Paclitaxel/Cisplatin Improves Survival In Advanced Ovarian Cancer

LOS ANGELES--Using paclitaxel (Taxol) rather than cyclophosphamidein combination with cisplatin (Platinol) significantly increasesboth progression-free and overall survival in patients with advancedovarian cancer, William P. McGuire, MD, said in his presentationat the plenary session of ASCO.

Two years ago, Dr. McGuire presented preliminary data from thisrandomized Gynecologic Oncology Group study showing that paclitaxel/cisplatinproduced better response rates than cyclophosphamide/cisplatinin 386 patients with optimally debulked stage III and IV disease.Now the mature data, with a median follow-up of 38 months, showa 13-month survival advantage for the paclitaxel-treated patients.

"The combination of Taxol and cis-platin should now becomethe standard to which other therapies should be compared in advancedovarian carcinoma, particularly those patients with suboptimalstage III and IV disease," said Dr. McGuire, professor ofmedicine, Winship Cancer Center of Emory University.

Median progression-free survival in the paclitaxel patients was5 months longer than with standard therapy, with a relative riskof .66, meaning a reduction of approximately one third in therisk of progression. The 13-month paclitaxel advantage in medianoverall survival gave a relative risk of .61 and was highly statisticallysignificant (P less than.0001).

The overall clinical response was significantly higher in thepaclitaxel arm (73% vs 60% for standard therapy).

Although grade 4 neutropenia and leukopenia were significantlymore common in the paclitaxel arm, the overall incidence of febrileneutropenia was relatively small. "This is due, in largepart, to the relatively brief period of neutropenia that is inducedby the Taxol/cisplatin combination," Dr. McGuire said.

Alopecia, allergic reactions, and cardiac events were also morecommon in the experimental arm, but did not appear to be clinicallysignificant. However, the bottom line in regard to toxicities,Dr. McGuire said, is that in the later courses of cyclophosphamide/cisplatin,there were treatment delays due to chronic and cumulative hematologictoxicity. "We were able to give therapy more efficientlywith Taxol/cisplatin," he said.

At a press conference, Dr. McGuire was asked if the cost of paclitaxelwould hinder its use in this setting. He responded that usingpaclitaxel in place of cyclophosphamide adds between $16,000 and$24,000 to the cost of treatment. This expense is similar to thatof other common life-saving measures such as the addition of seatbelts to cars, which costs about $25,000 per year of life saved.