Docetaxel has a different toxicity profile from paclitaxel. The SCOT-ROC (Scottish Gynaecological Cancer Trials Group) study randomly assigned 1,077 women with stages Ic to IV epithelial ovarian cancer to carboplatin with either paclitaxel or docetaxel (210). The efficacy of docetaxel appeared to be similar to paclitaxel: The median progression-free survival was 15.1 months versus 15.4 months, and the docetaxel group had fewer neurologic effects, arthralgias, myalgias, and extremity weakness than the paclitaxel group. The docetaxel plus carboplatin regimen was associated with significantly more myelosuppression and its consequences (i.e., serious infections and prolonged grade 3 to 4 neutropenia). Additional study is necessary to determine whether docetaxel should supplant paclitaxel in the primary treatment of epithelial ovarian cancer.
CHAPTER 37 Ovarian, Fallopian Tube, and Peritoneal Cancer
Treatment residual disease Alive Dead Patients cisplatin/paclitaxel mirco 83 61 144 cisplatin/paclitaxel macro 87 168 255 carboplatin/paclitaxel micro 88 49 137 carboplatin/paclitaxel macro 57 198 255 0 12 24 36 48 60 Proportion surviving 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0A 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3
Figure 37.15 Survival of patients with stage III epithelial ovarian cancer treated with carboplatin and paclitaxel versus cisplatin and paclitaxel: a Gynecologic Oncology Group study.
0.2 0.1
A: Survival by treatment. B: Survival by treatment group (micro vs. macro). (From Ozols RF, Bundy BN, Greer BE, et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol 2003;21:3194–3200, with permission; Berek JS, Hacker NF. Berek & Hacker’s Gynecologic Oncology. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2010:475, with permission.)
An Intergroup, international trial—GOG 182/Southwest Oncology Group (SWOG) 182/ICON5—compared the standard combination of carboplatin and paclitaxel with these drugs in combination with gemcitabine, topotecan,or liposomal doxorubicin in sequential doublets or triplets (211). The study showed that the addition of any these three drugs to the standard chemotherapy with carboplatin and paclitaxel did not improve progression-free survival or overall survival.