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Platinum-containing chemotherapy regimens
Source: Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: May 14, 2025 · Captured 2026-09-09.
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Table 8 shows the chemotherapy regimens used in first relapse for the treatment of platinum-sensitive recurrent ovarian cancer.
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| Eligibility (mo since end of initial therapy) | Regimen | No. of Patients | Comparator | Comments on Outcome (mo) |
|---|---|---|---|---|
| HR = hazard ratio; No. = number; OS = overall survival; PFS = progression-free survival; PLD = pegylated liposomal doxorubicin. | ||||
| aTrabectedin has been approved for use in treating recurrent ovarian cancer in Europe and Canada. | ||||
| bOS data were not mature at the time the manuscript was published.[11] | ||||
| cP < .0001. | ||||
| dP = .012. | ||||
| eHR, 0.51; P = .0001. | ||||
| Most Commonly Used | ||||
| Platinum sensitive (>6) | Cisplatin or carboplatin + paclitaxel | 802 | Single-agent nontaxane + platinum agents | PFS 11 vs. 9; OS 24 vs. 19 [5] |
| Platinum sensitive (>6) | Carboplatin + gemcitabine | 356 | Carboplatin | PFS 8.6 vs. 5.8; OS 18 vs. 17 [12] |
| Platinum sensitive (>6) | Carboplatin + PLD | 976 | Carboplatin + paclitaxel | PFS 11.3 vs. 9.4; OS 30.7 vs. 33.0 [13] |
| Other Regimens | ||||
| Platinum sensitive (>6) | Carboplatin + epirubicin | 190 | Carboplatin | Powered for response differences; OS 17 vs. 15 [14] |
| Platinum sensitive (≥12) | Cisplatin + doxorubicin + cyclophosphamide | 97 | Paclitaxel | PFS 15.7 vs. 9; OS 34.7 vs. 25.8 [15] |
| Platinum sensitive + resistant | PLD + trabectedina | 672 | PLD | PFS 7.3 vs. 5.8; OS 20.5 vs. 19.4b |
| Platinum sensitive | Paclitaxel + carboplatin | 674 | Paclitaxel + carboplatin + bevacizumab | PFS 10.4 vs. 13.8c; OS 37.4 vs. 42.2 [7] |
| Platinum sensitive | Carboplatin + PLD + bevacizumab | 682 | Carboplatin + gemcitabine + bevacizumab | PFS 12.4 vs. 11.3d, OS 31.9 vs. 27.8 [16] |
| Platinum sensitive | Carboplatin + paclitaxel or gemcitabine or PLD | 406 | Same doublets + bevacizumab | PFS 8.8 vs. 11.8e, deaths 68 vs. 79, OS 27.1 vs. 26.7 [17] |
Based on improved survival with etoposide or fluorouracil, carboplatin was approved in 1987 for the treatment of patients with ovarian cancer whose disease recurred after treatment with cisplatin.[18] In a randomized phase II trial of paclitaxel, a currently used second-line drug, the cisplatin-containing combination of cisplatin plus doxorubicin plus cyclophosphamide, yielded a superior survival outcome.[15] This study and subsequent studies (see Table 8) have reinforced the use of carboplatin as the treatment core for patients with platinum-sensitive recurrences. Cisplatin is occasionally used, particularly in combination with other drugs, because of its lesser myelosuppression, but this advantage over carboplatin is counterbalanced by greater patient intolerance.
Oxaliplatin, initially introduced with the hope that it would overcome platinum resistance, has activity mostly in platinum-sensitive patients [19] but has not been compared with carboplatin alone or in combinations.
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With all platinum agents, outcome is generally better the longer the initial interval without recurrence from the initial platinum-containing regimens.[20] Therefore, on occasion, patients with platinum-sensitive recurrences relapsing within 1 year have been included in trials of nonplatinum drugs. In one such trial, comparing the pegylated liposomal doxorubicin to topotecan, the subset of patients who were platinum sensitive had better outcomes with either drug (and in particular with pegylated liposomal doxorubicin) relative to the platinum-resistant cohort.[21]
Several randomized trials have addressed whether the use of a platinum in combination with other chemotherapy agents is superior to single agents (see Table 8).
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Evidence (platinum in combination with other chemotherapy agents):
In an analysis of data examining jointly the results of trials performed by the MRC/Arbeitsgemeinschaft Gynaekologische Onkologie (MRC/AGO) and the International Collaborative Ovarian Neoplasm (ICON) investigators (ICON4), the following results were observed:[5,14][Level of evidence A1]
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In an analysis of data examining jointly the results of trials performed by the MRC/Arbeitsgemeinschaft Gynaekologische Onkologie (MRC/AGO) and the International Collaborative Ovarian Neoplasm (ICON) investigators (ICON4), the following results were observed:[5,14][Level of evidence A1]
A platinum-plus-paclitaxel combination yielded superior response rates, progression-free survival (PFS), and overall survival (OS), compared with carboplatin as a single agent or other platinum-containing combinations as controls.
