Sequential chemotherapy with carboplatin followed by weekly paclitaxel in advanced ovarian cancer: Results of a multicenter phase II study of the northeastern German society of gynecological oncology

BackgroundFor the adjuvant setting of advanced ovarian cancer (AOC) after primary radical surgery the combination of paclitaxel and platinum in a 3-week schedule has emerged as the current standard. In preclinical studies additional anti-angiogenic effects of low dose paclitaxel infusion were demonstrated. A sequential schedule of carboplatin and paclitaxel has the potential to improve the therapeutic index.MethodsIn this multicenter phase II trial four cycles of carboplatin at a dose of AUC 5 (d1/q21d) followed by 12 cycles of weekly paclitaxel at a dose of 80 mg/m2 (d1/q7d) were applied after primary radical surgery. Eligible were all optimally or sub-optimally debulked patients with FIGO IA–IV ovarian cancer. All patients with hemoglobin levels  < 12 mg/dl received erythropoietin additionally.ResultsBetween July 2003 and May 2005, 105 patients from 27 institutions were enrolled. The median age was 60 years (range: 23–80 years). A median number of 16 courses (range 1–16) were applied. The incidence of non-hematological toxicities was very low. Only 41% of patients experienced alopecia (grade 1–2). Neurotoxicity (grade 3—4) was not observed. Grade 3–4 hematological toxicity (43% of all patients) included thrombocytopenia (17%), anemia (3%), leucopenia (23%), and neutropenic fever (0%).Ninety-seven percent received erythropoietin. Thromboembolic events (4%) were not increased in patients who received erythropoietin. After a median time of 23 months (range: 1–42 months) 32 patients had died, and the median overall survival was not reached. The progression-free survival was 25.4 months (95% CI: 18.8–40+).ConclusionThese results suggest that this sequential regimen using weekly paclitaxel represents an efficacious and well-tolerated regimen. A randomized study comparing this new schedule with the conventional 3-week protocol is warranted.