COMPARISON OF IFOSFAMIDE VERSUS CYCLOPHOSPHAMIDE IN COMBINATION WITH CISPLATIN AND DOXORUBICIN (ADRIAMYCIN), AS FIRST-LINE THERAPY FOR ADVANCED EPITHELIAL OVARIAN-CANCER - REPORT OF A PILOT-STUDY

Cisplatin induction therapy followed by combination chemotherapy emplo ying cisplatin, doxorubicin, and ifosfamide was administered to 25 con secutive patients with FIGO stage III:or IV epithelial ovarian cancer as first-line therapy following cytoreductive surgery. A median of sev en (3-10) courses of combination chemotherapy were administered. Myelo toxicity necessitated dose attenuation in 20 (80%) patients. Microscop ic hematuria was observed in one (4%) patient. Serious central neuroto xicity occurred in two (8%) patients. A surgically documentable respon se to therapy was observed in 16 of 19 (84%) patients who underwent se cond-look laparotomy. Thirteen (68%) patients had a surgical complete response, three (12%) patients had a surgical partial response, and th ree (12%) patients demonstrated progression of disease. The estimated two-year survival for the study population was 81%. The results observ ed in the current study were compared to those reported for a populati on of 40 patients with advanced ovarian cancer treated with cisplatin, doxorubicin, and cyclophosphamide (PAC). Patients treated with PAI ha d significantly (p=0.04) fewer episodes of sepsis, a significantly (p= 0.02) greater percentage of patients requiring dose reduction secondar y to myelotoxicity, and a significantly (p=0.02) higher surgical compl ete response rate. The two-year survival for patients treated with PAI of 81% and that for patients treated with PAC of 68%, do not differ s ignificantly (p=0.39). The two-year disease-free survival for patients treated with PAI of 34% and the two-year disease-free survival of 55% for patients treated with PAC do not differ significantly (p=0.99). T he combination of cisplatin, doxorubicin, and ifosfamide is effective as first-line therapy in the treatment of advanced epithelial ovarian cancer, but a significant advantage over the less costly standard regi men which employs cisplatin, doxorubicin and cyclophosphamide is not d emonstrable in the current study.