Docetaxel and Carboplatin as Salvage Therapy for First-Relapsed, Platinum-Sensitive, Stage III/IV Advanced Ovarian Cancer

Background

The optimal therapy to treat relapsed, platinum-sensitive ovarian cancer remains elusive. Because most patients receive initial therapy with paclitaxel and platinum, there is a lack of cross-reaction of docetaxel and paclitaxel and retreatment with platinum is standard of care; we evaluated the toxicity and efficacy of docetaxel and carboplatin as salvage therapy for relapsed, platinum-sensitive ovarian cancer.

Materials and Methods

This phase II study treated the first-relapsed, platinum-sensitive, stage III/IV ovarian cancer patients with docetaxel 80 mg/m² intravenous (IV) over 60 minutes followed by carboplatin area under the curve 6 IV over 30 minutes every 21 days, for 6 cycles. End points were toxicity, response rates, relapse rates, event-free survival, and survival rates.

Results

Thirty-six patients were enrolled and 35 were evaluable. Twenty-three percent of patients were age ≥ 70 years. A total of 170 cycles of therapy were given. Ten patients required dose reduction. Thirty-eight percent had a delay in starting subsequent planned cycles. Most delays were due to hematologic recovery. Hematologic toxicity was most common and significant; 77% grade 4 neutropenia. One patient died from typhilitis. Total complete remission (38%) and partial remission (27%) rate was 65%. Median time to progression was 261 days (60-717). Five (14%) patients remain alive without ovarian cancer, with median follow-up of 5.1 years. Patients who entered the study with ≥ 12-month duration of initial remission had best response.

Conclusion

The combination of docetaxel and carboplatin has toxicity, especially hematologic, and requires growth factor support and close monitoring for infections. Its role for treating ovarian cancer patients was better in patients in whom initial response to therapy was ≥ 12 months.