We randomly assigned 1077 patients to receive
docetaxel at 75 mg/m2 of body surface area (1-hour
intravenous infusion) or
paclitaxel at 175 mg/m2 (3-hour
intravenous infusion). Both treatments then were followed by
carboplatin to an area under the plasma concentration-time curve of 5. The treatments were repeated every 3 weeks for six cycles; in responding patients, an additional three cycles of single-agent
carboplatin was permitted. Survival curves were calculated by the Kaplan-Meier method, and hazard ratios were estimated with the Cox proportional hazards model. All statistical tests were two-sided.
RESULTS: After a median follow-up of 23 months, both groups had similar progression-free survival (medians of 15.0 months for
docetaxel-
carboplatin and 14.8 months for
paclitaxel-
carboplatin; hazard ratio [HR]
docetaxel-
paclitaxel = 0.97, 95% confidence interval [CI] = 0.83 to 1.13;
P = .707), overall survival rates at 2 years (64.2% and 68.9%, respectively; HR = 1.13, 95% CI = 0.92 to 1.39; P = .238), and objective
tumor (58.7% and 59.5%, respectively; difference between
docetaxel and
paclitaxel = -0.8%, 95% CI = -8.6% to 7.1%; P = .868) and CA-125 (75.8% and 76.8%, respectively; difference
docetaxel-
paclitaxel = -1.0%, 95% CI = -7.2% to 5.1%; P = .794) response rates. However,
docetaxel-
carboplatin was associated with substantially less overall and grade 2 or higher neurotoxicity than
paclitaxel-
carboplatin (grade > or =2 neurosensory toxicity in 11% versus 30%, difference = 19%, 95% CI = 15% to 24%; P<.001; grade > or =2 neuromotor toxicity in 3% versus 7%, difference = 4%, 95% CI = 1% to 7%; P<.001). Treatment with
docetaxel-
carboplatin was associated with statistically significantly more grade 3-4
neutropenia (94% versus 84%, difference = 11%, 95% CI = 7% to 14%; P<.001) and neutropenic complications than treatment with
paclitaxel-
carboplatin, although myelosuppression did not influence dose delivery or patient safety. Global quality of life was similar in both arms, but substantive differences in many symptom scores favored
docetaxel.
CONCLUSIONS: