TANDEM HIGH-DOSE CHEMOTHERAPY WITH IFOSFAMIDE, CARBOPLATIN, AND TENIPOSIDE WITH AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR THE TREATMENT OFPOOR-PROGNOSIS COMMON EPITHELIAL OVARIAN-CARCINOMA

BACKGROUND. A Phase I or II trial was conducted to assess the toxicity and the efficacy of a tandem high dose chemotherapy combining ifosfam ide, carboplatin, and teniposide in patients with poor prognosis ovari an carcinoma. METHODS. Thirty-seven patients were scheduled to receive tandem high dose therapy combining ifosfamide 7500 to 11250 mg/m(2), carboplatin 875 to 1000 mg/m(2) and teniposide 750 to 1000 mg/m(2), fo llowed by autologous bone marrow transplantation (ABMT). Eight patient s were refractory to the platin-based regimen, 7 were treated in chemo sensitive relapse, and 22 in partial or complete response (PR/CR) were treated. Sixty-six cycles were administered. Sixteen patients were ev aluated for response. RESULTS. The overall response rate was 56% (CR r ate: 12%). Toxic effects consisted of mainly renal toxicity, esophagit is, and enterocolitis. Three patients died of therapy-related complica tions. Since the time of ABMT, the median overall survival (OS) durati on of the whole population was 18 months and the survival rate was 14% at 60 months. For the 22 patients treated after PR or CR, the median OS duration was 24 months and the survival rate was 32% at 60 months. Tandem high dose therapy with ABMT was unable to circumvent resistance to conventional chemotherapy or to prolong the duration of survival f or patients treated in chemosensitive relapse. For patients treated af ter CR or PR, the survival results were similar to that achieved with conventional therapy. CONCLUSIONS. Prospective, randomized studies, in cluding patients only after CR or with minimal residual disease, are u rgently required to evaluate the activity of high dose therapy in the treatment of advanced ovarian carcinoma. (C) American Cancer Society.