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

Rose PG, Fusco N, Fluellen L, Rodriguiz M. 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 carboplatin as first-line therapy. Ovarian, peritoneal, and fallopian tubal carcinoma patients treated with 24-h paclitaxel and carboplatin as first-line therapy were retrospectively reviewed. Paclitaxel was administered at a dose of 135 mg/m2 as a 24-h infusion followed by carboplatin at an AUC of 5 every 21 days. Toxicity was graded 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 switched to paclitaxel and carboplatin for severe cisplatin-associated toxicities. A total of 86 courses were administered (median 6, range 1-9). Hematologic 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/m2 neutropenic sepsis did not recur except in one patient with recurrent C. difficile colitis. The two patients who switched from paclitaxel/cisplatin to paclitaxel/carboplatin 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 response rate.