FIRST-LINE CHEMOTHERAPY FOR ADVANCED OVARIAN-CANCER - PACLITAXEL, CISPLATIN AND THE EVIDENCE

As of June 1998, four randomized trials have been completed comparing the combination of paclitaxel and cisplatin with a cisplatin-based con trol arm. The results of three of these trials are available; one has been published as a full paper, the other two in abstract form only. T wo of the reported trials (GOG-111 and the Intergroup trial) provide c lear evidence that cisplatin combined with paclitaxel is a more effect ive regimen than one using the same dose of cisplatin combined with cy clophosphamide. The results of the third reported trial (GOG-132) are rather different, suggesting that a higher dose of single-agent cispla tin may be as effective as the paclitaxel/cisplatin combination tested in the other two trials. A number of explanations for these unexpecte d results have been proposed: false-positive results in GOG-111 and th e Intergroup trial; false-negative results in GOG-132; high crossover in GOG-132 (including crossover before progression); the cyclophospham ide in the control arm of GOG-111 and the Intergroup trial had a negat ive impact on outcome in the control group in these trials; the higher dose of cisplatin when used as a single agent in GOG-132 had a positi ve impact on outcome for the control group in this trial. These explan ations are discussed in detail, and their implications explored.