Chemotherapy for stage III-IV epithelial ovarian cancer with cis-dichlorodiammineplatinum(II), adriamycin, and cyclophosphamide: A preliminary report

C. E. Ehrlich, L. Einhorn, S. D. Williams, MorganJ.

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This study was designed to evaluate the effectiveness of cis-dichlorodiammineplatinum(II) (cis-platinum), adriamycin, and cyclophosphamide (PAC) as primary therapy for advanced ovarian cancer and to compare a 1-day versus a 5-day schedule for administering cis-platinum to determine the superior schedule for response and toxicity. Patients were randomized between two schemes: PAC-V - cis-platinum at a dose of 20 mg/m2iv daily for 5 days, adriamycin at a dose of 50 mg/m2 iv on Day 1, and cyclophosphamide at a dose of 750 mg/m2iv on Day 1; or PAC-I - cis-platinum at a dose of 50 mg/m2, adriamycin at a dose of 50 mg/m2, and cyclophosphamide at a dose of 750 mg/m2, all on Day 1. PAC-V was repeated every 4 weeks and PAC-I was repeated every 3 weeks. All treatment with cis-platinum was given to patients in the hospital with posttreatment iv hydration. cis-Platinum was discontinued at a total dose of 300 mg/m2 and adriamycin was discontinued at a total dose of 450 mg/m2; thereafter, cyclophosphamide was increased by 20% and was given orally every 4 weeks. Thirty-five of 39 patients who were entered in this study are evaluable. PAC is an active drug combination against advanced epithelial ovarian cancer with an overall response rate of 68.5%, a complete response rate of 37%, and a partial response rate of 31.5%. The interval to response was 4-12 weeks. Hematologic toxicity was severe, with all patients developing a leukopenia of <2000 cells/mm3 and 51% of the patients developing a leukopenia of <1000 cells/mm3. Thrombocytopenia was moderate in most patients with 28% of the patients developing a thrombocytopenia of <50,000 cells/mm3. Hemoglobin levels of <9.5 g/100 ml developed in 86% of the patients; 67% of PAC-I and 29% of PAC-V patients required transfusions for symptomatic anemia. Dose-limiting nephrotoxicity was seen in two patients early in the use of this combination. Posttreatment iv hydration of patients in the hospital has limited the nephrotoxicity; 46% of the patients had a BUN level of 21-40 mg/100 ml and/or a serum creatinine level of 1.3-2.0 mg/100 ml. No progressive nephrotoxicity was observed after discontinuing the cis-platinum, and cardiac toxicity was seen in only one patient. Nausea, vomiting, and alopecia were seen in all patients while no significant neurotoxicity or ototoxicity was observed.

Original languageEnglish (US)
Pages (from-to)281-288
Number of pages8
JournalCancer Treatment Reports
Issue number2
StatePublished - Jan 1 1979


ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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