3 The technology
3.1 Paclitaxel (Taxol) is a cytotoxic anticancer drug and belongs to the taxane group of drugs. It has the following licensed indications for ovarian cancer in the UK:
primary ovarian cancer in combination with cisplatin (a platinum drug) in patients with advanced disease or residual disease after initial surgical treatment
metastatic ovarian cancer where standard platinum-containing therapy (cisplatin or carboplatin) has failed (that is, paclitaxel as monotherapy).
3.2 Paclitaxel is usually administered at a dose of 175 mg per m2 body surface area, in a 3-hour intravenous infusion, followed by a platinum compound, at 3-weekly intervals. The paclitaxel infusion is usually undertaken on an outpatient basis, with drug costs of approximately £1100 per cycle. Patients normally receive six cycles, with a total drug cost of approximately £6600, excluding costs of platinum drugs, pre-medication, wider outpatient or inpatient care, the cost of treating side effects, and value added tax (VAT).
3.3 While paclitaxel is licensed in combination with cisplatin for first-line therapy, both carboplatin and cisplatin are licensed for monotherapy in ovarian cancer and there is good evidence of their equivalent efficacy. However, carboplatin is recognised as being less toxic and resulting in fewer side effects. Consequently in UK clinical practice, paclitaxel is usually provided in combination with carboplatin.