**2. Staging**

Following explorative surgery and after histological assessment, the tumor can be formally "staged" according to the size, extent and location of the cancer. Staging during surgery determines the appropriate treatment regimen and the long-term outcome (prognosis).

**3.4. What drug should be combined with platinum (the role of taxane)?**

cline in 1986 due to cardiotoxicity that may outweigh the clinical benefit [5].

Five meta-analyses from 10 trials in 1702 patients compared cyclophosphamide plus cisplatin with cyclophosphamide, cisplatin and doxorubicine (C A P), a modest but significant improvement in survival was seen for the regimen using doxorubicine (overall hazard ratio 0.85, P 1/4 0.003) [5] . Most investigators in the United States abandoned the use of anthracy-

A significant development in the treatment of ovarian cancer was the discovery of the taxane class of cytotoxics. Two randomized controlled trials of first-line cisplatin based dual therapy showed additional clinical benefit when cyclophosphamide was replaced by pacli-

The Gynecological Oncology Group (GOG) 111 trial studied 386 women with stage III suboptimally debulked or stage IV disease [6]. Whereas the intergroup OV10 trial had wider selection criteria and assessed 675 women with FIGO stage IIb, IIc, III or IV disease with or

intervals were 38.5 and 37 months in the OV10 and GOG 111 studies, respectively; the combination of platinum and paclitaxel is more effective with respect to OS and PFS. Hence the

Regimens containing carboplatin and paclitaxel were generally better tolerated than cisplatin plus paclitaxel in three major studies in which the two doublets showed similar efficacity.

The Dutch/Danish study [8], treated 208 patients and Arbeitsgemeinschaft Gyneco-oncology

Patients in both studies had stage IIb, IV and were followed up for a median of 37 months [8]. The GOG 158 trial compared 792 eligible patients with optimal stage III disease given

The final results from AGO, GOG 158 and Dutch/Danish study noted little difference between treatments in the median PFS (the median overall survival was similar between treatment arms in each study), toxicities were mainly as expected, paclitaxel plus carboplatin were bet-

(AGO) study [9] examined 798 patients (3 weekly paclitaxel at 175 or 185 mg/m2

over 24 h added to cisplatin at 75 mg/m2

over 24 h with cisplatin at 75 mg/m2

with paclitaxel 175 mg/m2

over 3 h. The median follow-up

given over

over

every 3 weeks for a total of 6 courses. The same drugs

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with carboplatin AUC 5 or 6 plus the same dose of paclitaxel).

*3.4.1. Anthracycline*

*3.4.2. Paclitaxel*

taxel [6, 7].

without successful debulking surgery [7].

or cyclophosphamide at 750 mg/m2

3 h plus cisplatin at 75 mg/m2

3 hrs added to carboplatin AUC 7.5 [10].

paclitaxel 135 mg/m2

ter tolerated [8–10].

In GOG 111, patients received paclitaxel at 135 mg/m<sup>2</sup>

chemotherapy regimen is based on this combination.

**3.5. Carboplatin as a substitute for cisplatin**

were studied in OV10 and paclitaxel was given at 175 mg/m<sup>2</sup>

Recommendations for treatment after surgery are dependent on the stage of the cancer. Chemotherapy is recommended after surgery for stage III or IV ovarian cancer; certain tumor factors determine its use in stage I or II disease.
