Treatment Outcomes of Paclitaxel for Refractory or Recurrent Epithelial Ovarian Cancer Patients in Thailand

  • Pitakkarnkul, Supakorn (Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis) ;
  • Tangjitgamol, Siriwan (Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis) ;
  • Srijaipracharoen, Sunamchok (Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis) ;
  • Manusirivithaya, Sumonmal (Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis) ;
  • Pataradool, Kamol (Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis) ;
  • Prutthiphongsit, Watchara (Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis) ;
  • Khunnarong, Jakkapan (Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis) ;
  • Thavaramara, Thaovalai (Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis)
  • Published : 2013.04.30


Background: To study the response rate, toxicity profiles, and survival of refractory or recurrent epithelial ovarian cancer (EOC) patients treated with paclitaxel. Materials and Methods: Patients with refractory or recurrent EOC who were treated with paclitaxel between January 2002 and December 2011 at the Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital were identified. Clinicopathological features of the patients including detailed data of paclitaxel treatment were collected. Results: During the study period, a total of 44 patients were identified, with a mean age of $52.9{\pm}8.2$ years. Some 13.6% (six patients) had refractory cancer to first-line chemotherapy while 86.4% (38 patients) had recurrent cancer. Among these, 35 (79.6%) and 9 (20.4%) patients were considered as platinum-sensitive and platinum-resistant, respectively. Three patients (6.8%) received fewer than 2 cycles of paclitaxel due to loss to follow-up, leaving 41 patients evaluable for response. The overall response rate observed in all 41 patients was 41.5% (17 patients; 12 complete and five partial responses): 12.5% or 1/8 patients with refractory or platinum-resistant cancer and 48.5% or 16/33 patients with platinum-sensitive disease. Stable disease was demonstrated in 17.0% (seven patients) while progressive disease was apparent in 41.5% (17 patients). Median time to progress was 4.5 months (range, 0.67-58.6 months). Median progression-free survival was not reached while median overall survival was 16.3 months (95% confidence interval, 11.0 months -21.6 months). Common toxicities were neutropenia, neuropathy, and alopecia. Conclusions: Paclitaxel is an active agent for refractory or recurrent EOC. Neutropenia, neuropathy and alopecia are common side effects.


