Treatment of advanced ovarian cancer (AOC). From platinum compound to taxol: an Indian experience

Abstract

From Jan. '91 patients with AOC have been treated with P (400 mg/m² Q 4 W × 6) and cyclophosphamide (C) (600 mg/m² Q 4 W × 6). Between Jan. '91-Oct. '94 19 patients with AOC (St. III C = 15, St IV = 4) median age 53 yrs (36-73) were treated with PC Protocol. 15/19 had primary debulking, of which 5 were suboptimal. 4/19 received PC primum only ¼ subsequently had suboptimal interval debulking, 3 progressed on therapy. Median Progression free interval for the group is 8 mths (1-47 range). There was no neurotoxicity, nephrotoxicity, Myelosuppression was minimal (gr I-II). PC although standard and well tolerated treatment survival remains suboptimal. Taxol (T) has been identified as an active agent in salvage therapy in AOC. T is being indigenously manufactured in India (Inlaxel, Dabur India ltd.) and available for use since Nov. '94. We have treated so far 2 patients of AOC primarily with P (300 mg/m² Q 4 W × 6) and T (135 mg/m² escalated to 175 mg/m² Q 4 W × 6). T is given as 3 hrs infusion followed by 1 hr infusion of P with premedication. The toxicity of TP is acceptable in the above doses. No cardiotoxicity, nausea gr I-II, myelosuppression gr I-II, arthralgia and myalgia managable with mild analgesic and mild autonomic disturbances were observed. We intend to escalate further the dose of T till such point where myelosuppression is manageable without support of growth factors, the target being higher dose intensity for better survival advantage. The data will be updated till Sep. '95 & discussed.