Infusional cisplatin plus cyclophosphamide in advanced ovarian cancer

Twenty-one patients with previously untreated advanced ovarian cancer received a two-drug regimen of cisplatin delivered as a systemic infusion at 20 mg/m2/d for 5 days concomitant with oral cyclophosphamide 150 mg/d in divided doses. Courses were repeated at 3- to 4-week intervals. Responses were observed in 14 of 19 evaluable patients (74%) with three complete responses (one pathologically confirmed at second-look laparotomy) and 11 partial responses. Median time to disease progression in the responders was 12 months (range, 4 to 24 months with four patients maintaining remission at 11, 13, 14, and 19 months). The median survival for the entire group was 12 months (range, 1 to 64 months). A higher-than-expected frequency of nephrotoxicity (38%) and neurotoxicity (24%) was observed, suggesting that infusional cisplatin may lead to cumulative adverse effects and necessitate limiting the number of courses delivered in this fashion. Forty-three percent of patients received less than four courses of therapy related to these two categories of toxicity. The therapeutic effect of infusional cisplatin may be comparable to previous reports of bolus schedules in ovarian cancer when employed in combination with cyclophosphamide but the non-hematologic toxicities are substantial.