In an analysis of data examining jointly the results of trials performed by the MRC/Arbeitsgemeinschaft Gynaekologische Onkologie (MRC/AGO) and the International Collaborative Ovarian Neoplasm (ICON) investigators (ICON4), the following results were observed:[5,14][Level of evidence A1]
Platinum plus paclitaxel was compared with several control regimens, although 71% used carboplatin as a single agent in the control, and 80% used carboplatin plus paclitaxel. Prolonged PFS (HR, 0.76; 95% CI, 0.66–0.89; P = .004) and OS (HR, 0.82; 95% CI, 0.69–0.97; P = .023) were improved in the platinum-plus-paclitaxel arm.[14]; [5][Level of evidence A1]
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In an analysis of data examining jointly the results of trials performed by the MRC/Arbeitsgemeinschaft Gynaekologische Onkologie (MRC/AGO) and the International Collaborative Ovarian Neoplasm (ICON) investigators (ICON4), the following results were observed:[5,14][Level of evidence A1]
The AGO had previously compared the combination of epirubicin plus carboplatin with carboplatin alone and had not found significant differences in outcome.
In an analysis of data examining jointly the results of trials performed by the MRC/Arbeitsgemeinschaft Gynaekologische Onkologie (MRC/AGO) and the International Collaborative Ovarian Neoplasm (ICON) investigators (ICON4), the following results were observed:[5,14][Level of evidence A1]
A meta-analysis of five trials (three of which are in Table 8), with four reviewing independent patient data, supports the use of platinum agents in combination with other active agents rather than carboplatin alone for patients with platinum-sensitive recurrent ovarian cancer.[22]
Another trial by European and Canadian groups compared gemcitabine plus carboplatin with carboplatin.
Another trial by European and Canadian groups compared gemcitabine plus carboplatin with carboplatin.
The PFS of 8.6 months with the combination was significantly superior to 5.8 months for the carboplatin alone (HR, 0.72; 95% CI, 0.58–0.90; P = .003).[12][Level of evidence B1]
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Another trial by European and Canadian groups compared gemcitabine plus carboplatin with carboplatin.
The study was not powered to detect significant differences in OS, and the median survival for both arms was 18 months (HR, 0.96; CI, 0.75–1.23; P = .73).
In a phase III trial, carboplatin plus pegylated liposomal doxorubicin was compared with carboplatin plus paclitaxel in patients with platinum-sensitive recurrence (>6 months). The primary end point was PFS. Given its toxicity profile and noninferiority to the standard regimen, carboplatin plus pegylated liposomal doxorubicin is an important option for patients with platinum-sensitive recurrence.
In a phase III trial, carboplatin plus pegylated liposomal doxorubicin was compared with carboplatin plus paclitaxel in patients with platinum-sensitive recurrence (>6 months). The primary end point was PFS. Given its toxicity profile and noninferiority to the standard regimen, carboplatin plus pegylated liposomal doxorubicin is an important option for patients with platinum-sensitive recurrence.
The median PFS for the carboplatin-plus-pegylated-liposomal-doxorubicin arm was 11.3 months versus 9.4 months for the carboplatin-plus-paclitaxel arm (HR, 0.823; 95% CI, 0.72–0.94; P = .005).[23][Level of evidence B1]
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In a phase III trial, carboplatin plus pegylated liposomal doxorubicin was compared with carboplatin plus paclitaxel in patients with platinum-sensitive recurrence (>6 months). The primary end point was PFS. Given its toxicity profile and noninferiority to the standard regimen, carboplatin plus pegylated liposomal doxorubicin is an important option for patients with platinum-sensitive recurrence.
Long-term follow-up revealed no difference in OS rates between the two arms (30.7 months for carboplatin plus pegylated liposomal doxorubicin vs. 33.0 months for carboplatin plus paclitaxel).[13]
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In a phase III trial, carboplatin plus pegylated liposomal doxorubicin was compared with carboplatin plus paclitaxel in patients with platinum-sensitive recurrence (>6 months). The primary end point was PFS. Given its toxicity profile and noninferiority to the standard regimen, carboplatin plus pegylated liposomal doxorubicin is an important option for patients with platinum-sensitive recurrence.
The carboplatin-plus-paclitaxel arm was associated with increased severe neutropenia, alopecia, neuropathy, and allergic reaction. The carboplatin-plus-pegylated-liposomal-doxorubicin arm was associated with increased severe thrombocytopenia, nausea, and hand-foot syndrome.
Carboplatin plus paclitaxel has been considered the standard regimen for platinum-sensitive recurrence in the absence of residual neurological toxic effects. The GOG-0213 trial is comparing this regimen with the experimental arm that adds bevacizumab to carboplatin plus paclitaxel.
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Studies cited in this source section
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Publication references
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Preserved source evidence · Not medical advice