS AND METHODS Patients with recurrent ovarian carcinoma , 6 months after treatment with a platinum-based regimen and with no more than two previous chemotherapy lines , were r and omized to receive carboplatin area under the curve ( AUC ) 5 ( arm A ) or paclitaxel 175 mg/m(2 ) + carboplatin AUC 5 ( arm B ) . The primary end point was objective response , following a ' pick up the winner ' design . Secondary end points included time to progression ( TTP ) , overall survival , tolerability and quality of life ( QoL ) . RESULTS Eighty-one patients were r and omized and included in the intention-to-treat analysis . The response rate in arm B was 75.6 % [ 26.8 % complete response ( CR ) + 48.8 % partial response ( PR ) ] [ 95 % confidence interval ( CI ) 59.7 % to 87.6 % ] and 50 % in arm A ( 20 % CR + 30 % PR ) ( 95 % CI 33.8 % to 66.2 % ) . No significant differences were observed in grade 3 - 4 hematological toxicity . Conversely , mucositis , myalgia/arthralgia and peripheral neurophaty were more frequent in arm B. Median TTP was 49.1 weeks in arm B ( 95 % CI 36.9 - 61.3 ) and 33.7 weeks in arm A ( 95 % CI 25.8 - 41.5 ) . No significant differences were found in the QoL analysis . CONCLUSIONS Paclitaxel-carboplatin combination is a tolerable regimen with a higher response rate than carboplatin monotherapy in platinum-sensitive recurrent ovarian carcinoma We conducted a r and omized clinical trial to compare the efficacy and safety of paclitaxel and a combination including paclitaxel and epidoxorubicin as second-line treatment in platinum-refractory or -resistant ovarian cancer . Patients who had progressive or stable disease during first-line therapy with regimens containing cisplatin or carboplatin ( platinum-refractory patients ) or who responded and subsequently relapsed within 6 months after discontinuation of first-line platinum-based regimen ( platinum-resistant patients ) were eligible for the study . They were r and omly allocated to paclitaxel 175 mg/m2 every 28 days ( 41 women ) for five cycles or epidoxorubicin 120 mg/m2 iv plus paclitaxel 150 mg/m2 iv every 28 days ( 40 women ) . The overall response rates ( complete plus partial response ) were , respectively , 17.1 % in the paclitaxel and 34.2 % in the epidoxorubicin plus paclitaxel group ( P = 0.10 ) . The 2-year percentage survival was 18 in the paclitaxel group and 10 in the epidoxorubicin plus paclitaxel group . A higher frequency of leukopenia and thrombocytopenia was reported in women allocated to epidoxorubicin plus paclitaxel than in the paclitaxel alone group , but the frequency of neurotoxicity was higher in the paclitaxel alone group . An important limitation of the study is the small sample size . With this sample size we can exclude that multiagent therapy in comparison with single-agent therapy improves response in platinum-refractory and -resistant ovarian cancer of more than 25 % PURPOSE To assess the activity , efficacy , and tolerability of single-agent paclitaxel and a platinum-containing regimen in previously treated patients with recurrent ovarian cancer . PATIENTS AND METHODS Patients who achieved complete remission with platinum-based regimens and whose disease recurred after a progression-free interval of more than 12 months were included in the study . Every 21 days , patients received paclitaxel 175 mg/m(2 ) intravenously ( IV ) over 3 hours or cyclophosphamide 500 mg/m(2 ) , doxorubicin 50 mg/m(2 ) , and cisplatin 50 mg/m(2 ) ( CAP ) IV . RESULTS Between June 1992 and May 1995 , 97 consecutive patients with assessable or measurable disease were r and omized to  paclitaxel ( n = 50 ) or CAP ( n = 47 ) . The median number of cycles on each arm was six . Toxicities included grade 3/4 leukopenia ( 4 % for paclitaxel v 34 % for CAP ) , grade 3/4 neutropenia ( 13 % v 36 % ) , grade 1/2 myalgia ( 19 % v 4 % ) , allergic reactions ( 15 % v 2 % ) , and grade 2/3 nausea and vomiting ( 17 % v 51 % ) . Complete responses were achieved in 17 % and 30 % of patients receiving paclitaxel and CAP , respectively , and partial responses were achieved in 28 % and 25 % , respectively ( P = .062 ) . At a median follow-up time of 49 months , median progression-free intervals were 9 months for paclitaxel and 15.7 months for CAP ( Cox analysis : hazards ratio [ HR ] , 0.60 ; 95 % confidence interval [ CI ] , 0.37 to 0.97 ; P = .038 ) ; median overall survival times were 25.8 months for paclitaxel and 34.7 months for CAP ( Cox analysis : HR , 0.58 ; 95 % CI , 0.34 to 0.98 ; P = .043 ) . CONCLUSION Rechallenge with either single-agent paclitaxel or platinum-based chemotherapy is effective in this patient population . Preliminary results suggest that single-agent paclitaxel may not be as active as platinum-based chemotherapy in recurrent ovarian cancer . Larger r and omized trials are needed Fifty-four patients with ovarian cancer who achieved a complete or partial remission with cisplatin or carboplatin  were rechallenged with the same drug or crossed over to the other platinum compound at relapse . Fifteen of 43 ( 35 % ) crossover patients and 1/11 ( 9 % ) rechallenged patients responded ; the difference was not significant and there was no difference in survival between the two groups . Responders survived significantly longer than nonresponders ( P = 0.001 ) but there was no survival difference between those who responded to a rechallenge and those who responded to crossing over to the other platinum compound . The progression-free interval between the end of initial treatment and relapse was a significant prognostic factor for response to treatment and survival ; 17 % ( 6/35 ) of patients who relapsed before 18 months responded as compared to 53 % ( 10/19 ) who relapsed after 18 months ( P = 0.006 ) and median survival was 221 and 486 days , respectively , for these two groups ( P = 0.026 ) OBJECTIVE The aim of the study was to analyze the benefit/toxicity profile of a second-line treatment with carboplatin alone or carboplatin plus another non-cross-resistant drug ( epidoxorubicin ) in ovarian cancer patients sensitive to cisplatin-based chemotherapy at first-line treatment . METHODS We conducted a r and omized clinical trial . Women with epithelial ovarian cancer FIGO Stage II -- IV who had a complete or partial response to first-line treatment with cisplatin or carboplatin-based regiments and subsequently progressed or relapsed more than 6 months after discontinuation of first-line treatment were eligible for the study . A total of 190 subjects entered the study . They were r and omly allocated to either 300 mg/m(2 ) of carboplatin every 28 days for five cycles ( 95 patients ) or 120 mg/m(2 ) of epidoxorubicin and 300 mg/m(2 ) of carboplatin every 28 days for five cycles ( 95 patients ) . RESULTS A complete response was reported , respectively , in 32 ( 36 % ) women allocated to carboplatin alone and in 28 ( 31.8 % ) of those allocated to carboplatin plus epidoxorubicin . The corresponding figures for partial response were 18 ( 20.2 % ) and 26 ( 29.9 % ) . Comparing the frequency of complete response , partial response , no change , and progression , the differences between the two groups were not significant ( chi(2)(3 ) 5.10 , P = 0.16 ) . The median duration of response was 16 months in 
    Output:
    
Toxicity was reported in all of the r and omized trials , and although data on adverse events varied by treatment regimen , the observed adverse events correlated with known toxicity profiles .
As expected , combination chemotherapy was associated with higher rates of adverse events .
As compared with carboplatin alone , the combination of carboplatin and paclitaxel significantly improved both progression-free and overall survival .
If combination platinum-based chemotherapy is not indicated , then a single platinum agent should be considered .
Carboplatin has demonstrated efficacy across trials and has a manageable toxicity profile .
If a single platinum agent is not being considered , then monotherapy with paclitaxel , topotecan , or pegylated liposomal doxorubicin are seen as reasonable treatment options .
Some patients may be repeatedly sensitive to treatment and may benefit from multiple lines of chemotherapy .
With non-platinum agents , monotherapy should be considered because no advantage appears to accrue to the use of non-platinum-containing combination chemotherapy in this group of patients .
Single-agent paclitaxel , topotecan , or pegylated liposomal doxorubicin have demonstrated activity in this patient population and are reasonable treatment options .
No evidence either supports or refutes the use of more than one line of chemotherapy in patients with platinum-refractory or platinum-resistant recurrence .