CISPLATIN-CONTAINING, EPIRUBICIN-CONTAINING AND PACLITAXEL-CONTAININGCHEMOTHERAPY IN UTERINE ADENOCARCINOMA

Purpose: to evaluate the toxic effects and antitumour activity of a mu ltidrug regimen with cisplatin, epirubicin and paclitaxel (CEP) as ini tial therapy in patients with uterine adenocarcinoma. Patients and met hods: Forty-nine patients with histologically-confirmed diagnoses of l ocally advanced, recurrent or metastatic cervical or endometrial adeno carcinoma entered the study. Treatment consisted of epirubicin (E) giv en at 70 mg/m(2) followed by paclitaxel(P) (175 mg/m(2) over three hou rs) and cisplatin (C) (50 mg/m(2)), repeated every three weeks. Eligib ility criteria also included age less than or equal to 75 years, no pr evious chemotherapy, no previous radiotherapy to the tumour parameters , bidimensionally-measurable lesions, no previous or ongoing cardiac d isease, and renal and liver function within normal limits, Complete bl ood cell counts were repeated weekly, and tumor response was assessed every three cycles. A maximum of eight courses was administered in res ponding patients. Results: From January 1996 to January 1997, 30 patie nts with endometrial adenocarcinoma and 19 with cervical adenocarcinom a entered the study, for a total of 213 cycles of treatment. In patien ts with endometrial carcinoma the overall clinical and pathological re sponse rates were 73% (95% CI, range 54%-88%) and 35% (95% CI, range 1 6%-57%) respectively; in patients with locally advanced cervical carci noma the overall clinical and pathological response rates were 64% and 62%. WHO grade 3-4 neutropenia occurred in 61% of the patients, with one possible toxic death. Retreatment had to be delayed for at least o ne week because of persisting neutropenia in 34% of the patients. Mild peripheral neuropathy and stomatitis were observed in 46% and 23% of the patients. One patient presented acute congestive heart failure aft er the third cycle of treatment. Conclusion. The high antitumour activ ity and the good tolerability of CEP suggest that this regimen should be prospectively compared to standard combinations as initial treatmen t of advanced endometrial carcinoma.