The impact of diabetes mellitus on the toxicity of therapy for advanced ovarian cancer.

A retrospective review was undertaken to obtain more precise information about neurotoxicity, nephrotoxicity, and the effects of dexamethasone on the frequency and severity of hyperglycemia in diabetic patients with epithelial ovarian cancer treated with paclitaxel and/or cisplatin. Thirty-three patients were identified from 1254 patients over a 10-year period. In the cisplatin-treated patients, 21 of 24 (67%) had progression of neurological symptoms, three experienced grade 3 sensory neuropathy, and two had ototoxicity. Four patients had evidence of mild nephrotoxicity and two required a 50% dose reduction. In the group of patients treated with paclitaxel, 9 of the 18 (50%) had progression of symptoms, 2 to grade 3, and 2 had ototoxicity. No discontinuation of therapy due to neuropathy was required and no patient had evidence of drug-induced autonomic nervous system dysfunction. Hyperglycemia was frequently exacerbated, and 5 patients required treatment change, but no patient was hospitalized in relation to this. Our results indicate that the paclitaxel/cisplatin combination regimen or paclitaxel alone could be safely administered in diabetic patients at standard doses, with concurrent glucose and creatinine monitoring, as well as history of neurological symptoms and physical examination.