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International Study Suggests Carboplatin Could Be First-line Chemotherapy Drug For Ovarian Cancer

August 14, 2002

Results of an international study in this week's issue of THE LANCET suggest that the drug carboplatin could become a first-line chemotherapeutic agent for the treatment of ovarian cancer. Carboplatin was found to be less toxic, although it had no overall survival benefit, compared with other drugs assessed in the study.

Ovarian cancer is the sixth most common cancer of women worldwide; around 165,000 people are diagnosed with the disease every year, and five-year survival for women with advanced disease is only around 30%. Treatment involves surgery (eg. total hysterectomy or removal of the ovaries) and postoperative chemotherapy.

Previous research has shown that both combinations of the chemotherapeutic drugs cyclophosphamide, doxorubicin, and cisplatin ( known as CAP) and use of carboplatin produce similar survival and progression-free survival rates. More recently, the taxane paclitaxel combined with carboplatin has become a widely accepted treatment for the disease. The International Collaborative Ovarian Neoplasm (ICON) Collaborators, led by Peter Harper, consultant medical oncologist at Guy`s Hospital in London, and Nicoletta Colombo, Associate Professor in Obstetrics and Gynaecology at the European Institute of Oncology in Milan, Italy, aimed to compare the safety and efficacy of paclitaxel plus carboplatin with a control of either CAP or carboplatin alone. The trial was coordinated by the MRC Clinical Trials Unit, London, UK.

2074 women with ovarian cancer from 130 centres in eight countries were randomly assigned paclitaxel plus carboplatin or control, the control (CAP or single-agent carboplatin) being chosen by the patients' physician before randomisation. Average follow-up was just over four years; the average survival (around three years) and average time to disease recurrence (around a year and a half) was similar among all women studied. Those given paclitaxel plus carboplatin had more serious side effects such as alopecia (hair loss), fever, and sensory neuropathy (loss of sensation in the skin) than other treatments.

Peter Harper comments: "The results of ICON3 suggest that, up to 5 years from treatment, single-agent carboplatin, CAP, and paclitaxel plus carboplatin are all safe and show similar effectiveness as first-line treatments for women requiring chemotherapy for ovarian cancer. Of these three treatments, carboplatin might be regarded as the preferred treatment because of its better toxicity profile."

In an accompanying Commentary (p 500), Martin Tattersall from Sydney University, Australia, refers to previous research which illustrated how patients with advanced ovarian cancer predominantly opted for chemotherapy which offered marginal survival benefit, rather than treatment which could provide better quality of life because of reduced toxicity. He concludes: "The proportion of women with advanced ovarian cancer who have a normal life expectancy remains low despite claims of major progress in treatment in the past few years.13,14 The creation and nurturing of large collaborative clinical trial groups in ovarian cancer will facilitate rapid accrual of the numbers of patients required to document improved outcomes which are possible with the treatment approaches now under evaluation."

Lancet