High-dose chemotherapy with hematopoietic stem cell support in patients with advanced epithelial ovarian cancer: Analysis of 67 patients treated in asingle institution

Background: Advanced ovarian carcinoma is a chemosensitive tumor, but its p rognosis is pool with 20 to 30% 5-year survival using conventional therapy. Increasing doses of chemotherapy might improve the prognosis because of th e dose-effect. Materials and Methods: Between 1980 and 1994 art Institut Pa oli-Calmettes, 67 patients with advanced ovarian cancer were treated with d ifferent alkylating agents-based regimens of high dose chemotherapy (HDC) a nd hematopoietic stem cell support (HSCS). The population was divided in 2 groups: a salvage group (n = 30) including initial conventional chemotherap y-refractory patients, land a consolidation group (n=37) including patients whose disease was sensitive to classical first-line chemotherapy after deb ulking surgery. Results: Toxicity was essentially hematological (severe apl asia) and digestive (mucositis). Four toxic deaths occured related to infec tion during immunosuppression. In the salvage group, 9 out of 22 evaluable patients responded (41%), but the duration of responses was short (median r ange of 6 months) and the 2-year overall survival rate was 13%. In the cons olidation group, 17 patients are still alive, 12 with progression with a me dian followup of 63 months. The 5-year disease-free survival rate was 32% w hile the 5-year overall survival rate was 46%. Conclusions: Toxicity of HDC with HSCS is acceptable for poor-prognosis patients. In the long term, thi s therapy is not beneficial for chemotherapy refractory patients, despite o bjective response rates better than the conventional treatment, confirming the dose-effect for alkylating agents in ovarian cancer. On the other hand the results seem better than classical therapy in case of chemosensitive di sease and should be confirmed prospectively in a larger cohort of patients.