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Docetaxel and Cisplatin in Combination as First-Line Chemotherapy for Advanced Epithelial Ovarian Cancer

From the Cancer Research Campaign Department of Medical Oncology, Beatson Oncology Centre, Western Infirmary, Glasgow; Belfast City Hospital, Belfast; Bristol Oncology Centre, Bristol; Airedale General Hospital, Steeton, West Yorkshire; Weston Park Hospital, Sheffield; Hammersmith Hospital, London; Stobhill Hospital, Springburn, Glasgow, United Kingdom; and Rhône-Poulenc Rorer, Antony, France.

Address reprint requests to Paul A. Vasey, MD, CRC Department of Medical Oncology, Beatson Oncology Centre, Western Infirmary, Glasgow G11 6NT, United Kingdom; email pav1y{at}clinmed.gla.ac.uk

PURPOSE: A prospective, nonrandomized, multicenter, open feasibility study of cisplatin and docetaxel as first-line chemotherapy in International Federation of Gynecology and Obstetrics (FIGO) stage IC-IV epithelial ovarian cancer was conducted. The primary end point was the incidence of severe fluid retention that necessitated treatment withdrawal.

PATIENTS AND METHODS: Cisplatin and docetaxel were administered every 3 weeks for six planned cycles, with a 5-day prophylactic dexamethasone regimen (8 mg two times per day). One hundred patients (median age, 53 years; range, 24 to 71 years) received a total of 512 cycles of chemotherapy in two cohorts: cohort 1, 49 patients, 258 cycles (cisplatin 75 mg/m² and docetaxel 75 mg/m²); cohort 2, 51 patients, 254 cycles (cisplatin 75 mg/m² and docetaxel 85 mg/m²).

RESULTS: No patients were taken off study because of fluid retention. Sixty-six patients completed six cycles of protocol therapy; 16 stopped early because of toxicity (neurotoxicity in six patients, nephrotoxicity in three, neutropenia in two, and hypersensitivity, diarrhea and vomiting, skin rash, clinical deterioration, and patient's wishes in one patient each). Grade 3/4 neutropenia was observed in more than 75% of patients and seemed to be cumulative. Patients in cohort 2 had significantly more severe neutropenia and lethargy than those in cohort 1. In addition, there were five treatment-related deaths in cohort 2 (three neutropenia and two upper gastrointestinal hemorrhage). Neurotoxicity (mainly sensory, > grade 1) was observed in 23 patients. The overall clinical response rate was 69% (complete response, 38%; partial response, 31%); CA-125 response rate was 73%. Median progression-free survival for the group was 12 months.

CONCLUSION: Cisplatin and docetaxel can be administered at doses of 75 mg/m² and 75 mg/m², respectively, every 3 weeks, and the utility of this regimen is not limited by fluid retention. However, 33 of 100 patients were unable to complete the planned six cycles, which may explain, in part, the poor overall progression-free survival. Increasing the docetaxel dose to 85 mg/m² adds unacceptable hematologic toxicity and potential risks to the patient.

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