Lay Summary: Taxotere is essentially as effective as Taxol in ovarian cancer.
The combination of paclitaxel and Paraplatin® is the most common chemotherapy regimen for the initial treatment of patients with advanced or metastatic ovarian cancer. The limiting toxicity of this drug combination is neurotoxicity. Although the combination of paclitaxel and Paraplatin® is associated with a high response rate, the majority of women with stage III and IV ovarian cancer ultimately relapse and will need salvage chemotherapy. There is in-vitro evidence to suggest that Taxotere® and paclitaxel are not completely cross resistant and clinical responses to Taxotere® have been observed in patients who have failed Paraplatin® and paclitaxel. The response rate of patients with ovarian cancer who have failed Paraplatin® and paclitaxel and were treated with Taxotere® has been determined in a Gynecologic Oncology Group (GOG) clinical trial. The results of this clinical trial were published in the February 2003 issue of Gynecologic Oncology.
This study involved 60 patients who had disease progression within 6 months of receiving a platinum and paclitaxel-based regimen. Taxotere® was administered at a dose of 100 mg/m2 every 21 days. The response rate was 22.4%, with 5.2% being complete and a median duration of response of 2.5 months. The major dose-limiting toxicity was neutropenia which led to dose reductions in 36% of patients. There was one treatment-related death. Neurotoxicity did not appear to be a major problem. These authors concluded that Taxotere® is active in paclitaxel-resistant ovarian and peritoneal cancer but, in view of significant hematologic toxicity, further study is warranted to ascertain its optimal dose and schedule.
This study is of interest as it confirms previous reports of responses to Taxotere® after failure of paclitaxel-containing regimens. However, the response rates were low and the duration of responses short. There is, however, emerging evidence to suggest that Taxotere® may be a better drug for the initial treatment of ovarian cancer than paclitaxel.
The status of Taxotere® for the treatment of ovarian cancer has been the subject of a recent review by Drs Kaye and Vasey. In this review, they summarized the outcome of a large clinical trial carried out in England and Europe. A total 1,077 newly diagnosed patients with stage Ic-IV ovarian cancer were randomly allocated to be treated with Paraplatin® and Taxotere® or Paraplatin® and paclitaxel. They reported that Patients treated with paclitaxel plus carboplatin experienced significantly greater neurotoxicity than those treated with docetaxel plus carboplatin. Docetaxel/carboplatin and paclitaxel/carboplatin produced similar rates of objective response (66% and 62%, respectively), and initial data on progression-free survival indicate that the two treatments appear very similar in efficacy. This study strongly suggests that Taxotere® may be the best drug to combine with Paraplatin® for the initial treatment of ovarian cancer. NCCN includes both paclitaxel and docetaxel (Taxotere) by referring generically to “taxane”.
1. Rose P, Blessing J, Boll H, et al. A phase II study of docetaxel in paclitaxel-resistant ovarian and peritoneal cancer: A Gynecologic Oncology Study Group study. Gynecologic Oncology. 2003;88:130-135.
2. Kaye S, Vasey P. Docetaxel in ovarian cancer: phase III perspectives and future development. Seminars in Oncology. 2002;29(3 Suppl 12):22-7.
3. NCCB, Ovarian Cancer 2017
4.Robert M. Wenham et al, A phase II trial of docetaxel and bevacizumab in recurrent ovarian cancer within 12 months of prior platinum-based chemotherapy. Gynecologic Oncology Volume 130, Issue 1, July 2013, Pages 19–24