title: Carboplatin plus paclitaxel combination chemotherapy: impact of sequence of drug administration on treatment-induced neutropenia.
abstract: OBJECTIVE
  While the importance of the sequence of administration of cisplatin and paclitaxel on the degree of observed neutropenia has been documented, there is limited information available in the oncology literature to determine whether there exists sequence-dependent toxicity for the combination of carboplatin plus paclitaxel.
  
  
  METHODS
  Patients with advanced gynecologic malignancies were randomized to receive either carboplatin (AUC 6), followed by paclitaxel (175 mg/m(2) over 3 h) (C-P), or the same doses of the agents delivered in the opposite sequence (P-C). The primary endpoint was the degree of neutropenia experienced during the initial treatment course.
  
  
  RESULTS
  A total of 40 patients (median age: 63) entered this trial, of whom 27 had complete pretreatment and nadir counts available for course 1 and 24 for both course 1 and course 2. By random chance, patients initially receiving P-C began therapy with a higher baseline ANC than those treated with C-P. During course 1, the P-C population was noted to have a greater reduction, from baseline, in ANC (P = 0.02), but no difference in absolute nadir counts (ignoring the baseline value) (P = 0.64). There was no difference between P-C, followed by C-P, versus C-P, followed by P-C in the severity of neutropenia experienced during course 2 (P = 0.38).
  
  
  CONCLUSIONS
  The sequence of carboplatin/paclitaxel administration does not exert a significant influence on the level of observed neutropenia. This finding leads to the suggestion that the sequence of drug delivery can be modified, as necessary, to satisfy unique requirements of individual patients and to establish the optimal drug delivery strategy of an innovative investigational treatment regimen.
authors.affiliation: Cleveland Clinic Taussig Cancer Center and Departments of Gynecology/Obstetrics and Hematology/Medical Oncology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. markman@ccf.org
authors.forename: Maurie
authors.initials: M
authors.lastname: Markman
authors.forename: Paul
authors.initials: P
authors.lastname: Elson
authors.forename: Barb
authors.initials: B
authors.lastname: Kulp
authors.forename: Gertrude
authors.initials: G
authors.lastname: Peterson
authors.forename: Kristine
authors.initials: K
authors.lastname: Zanotti
authors.forename: Kenneth
authors.initials: K
authors.lastname: Webster
authors.forename: Jerome
authors.initials: J
authors.lastname: Belinson
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D005833:Genital Neoplasms, Female / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D009503:Neutropenia / Q000139:chemically induced*; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D016190:Carboplatin; D017239:Paclitaxel