Review of Dose-intense Platinum and/or Paclitaxel Containing Chemotherapy in Advanced and Recurrent Epithelial Ovarian Cancer

Ovarian cancer is the most lethal gynecological cancer in women in the western world with a 5-year survival of 49.7%. Advanced stage ovarian cancer is treated both surgically and with chemotherapy, but despite initial high response rates of 60- 75%, many women experience disease recurrence with a dismal prognosis, 5 year overall survival for FIGO stage IIIc and IV disease being only 32 and 18%. In an attempt to improve outcome for both primary and recurrent disease, dose-intense and dose-dense chemotherapy regimens have been investigated. This overview summarizes these results in first and second-line treatment. In first-line treatment, no benefit was found of dose-intense regimes in the majority of the studies, only toxicity was increased. However, results are conflicting with the recent Japanese Gynecologic Oncology Group (JGOG) trial showing an improved progression free and overall survival in patients treated with dose-dense weekly paclitaxel combined with standard 3-weekly carboplatin. For recurrent disease dose-dense weekly combination chemotherapy seems to be very effective in patients with platinum-resistant ovarian cancer. Several phase II studies showed an increase in response rate, progression free survival and overall survival for dose-dense paclitaxel and carboplatin, compared to results of nonplatinum chemotherapy. In platinum-sensitive ovarian cancer, on contrary, the results of weekly paclitaxel and carboplatin seem to be comparable with standard 3-weekly regimens.