A five-drug alternating chemotherapy regimen for patients with advanced epithelial ovarian cancer

Twenty-six patients, 22 previously untreated, with FIGO stage III/IV epithelial ovarian cancer were treated with a five-drug combination regimen consisting of cycles of cisplatinum (60 or 75 mg/m2 IV) and cyclophosphamide (600 or 750 mg/m2 IV) [CP], alternating every 3 weeks with cycles of adriamycin [50 mg/m2 IV], bleomycin [15 mg IV], and chlorambucil [6 mg/m2 orally for 7 days] [ABC]. A total of six cycles, CP x 3 and ABC x 3, were planned. There was a 67% response rate with 7 complete and 5 partial remissions in 18 patients with evaluable disease. Median progression-free interval was 13 months and median survival 24 months for the whole group. The regimen was well tolerated with WHO toxicity greater than 2 in only 5 patients and treatment delay occurring in only 18 of 128 cycles [14%] in 11 patients. The toxicity of combination cytotoxic regimens can be reduced by alternating cycles of therapy. A randomized trial comparing such a regimen with nonalternating therapy would be necessary to determine whether the response rate and duration of response are compromised when the cumulative dose of cisplatinum is reduced.