NEW ORLEANS--In combination with cisplatin (Platinol) for treatment
of gynecologic malignancies, 3-hour infu-sional paclitaxel (Taxol)
might be easier to administer but it produces more peripheral
neuropathy than the standard 24-hour infusion, a Cleveland Clinic
"The incidence of neurological side effects is excessive,"
Maurie Markman, MD, reported at the Society of Gynecologic Oncologists
meeting. "This is likely the result of high peak concentrations
of two neurotoxic agents reaching the peripheral nerves at the
same time. We recommend against its use."
The study examined 38 patients with ovarian, primary peritoneal,
and endometrial malignancies, who received cis-platin (75 mg/m²)
and a 3-hour infusion of paclitaxel (135 or 175 mg/m²). Therapy
had to be modified in 42% of patients.
The regimen was quite active, producing a 90% reduction in CA
125 levels over pretreatment levels in 23 patients (70%). However,
27 patients (71%) developed neurological toxicity, which was severe
in several cases. Sixteen patients (42%) experienced grade 2 or
greater peripheral neuropathy; 21% of these had grade 3 or 4 neuropathy.
In contrast, patients receiving pacli-taxel over 24 hours and
the same dose of cisplatin in the Gynecologic Oncology Group ovarian
cancer protocol had only a 13% incidence of grade 2 or greater
peripheral neuropathy, said William McGuire III, MD, of Emory
University. "The message is that changing the schedule of
administration significantly changes the toxicity," he said.