Tolerance of twenty-four hour paclitaxel and carboplatin as first-line therapy in ovarian, peritoneal and fallopian tube carcinoma

A combination of a platinum and taxane are accepted as standard first-line therapy for ovarian cancer. However, both 24-h paclitaxel and cisplatin and 3-h paclitaxel and carboplatin have significant neurotoxicity. The present study was undertaken to determine the toxicity of 24-h paclitaxel and carb oplatin as first-line therapy. Ovarian, peritoneal, and fallopian tubal carcinoma patients treated with 24 -h paclitaxel and carboplatin as first-line therapy were retrospectively re viewed. Paclitaxel was administered at a dose of 135 mg/m(2) as a 24-h infu sion followed by carboplatin at an AUC of 5 every 21 days. Toxicity was gra ded according to NCI Common Toxicity Scale. Fourteen patients with ovarian, peritoneal or tubal carcinoma were studied. Twelve were treated primarily with paclitaxel and carboplatin and two were originally treated with paclitaxel and cisplatin for two cycles but switch ed to paclitaxel and carboplatin for severe cisplatin-associated toxicities . A total of 86 courses were administered (median 6, range 1-9). Hematologi c toxicity was the principal toxicity with neutropenic fever occurring in 8 patients (57%). The duration of neutropenia was brief and no septic deaths occurred. Following paclitaxel dose reduction to 110 mg/m(2) neutropenic s epsis did not recur except in one patient with recurrent C difficile coliti s. The two patients who switched from paclitaxel/cisplatin to paclitaxel/ca rboplatin reported better tolerance of the chemotherapy regimen. Among the 13 patients with ovarian and peritoneal carcinoma 100% achieved a clinical complete response. Although associated with a high incidence of neutropenia, this regimen had rare severe or chronic toxicities in particular neurotoxicity and a high re sponse rate.