THE SUBRENAL CAPSULE ASSAY IN SELECTING CHEMOTHERAPY FOR OVARIAN-CANCER - A PROSPECTIVE RANDOMIZED TRIAL

In order to find out whether the response rate and survival in epithel ial ovarian cancer can be improved by aid of sensitivity testing with the subrenal capsule assay (SRCA), 196 patients with FIGO Stage II-IV epithelial ovarian cancer were randomized to be treated with either cy clophosphamide-doxorubicin-cisplatin (CAP) or SRCA-guided chemotherapy . The drug combinations tested with the SRCA were (1) cyclophosphamide -doxorubicin-carboplatin (CACAR), (2) CAP, (3) carboquone-methotrexate -tegafur (CQ-MTX-TEG), (4) cisplatin-etoposide-hexamethylmelamine (P-V P-HXM), and (5) bleomycin-epirubicin-cisplatin (BEP). A total of 132 p atients (CAP, 69; SRCA, 63) were eligible for efficacy analysis based on relaparotomy findings. The overall response rate was 59% in the CAP arm and 62% in the SRCA arm. In the SRCA arm, 16 patients were treate d with CACAR, 24 with CAP, 10 with CQ-MTX-TEG, 11 with P-VP-HXM, and 2 with BEP. The response rate to CACAR was 63% and to SRCA-CAP was 75%. The number of complete responses was higher when CAP was given as gui ded by the assay than when given at random (14/24 vs 23/69; P = 0.03, Pearson chi(2)). Survival curves as estimated by Kaplan-Meier method g ave a median survival of 24 (SE = 4) months to the SRCA arm and 28 (SE = 5) for the CAP arm (P = 0.7; log-rank test). Because no survival be nefit was achieved, the SRCA obviously needs further development befor e it can be routinely recommended in the choice of first-line chemothe rapy for patients with ovarian cancer. (C) 1995 Academic Press, Inc.