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Taxol: A Unique Antineoplastic Agent with Significant Activity in Advanced Ovarian Epithelial Neoplasms

William P. McGuire, MD; Eric K. Rowinsky, MD; Neil B. Rosenshein, MD; Francis C. Grumbine, MD; David S. Ettinger, MD; Deborah K. Armstrong, MD; and Ross C. Donehower, MD
[+] Article, Author, and Disclosure Information

Current Author Addresses: Drs. McGuire, Rowinsky, Ettinger, Armstrong, and Donehower: The Johns Hopkins Oncology Center, 600 N. Wolfe Street, Baltimore, MD 21205.

Dr. Rosenshein: 550 N. Broadway, Room 1002, Baltimore, MD 21205.

Dr. Grumbine: Greater Baltimore Medical Center, Department of Obstetrics and Gynecology, 6701 N. Charles Street, Towson, MD 21204.

Grant Support: Supported in part by National Cancer Institute contract NOl-CM-47663.

Requests for Reprints: William P. McGuire, MD, The Johns Hopkins Oncology Center, 600 N. Wolfe Street, Baltimore, MD 21205.

©1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;111(4):273-279. doi:10.7326/0003-4819-111-4-273
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Study Objective: To assess the activity of taxol in patients with advanced, progressive, and drug-refractory ovarian cancer and to delineate more clearly the toxicity of taxol in this patient population.

Design: Nonrandomized, prospective phase II trial.

Patients: Forty-seven patients with drug-refractory epithelial ovarian cancer who had one or more lesions measurable in perpendicular diameters. Of these patients, 45 were evaluable for toxicity and 40 were evaluable for response.

Interventions: Patients were treated every 22 days with varying doses of taxol (110 to 250 mg/m2 body surface) given as a 24-hour infusion with subsequent doses based on adverse effects. A premedication regimen was used to avoid acute hypersensitivity reactions.

Measurements and Main Results: Twelve patients (30%; CI, 16% to 44%) responded to taxol for periods lasting from 3 to 15 months. The dose-limiting toxicity was myelosuppression with leukocytes affected more severely and commonly than thrombocytes or reticulocytes. Leukopenia was usually brief in duration but was associated with sepsis in 3 cases (2 fatal). Other adverse effects included myalgias, arthralgias, alopecia, diarrhea, nausea, vomiting, mucositis, and peripheral neuropathy. Rare cases of cardiac and central neurotoxicity were also noted.

Conclusions: Taxol is an active agent in drug-refractory ovarian cancer and deserves further study in combination with other active drugs in previously untreated patients with advanced ovarian cancer.





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