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What is the role of dose-dense therapy?
  1. M. E.L. VAN DER BURG*,
  3. I. VERGOTE,
  4. C. W. BURGER,
  5. H. C. VAN DOORN,
  6. R. DE WIT*,
  7. G. STOTER* and
  8. J. VERWEIJ*
  1. *Department of Medical Oncology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
  2. Department of Gynecological Oncology, University Hospital, Leuven, Belgium
  3. Department of Gynecological Oncology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
  1. Address correspondence and reprint requests to: M.E.L. van der Burg, MD, PhD, Department of Medical Oncology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. Email: m.e.l.vanderburg{at}


The introduction of paclitaxel/platinum combination chemotherapy and (interval) debulking surgery has significantly improved the prognosis of patients with ovarian cancer. Yet, many patients die of drug-resistant disease. Second-line chemotherapy may result in prolonged secondary remissions with alleviation of symptoms and improvement of quality of life. The response to second-line chemotherapy is strongly related to platinum sensitivity. More than 60% of platinum-sensitive patients respond to a re-challenge with platinum-containing chemotherapy. In platinum-resistant patients, on the contrary, the response rate to a re-challenge with 3-weekly platinum or any nonplatinum chemotherapy is less than 20%. The response to dose-dense weekly platinum-based regimens ranged from 48% to 64% in platinum-resistant patients. Moreover, the majority of the patients responded within 8 weeks after the start of the treatment. The progression-free survival ranged from a median of 5 months in a study using cisplatin/etoposide, to 11 months in a study with paclitaxel/carboplatin. The median survival was 11–15 months. The outpatient weekly paclitaxel/carboplatin regimen, with paclitaxel at a dose of 90 mg/m2 and carboplatin at area under the curve 4, seems similarly effective and is better tolerated. Dose-dense weekly paclitaxel/carboplatin is an effective and well-tolerated therapy for platinum-sensitive, as well as platinum-resistant tumors. Responses to therapy are observed within 8 weeks in the majority of the patients. Whether a weekly regimen indeed is more effective than 3-weekly paclitaxel/carboplatin needs to be answered in a randomized study.

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