DOXORUBICIN-MELPHALAN WITH AND WITHOUT CISPLATIN IN ADVANCED OVARIAN-CANCER - 10-YEAR SURVIVAL RESULTS FROM A PROSPECTIVE RANDOMIZED STUDY BY THE SWEDISH COOPERATIVE OVARIAN-CANCER STUDY-GROUP

In a controlled prospective randomized study the regimen doxorubicin ( A) 40 mg/m(2) + melphalan (M) 0.4 mg/kg was compared with A+M+cisplati n (C) 50 mg/m(2) given every four weeks in advanced ovarian cancer, FI GO stage III or IV and with serous or anaplastic histology. From 1981 to 1983, 300 patients entered the study and 295 patients were evaluabl e for response, toxicity and long-term survival. All patients were fol lowed for at least 10 years. The majority of patients had large residu al tumours >2 cm. Patients treated with MAC had a higher response rate compared with patients treated with MA (76% vs, 50%, p<0.01) and trea tment with MAC resulted in significantly more pathological complete re sponders than MA. There was a significant difference in median duratio n of response (19 months vs. 13 months, p<0.006) and in median surviva l time (26 months vs. 19 months, p=0.05). After 5- and 10 years a sign ificant difference in progression-free and overall survival was found. The independent prognostic factors in this study were residual tumour after primary surgery, treatment with MAC, tumour grade, ascites, and stage, objective and subjective side effects were significantly worse with MAC, although tolerable. In conclusion, this study shows that in corporating C into MA improves the duration of progression-free surviv al and overall survival in women with incompletely resected Stage III or Stage IV ovarian epithelial cancer. A 5- and 10-year survival of 25 % and 18%, respectively, is impressive.