CYCLES OF DOSE-INTENSIVE CHEMOTHERAPY WITH PERIPHERAL STEM-CELL SUPPORT IN PERSISTENT OR RECURRENT PLATINUM-SENSITIVE OVARIAN-CANCER

Objective. The objective was to determine the toxicity and surgically documented response rate of sequential high-dose chemotherapy with per ipheral stem cell support in patients with persistent or recurrent cis platin-sensitive ovarian cancer. Methods. Fourteen patients (average a ge, 45 years) were treated with cyclophosphamide (4.5 g/m(2)), followe d by granulocyte colony-stimulating factor (G-CSF)-stimulated peripher al stem cell harvests. The subsequent regimen prescribed three courses of carboplatin (1 g/m(2)) and cyclophosphamide (1.5 g/m(2) with 2-mer captoethanesulfonate) every 2 weeks with stem cell support. This was f ollowed by three courses of paclitaxel at 250 mg/m(2) every 2 weeks wi th G-CSF support only. Six patients were entered on the basis of a pos itive second-look laparotomy and 8 patients had a first recurrence aft er at least a 6-month disease-free interval. Results. Fourteen patient s were entered and 12 patients completed all planned courses of therap y (mean time, 13 weeks). Normal hematopoiesis was reestablished after each cycle. Hospitalization for neutropenic fever occurred in 11/93 cy cles (11.8%). Thirteen patients required blood transfusions and in 12 patients platelet transfusions were given. One patient had grade 3 neu rotoxicity, An initial elevated CA 125 returned to normal in 7/8 patie nts (88%) and 71% of patients with measurable disease responded to the rapy. There were 2 pathologic complete responders (PCR), making the PC R rate 2/14 or 14% (0-35%). Conclusion. Although this regimen was well tolerated and clinical response rates were high, the surgically docum ented response rate was not clearly superior to conventional salvage r egimens in platinum-sensitive patients. (C) 1997 Academic Press.