  1. Alberts DS, Hess LM, Von Hoff DD, Dorr RT (2009). Pharmacology and therapeutics in gynecologic cancer. In 'Principles and Practice of Gynecologic Oncology', Eds Barakat RR, Markman M, Randall ME. Lippincott Williams & Wilkins, Philadelphia, 5th ed, 409-61.
  2. Bookman MA, Brady MF, McGuire WP, et al (2009). Evaluation of new platinum-based treatment regimens in advanced-stage ovarian cancer: a phase III Trial of the gynecologic cancer intergroup. J Clin Oncol, 27, 1419-25.
  3. Browder T, Butterfield CE, Kraling BM, et al (2000). Antiangiogenic scheduling of chemotherapy improves efficacy against experimental drug-resistant cancer. Cancer Res, 60, 1878-86.
  4. Buda A, Floriani I, Rossi R, et al (2004). Randomised controlled trial comparing single agent paclitaxel vs epidoxorubicin plus paclitaxel in patients with advanced ovarian cancer in early progression after platinum-based chemotherapy: An Italian Collaborative Study from the Mario Negri Institute, Milan, G.O.N.O. (Gruppo Oncologico Nord Ovest) group and I.O.R. (Istituto Oncologico Romagnolo) group. Br J Cancer, 90, 2112-7.
  5. Cadron I, Abdulkadir L, Despierre E, et al (2013). The "Leuven" paclitaxel/carboplatin weekly regimen in patients with recurrent ovarian cancer, a retrospective study. Gynecol Oncol, 128, 34-7.
  6. Cannistra SA (2004). Cancer of the ovary. N Engl J Med, 351, 2519-29.
  7. Cantu MG, Buda A, Parma G, et al (2002). Randomized controlled trial of single-agent paclitaxel versus cyclophosphamide, doxorubicin, and cisplatin in patients with recurrent ovarian cancer who responded to first-line platinum-based regimens. J Clin Oncol, 20, 1232-7.
  8. Du Bois A, Luck HJ, Meier W, et al (2003). A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. J Natl Cancer Inst, 95, 1320-9.
  9. Elattar A, Bryant A, Winter-Roach BA, Hatem M, Naik R (2011). Optimal primary surgical treatment for advanced epithelial ovarian cancer. Cochrane Database of Syst Rev, 8, 7565.
  10. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: Globocan 2008. Int J Cancer, 127, 2893-917.
  11. Ghamande S, Lele S, Marchetti D, Baker T, Odunsi K (2003). Weekly paclitaxel in patients with recurrent or persistent advanced ovarian cancer. Int J Gynecol Cancer, 13, 142-7.
  12. Gordon AN, Fleagle JT, Guthrie D, et al (2001). Recurrent epithelial ovarian carcinoma: a randomized phase III study of pegylated liposomal doxorubicin versus topotecan. J Clin Oncol, 19, 3312-22.
  13. Guminski AD, Harnett PR, DeFazio A (2001). Carboplatin and paclitaxel interact antagonistically in a megakaryoblast cell line-a potential mechanism for paclitaxel-mediated sparing of carboplatin-induced thrombocytopenia. Cancer Chemother Pharmacol, 48, 229-34.
  14. Havrilesky LJ, Alvarez AA, Sayer RA, et al (2003). Weekly lowdose carboplatin and paclitaxel in the treatment of recurrent ovarian and peritoneal cancer. Gynecol Oncol, 88, 51-7.
  15. Katsumata N, Yasuda M, Takahashi F, et al (2009). Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial. Lancet, 374, 1331-8.
  16. Kita T, Kikuchi Y, Takano M, et al (2004). The effect of single weekly paclitaxel in heavily pretreated patients with recurrent or persistent advanced ovarian cancer. Gynecol Oncol, 92, 813-8.
  17. Linch M, Stavridi F, Hook J, et al (2008). Experience in a UK cancer centre of weekly paclitaxel in the treatment of relapsed ovarian and primary peritoneal cancer. Gynecol Oncol, 109, 27-32.
  18. Lund B, Hansen OP, Theilade K, Hansen M, Neijt JP (1994). Phase II study of gemcitabine (2',2'-difluorodeoxycytidine) in previously treated ovarian cancer patients. J Natl Cancer Inst, 86, 1530-3.
  19. Markman M, Blessing J, Rubin SC, et al (2006). Phase II trial of weekly paclitaxel (80 mg/m2) in platinum and paclitaxel-resistant ovarian and primary peritoneal cancers: a gynecologic oncology group study. Gynecol Oncol, 101, 436-40.
  20. Markman M, Hall J, Spitz D, et al (2002). Phase II trial of weekly single-agent paclitaxel in platinum/paclitaxel-refractory ovarian cancer. J Clin Oncol, 20, 2365-9.
  21. McGuire WP, Rowinsky EK, Rosenshein NB, et al (1989). Taxol: A unique antineoplastic agent with significant activity in advanced ovarian epithelial neoplasms. Ann Intern Med, 111, 273-9.
  22. Miller KD, Sweeney CJ, Sledge GW Jr (2001). Redefining the target: chemotherapeutics as antiangiogenics. J Clin Oncol, 19, 1195-206.
  23. Muggia FM, Braly PS, Brady MF, et al (2000). Phase III randomized study of cisplatin versus paclitaxel versus cisplatin and paclitaxel in patients with suboptimal stage III or IV ovarian cancer: a gynecologic oncology group study. J Clin Oncol, 18, 106-15.
