Sequential high dose-density chemotherapy in advanced ovarian cancer.
Introduction of paclitaxel or anthracyclines can improve the results of chemotherapy in advanced ovarian cancer. Dose intensification (by shortening of intervals between cycles) and sequential administration of active regimens at least theoretically may improve chemotherapy effectiveness. 18 patients entered into a pilot trial of combination chemotherapy. Treatment consisted of cisplatin 50 mg/m2, epidoxorubicin 60 mg/m2 and cyclophosphamide 500 mg/m2 every 14 days for six cycles, followed by paclitaxel 175 mg/m2 (3-hour infusion) every 14 days for four cycles. Granulocyte colony stimulating factor at 300 mcg was employed between cycles on days 5-10. 16 out of 18 patients who entered the study received a full dose chemotherapy with a ratio between actually received and planned dose intensity of 0.8 or more. No life-threatening side effect was observed and toxicity was acceptable. This new approach based on sequential administration of active regimens at high dose intensity proved feasible, active and devoid of unacceptable toxicity. The administration the booth of paclitaxel and epidoxorubicin with cisplatin and cyclophopshamide has been rendered possible. Further studies are warranted.