Technology Appraisal Guidance No. 55
Source: National Institute for Health and Care Excellence
Note: Recommendations 1.3, 1.4 and 1.5 of this guidance have been superceded by later guidance (Paclitaxel, pegylated liposomal doxorubicin hydrochloride and topotecan for second-line or subsequent treatment of advanced ovarian cancer: National Institute for Health and Clinical Excellence Technology Appraisal Guidance No 91. London: NICE, www.nice.org.uk, May 2005).
Technology Appraisal No. 55 replaces the previous guidance on the use of paclitaxel in the treatment of ovarian cancer (Guidance on the use of Taxanes for Ovarian Cancer: National Institute for Health and Clinical Excellence Technology Appraisal Guidance No 3. London: NICE, www.nice.org.uk, May 2000).
1.1 It is recommended that paclitaxel in combination with a platinum-based compound or platinum-based therapy alone (cisplatin or carboplatin) are offered as alternatives for first-line chemotherapy (usually following surgery) in the treatment of ovarian cancer.
1.2 The choice of treatment for first-line chemotherapy for ovarian cancer should be made after discussion between the responsible clinician and the patient about the risks and benefits of the options available. In choosing between treatment with a platinum-based compound alone or paclitaxel in combination with a platinum-based compound, this discussion should cover the side-effect profiles of the alternative therapies, the stage of the woman's disease, the extent of surgical treatment of the tumour, and disease-related performance status.
1.3 When relapse occurs after an initial (or subsequent) course of first-line chemotherapy, additional courses of treatment with the chosen chemotherapy regimen (re-challenge therapy) should be considered if the initial (or previous) response has been adequate in extent and duration. Once the tumour fails to respond adequately to the chosen first-line regimen, different treatment options should be considered as part of second-line therapy (see 1.4).
1.4 Paclitaxel is not recommended as second-line (or subsequent) therapy in women with ovarian cancer who have received the drug as part of their first-line treatment. For women who have not received paclitaxel as part of first-line treatment, it should be considered as one option alongside other drugs licensed for second-line treatment of ovarian cancer.
1.5 Only oncologists specialising in ovarian cancer should supervise the provision of chemotherapy in ovarian cancer.
The guidance shown above constitutes Section 1 of the full document. A copy of the full document and a summary of the evidence is available on the Internet at www.nice.org.uk/page.aspx?o=54687
Copies of the document can also be obtained by contacting 0845 003 7783 or emailing firstname.lastname@example.org and quoting reference number N0185.
This guidance represents the view of the Institute which was arrived at after careful consideration of the available evidence. Health professionals are expected to fully take it into account when exercising their clinical judgement. This guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
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Guidance on the Use of Paclitaxel in the Treatment of Ovarian Cancer.
Issue Date: January 2003
Review Date: July 2003