Question asked by: 
Sarah
Date asked: 
Feb 2015

How should someone with a stage 1C diagnosis decide whether to have single platinum based chemo or with the addition of Taxol when given the option given the lack of clearer research or data?

Single platinum based chemo or with the addition of Taxol?
It's an interesting question and a bit of a grey area.
Response by Professor Iain McNeish, Professor of Gynaecological Oncology

It's an interesting question and a bit of a grey area.

Factors that might lead you/ your oncologist one way or the other include:

  • Patient choice - especially in light of the added toxicity of Taxol (especially hair loss and neuropathy).
  • Patient performance status - if patient is frail that would sway you to single agent carbo.
  • Patient co-morbidities - e.g. diabetes, with pre-existing neuropathy would push you towards single agent.
  • Sub-stage. Stage IC is now divided into IC1, IC2, IC3 - this has been done because there was variability in survival in old IC and the new FIGO staging attempts to unpick the differences - so IC1 is intra-operative rupture, IC2 is pre-operative rupture and/or disease on the surface of the ovary, whilst IC3 is malignant cells in ascites/washings. Thus, having IC1 disease might make people veer towards single agent, whilst IC3 might suggest combination - however, no hard data to back this up.
  • Finally, pathology. There are data to suggest that clear cell carcinoma is less responsive to single agent carboplatin than high grade serous disease - thus, if patient has clear cell carcinoma, then that might persuade oncologist to use combination.

You should discuss all the above with your oncologist to be able to make a decision.