Role of Docetaxel in the Treatment of Newly Diagnosed Advanced Ovarian Cancer

Docetaxel is currently licensed for use in a variety of malignancies, including breast cancer and lung cancer, and is the preferred taxane in breast cancer treatment. In ovarian cancer, the taxane of choice has historically been paclitaxel; however, there is now substantial evidence that docetaxel also may be the preferred taxane in this disease. Docetaxel has many preclinical advantages over paclitaxel and has been shown to be effective in both platinum- and paclitaxel-resistant disease. Phase I and II studies have shown docetaxel plus carboplatin to be feasible, and the combination is associated with a tolerable adverse-effect profile. The Scottish Randomized Trial in Ovarian Cancer (SCOTROC) trial randomly assigned 1,077 patients with International Federation of Gynecology and Obstetrics stage Ic to IV disease to six cycles of docetaxel plus carboplatin (DC) or paclitaxel plus carboplatin (PC) as primary chemotherapy. Progression-free survival is not statistically different, and to date, no differences are apparent in overall survival. Toxicity differences were evident. There was more myelosuppression with DC but no additional mortality. More neuropathy was present with PC, with more patients stopping paclitaxel because of this toxicity during chemotherapy. Quality-of-life analyses highlighted important differences, all favoring the DC treatment arm. Additional SCOTROC studies using docetaxel are ongoing. These data indicate that docetaxel and carboplatin represent a reasonable first-line option for patients with newly diagnosed epithelial ovarian cancer.