First line chemotherapy with carboplatin plus paclitaxel in advanced ovarian cancer - a new standard of care?

Cisplatin 75 mg/m(2) plus paclitaxel 135 mg/m(2) administered over 24 hours have been established as the standard treatment for advanced ovarian cance r. This schedule can not be administered in an outpatient setting. A Europe an-Canadian trial confirmed the superiority of cisplatin-paclitaxel, but fa iled to improve the therapeutic index of this combination by reducing infus ion length of paclitaxel from 24 to 3 hours. The reduction of infusion dura tion combined with a dose escalation of paclitaxel from 135 mg/m(2) to 175 mg/m(2) induced a high rate of neurotoxicity. A further attempt to improve the therapeutic index of platinum-taxane combi nations was started with the substitution of cisplatin by carboplatin. At l east 7 phase I/II trials evaluated this combination. The promising results of these studies led to the initiation of 5 randomised phase III trials wit h carboplatin plus paclitaxel administered in 3-hours. Two of these trials have completed accrual and preliminary data were available for this review. Although long-term survival data are not available, the current results wa rrant the conclusion that the combination of carboplatin AUC 5 - 6 plus pac litaxel 175 mg/m(2) in a 3-hours infusion can be regarded as an alternative for the first-line treatment in patients with advanced ovarian cancer. Fin al analysis of the above mentioned phase III trials with longer follow-up i s awaited and will define the ultimate role of this combination.