All about Taxol
Most women with ovarian cancer require chemotherapy, although very early cancer may be cured by surgery alone.
The main chemotherapy drugs are the so-called platinums: cisplatin and carboplatin. Until recently, standard chemotherapy in the UK consisted of carboplatin alone, although in the USA and many parts of Europe cisplatin or carboplatin were often given in combination with other drugs. A large analysis of all the important trials performed in the 1970s and 1980s showed that there was little to choose between "single agent platinum therapy" (cisplatin or carboplatin used alone) and combination treatment utilising one of these platinum agents along with other drugs (such as cyclophosphamide).
Two large recently reported trials have resulted in a new standard of treatment being set for ovarian cancer. These trials were very important as they used a new drug, Taxol, along with cisplatin and compared this with cisplatin and cyclophosphamide. Platinum drugs are still the most important chemotherapy compounds but these two trials have shown that when they are given with Taxol survival is improved compared to treatment with previous standard chemotherapy.
The two trials that have shown this benefit used cisplatin and not carboplatin with paclitaxel and currently there is a debate as to whether or not carboplatin can be substituted for cisplatin in this new treatment. The reason for the debate is that, although carboplatin and cisplatin have previously been shown to be equally effective, these trials were performed before the introduction of Taxol. Carboplatin plus Taxol is better tolerated than cisplatin plus Taxol, but it remains to be seen whether or not it is as effective.
The main problem with combining Taxol with carboplatin is that the treatment becomes associated with more side effects than when carboplatin is used on its own. These side effects include pins and needles of the fingers and feet but this is usually reversible, occasional muscle aches during treatment and, more importantly, hair loss. These effects can make the treatment less acceptable to the elderly and frail.
Women need to choose whether or not they would rather:
- stick to the old standard treatment of carboplatin given alone, with its good record of tolerability
- or go for the new standard combination of a platinum drug with Taxol, with its survival advantage but slight increase in side effects. It is important that the severity of the increased toxicity is not exaggerated because the side effects are usually manageable and the treatment is perfectly acceptable, with most patients being treated on an out-patient basis.
Dr Martin Gore
London
If you would like to receive a copy of Ovacome’s leaflet entitled Paclitaxel Chemotherapy or a copy of the Journal of Clinical Oncology's consensus statement on the role of Taxol, please call the Ovacome office.
