INTENSIVE CHEMOTHERAPY WITH AUTOLOGOUS STEM-CELL TRANSPLANTATION IN OVARIAN-CANCER - ANALYSIS OF 67 PATIENTS TREATED AT THE INSTITUT-PAOLI-CALMETTES AND REVIEW OF THE LITERATURE

Despite important initial chemosensitivity, advanced ovarian cancer ha s a bad prognosis with a median survival of 20 to 30 months. These res ults might be better with intensive chemotherapy. We analysed 67 patie nts treated by intensive chemotherapy with autologous stem cell transp lantation for advanced ovarian cancer at Institut Paoli-Calmettes betw een 1980 and 1994. Population was divided in two groups: salvage group (n = 30) initial chemotherapy-refractory patients and consolidation g roup (n = 37) Sor sensitive patients. Several successive conditioning regimens were used, all bared on alkylating agents. Principal toxiciti es were severe aplasia and mucositis. Four patients died from toxicity related to infection during strong immunosuppression. In salvage grou p, 9 our of 21 evaluable patients responded (43%), but duration of res ponses was short (median range of 5 months) and 2-year overall surviva l rate was 8% after transplantation. I consolidation group, 19 patient s are alive and 15 are without disease progression with a median follo w-up of 42 months (17, 161) after diagnosis. Five-year disease-free su rvival rate is 28% (median range of 35 months) and 5-year overall surv ival rate is 48% (median range of 41 months). Intensification does not seem to be long term beneficial for initial chemotherapy refractory p atients, despite objective responses rate better than classical treatm ent. On the other hand, results seem better than conventional treatmen ts in case of chemosensitive disease and should be confirmed prospecti vely in larger cohort of patients. Moreover, other research directions are open like intensification supported by hematopoietic growth-facto rs and peripherial stem cells, definition of best conditioning regimen , use of taxanes, and intensification in first line chemotherapy after initial surgery.