I'm aware that NICE advises single agent carboplatin whilst the Scottish equivalent also includes Taxol. Some women are advised to have both in England as well though in other centres just one. Is this a cancer centre preference or is it dependent on subtype, grade and type of 1c? It can be bewildering for women given an option or unclear basis for the decision. What issues are considered?
Women with stage 1c disease, especially high grade serous cancer, have been included in many of the large clinical trials of carboplatin and Taxol (eg ICON3, ICON7, ICON8). However, the majority of women on these trials had more advanced disease so the number of women on these trials with Stage1c was too small to allow conclusions about which works best for them.
We don't yet have enough data from clinical trials to support different chemotherapy regimes for the different subtypes (at any stage).
NICE guidance for Stage II,III & IV ovarian cancer reflects this complex situation and the issues to be considered, as it allows for both the use of carboplatin alone or in conjunction with Taxol, as a decision to be made by the clinician and patient.
The NICE guidance states that the choice of treatment for first-line chemotherapy for ovarian cancer (stage II, III & IV) should be made after discussion between the clinician and the patient about the risks and benefits of the options available. This discussion should cover the side-effects of the different therapies, the stage of the woman's disease, the extent of surgical treatment of the tumour, and disease-related performance status.