Chemotherapy of advanced ovarian carcinoma: initial experience using a platinum-based combination

Thirty-five previously untreated patients with FIGO Stage III or IV ovarian carcinoma were treated with cis-diamminedichloroplatinum (II), Adriamycin and cyclophosphamide (PACe). Following four or five cycles of PACe, patients were assessed clinically for response. Twenty-one (60%) of the patients attained a clinical complete remission (CCR), seven (20%) a partial remission, and seven (20%) did not respond. The median survival of all patients was 19 months, 6.4 months for partial and nonresponders, and 26.5 months for clinical complete responders. Six patients remain relapse-free for more than two years. Patients entering into the study during the second year underwent a second-look procedure if they attained a CCR. Ten patients in CCR were assessed for second look; two refused, and eight underwent a laparotomy. Three of eight were in complete remission after second look, and a fourth patient who had microscopic disease in one ovary was rendered free of disease by surgery. Subjective toxicity was marked due to severe nausea and vomiting. Renal toxicity was not troublesome and myelosuppression was moderate. Ototoxicity and peripheral neuropathies were seen in seven patients. PACe is a highly effective induction regime but randomized studies are required to show that improved survival will result from it's use.