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Phase II study of carboplatin followed by sequential gemcitabine and paclitaxel as first-line treatment for advanced ovarian cancer
  1. M. Friedlander*,
  2. M. Buck,
  3. D. Wyld,
  4. M. Findlay§,
  5. B. Fitzharris,
  6. P. De Souza,
  7. T. Davies#,
  8. G. Kalimi**,
  9. S. Allan,,
  10. D. Perez, and
  11. P. Harnett§§
  1. * Prince of Wales Hospital, Randwick, New South Wales, Australia
  2. Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  3. Royal Brisbane Hospital, Herston, Queensland, Australia
  4. § Wellington Hospital, Wellington, New Zealand
  5. Christchurch Hospital, Christchurch, New Zealand
  6. St George Hospital Cancer Centre, Sydney, Australia
  7. # Eli Lilly Australia Pty Ltd, Sydney, New South Wales, Australia
  8. ** Eli Lilly and Company, Indianapolis, Indiana
  9. †† Palmerston North Hospital, Palmerston, New Zealand
  10. ‡‡ Dunedin Hospital, Dunedin, New Zealand
  11. §§ Westmead Hospital, Westmead, New South Wales, Australia
  1. Address correspondence and reprint requests to: Michael Friedlander, MD, PhD, Prince of Wales Hospital, High Street, Randwick, New South Wales 2036, Australia. Email: Michael.Friedlander{at}


The aim of this exploratory phase II study was to evaluate sequential chemotherapy with carboplatin followed by gemcitabine–paclitaxel combination in chemonaive patients with advanced ovarian cancer. The primary objective was to evaluate time to progressive disease (TTPD); secondary objectives included the evaluation of 1- and 3-year survival, response rates, and toxicity. Following initial debulking surgery or biopsy, patients with FIGO stage IIC–IV disease received four cycles of carboplatin area under the curve (AUC) 6 (day 1) every 21 days, followed by four cycles of gemcitabine 1000 mg/m2 (days 1 and 8) and paclitaxel 175 mg/m2 (day 8) every 21 days. A total of 47 patients enrolled, 44 (93.6%) completed the initial four cycles, and 39 patients (82.9%) completed the planned eight cycles. The median and maximum lengths of follow-up were 31.2 and 43.7 months, respectively. Median TTPD was 13.8 months (95% CI, 11.6–21.0 months), and median survival time was 31.2 months (95% CI, 25.2–39.6 months). Survival at 1 and 3 years was 95.7% and 44.2%, respectively. Of the 43 evaluable patients, most (95.3%) of them achieved a CA-125 marker response based on Gynecologic Cancer Intergroup (GCIG) definition. The partial response rate in the seven patients with measurable disease was 46.4%. Myelosuppression was the major toxicity, with grade 3 and 4 neutropenia observed in 76.6% patients and thrombocytopenia in 12.8% patients. The sequential approach of carboplatin followed by gemcitabine–paclitaxel as first-line treatment for patients with ovarian cancer is feasible and well tolerated, and depending upon the findings from other major trials, it may merit further evaluation.

  • carboplatin
  • gemcitabine
  • ovarian cancer
  • paclitaxel
  • sequential

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