  24. Parmar MK, Ledermann JA, Colombo N, et al (2003). Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: The ICON4/AGO-OVAR-2.2 trial. Lancet, 361, 2099-106.
  25. Pfisterer J, Plante M, Vergote I, et al (2006). Gemcitabine/ carboplatin vs. carboplatin in platinum sensitive recurrent ovarian cancer: results of a Gynecologic Cancer Intergroup randomized phase III trial of the AGOOVAR, the NCIC CTG and the EORTC GCG. J Clin Oncol, 24, 4699-707.
  26. Piccart MJ, Bertelsen K, James K, et al (2000). Randomized Intergroup trial of cisplatin-paclitaxel versus cisplatincyclophosphamide in women with advanced epithelial ovarian cancer: three-year results. J Natl Cancer Inst, 92, 699-708.
  27. Piccart MJ, Green JA, Lacave AJ, et al (2000). Oxaliplatin or paclitaxel in patients with platinum-pretreated advanced ovarian cancer: a randomized phase II study of the European organization for research and treatment of cancer gynecology group. J Clin Oncol, 18, 1193-202.
  28. Pujade-Lauraine E, Wagner U, Aavall-Lundqvist E, et al (2010). Pegylated liposomal doxorubicin and carboplatin compared with paclitaxel and carboplatin for patients with platinumsensitive ovarian cancer in late relapse. J Clin Oncol, 28, 3323-9.
  29. Rose PG, Blessing JA, Mayer AR, Homesley HD (1998). Prolonged oral etoposide as second-line therapy for platinumresistant and platinum-sensitive ovarian carcinoma: a gynecologic oncology group study. J Clin Oncol, 16, 405-10.
  30. Rosenberg P, Andersson H, Boman K, et al (2002). Randomized trial of single agent paclitaxel given weekly versus every three weeks and with peroral versus intravenous steroid premedication to patients with ovarian cancer previously treated with platinum. Acta Oncol, 41, 418-24.
  31. Sharma R, Graham J, Mitchell H, et al (2009). Extended weekly dose-dense paclitaxel/carboplatin is feasible and active in heavily pre-treated platinum-resistant recurrent ovarian cancer. Br J Cancer, 100, 707-12.
  32. Stuart GC, Kitchener H, Bacon M, et al (2011). 2010 Gynecologic Cancer InterGroup (GCIG) consensus statement on clinical trials in ovarian cancer: report from the fourth ovarian cancer consensus conference. Int J Gynecol Cancer, 21, 750-5.
  33. Swenerton K, Muss HB, Robinson E (1998). Salvage chemotherapy for refractory disease in ovarian cancer. In 'Ovarian cancer: controversies in management', Eds Gershenson DM, McGuire WP. Churchill Livingstone, NY, 169-94.
  34. Tangjitgamol S, Mamusirinitaya S, Leelahakorn S, et al (2005). Efficacy of platinum plus cyclophosphamide in patients with epithelial ovarian cancer. J Med Assoc Thai, 88, 1172-81.
  35. Ten Bokkel Huinink W, Gore M, Carmichael J, et al (1997). Topotecan versus paclitaxel for the treatment of recurrent epithelial ovarian cancer. J Clin Oncol, 15, 2183-93.
  36. Ten Bokkel Huinink W, Lane SR, Ross GA (2004). Long-term survival in a phase III, randomised study of topotecan versus paclitaxel in advanced epithelial ovarian carcinoma. Ann Oncol, 15, 100-3.
  37. Thigpen JT, Blessing JA, Ball H, Hummel SJ, Barrett RJ (1994). Phase II trial of paclitaxel in patients with progressive ovarian carcinoma after platinum-based chemotherapy: a gynecologic oncology group study. J Clin Oncol, 12, 1748-53.
  38. Thigpen JT, Vance RB, Khansur T (1993). Second-line chemotherapy for recurrent carcinoma of the ovary. Cancer, 71, 1559-64.
  39. Thirapakawong C, Senapad S, Padungsutt P, et al (2001). Phase II study of weekly paclitaxel (Taxol) as a second line chemotherapy in refractory epithelial ovarian cancer (EOC): a multicenter study. Proc Am Soc Clin Oncol, 20, 2506.
  40. Trimble EL, Adams JD, Vena D, et al (1993). Paclitaxel for platinum-refractory ovarian cancer: Results from the first 1,000 patients registered to National Cancer Institute Treatment Referral Center 9103. J Clin Oncol, 11, 2405-10.
  41. Ushijima K (2010). Treatment for Recurrent Ovarian Cancer-At First Relapse. J Oncol, 497429.
  42. World Health Organization (WHO) (2005). WHO Toxicity Criteria published August 2005.

Cited by

  1. Treatment Outcomes of Gemcitabine in Refractory or Recurrent Epithelial Ovarian Cancer Patients vol.15, pp.13, 2014,
  2. Clinical Study on Carboplatin for Treating Pediatric Patients with Wilms Tumors vol.15, pp.17, 2014,
  3. Overexpression of TRPM7 is Associated with Poor Prognosis in Human Ovarian Carcinoma vol.15, pp.9, 2014,
  4. Elevated Preoperative Platelet to Lymphocyte Ratio Associated with Decreased Survival of Women with Ovarian Clear Cell Carcinoma vol.15, pp.24, 2015,
  5. Effect of Paclitaxel-loaded Nanoparticles on the Viability of Human Hepatocellular Carcinoma HepG2 Cells vol.16, pp.5, 2015,
  6. Prognostic Factors of Early Stage Epithelial Ovarian Carcinoma vol.16, pp.4, 2019,