Advanced and recurrent carcinoma of the ovary treated with a combination of cyclophosphamide,doxorubicin, and cytosine arabinoside

Twenty-six patients with advanced or recurrent epithelial ovarian carcinoma, FIGO Stages III and IV, were treated with combination chemotherapy using cyclophosphamide, doxorubicin, and cytosine arabinoside (CARA). In 17 cases, CARA was initiated following failure to single-agent chemotherapy, in all cases, melphalan. Nine patients with advanced cancer received CARA as their primary chemotherapy after maximum cytoreductive surgery. The overall response rate was 27%; however, in patients without prior chemotherapy the response rate was 44%. There were 6 complete responders, 1 partial responder, 13 patients with stable disease, and 6 who failed to respond to therapy. Four of six complete responders had remission durations greater than 10 months. The median progression free interval (PFI) of patients with residual tumor diameters less than 2 cm was significantly longer (P ? 0.04) than the PFI of patients with greater initial tumor burden. The median PFI of complete responders was significantly longer (P = 0.007) than PFI of patients with less than complete response. Previously untreated patients had longer median PFI than those who had failed previous chemotherapy (P = 0.07). The major dose-limiting toxicity of CARA was thrombocytopenia. Other myelosuppression was moderate and no cardiotoxicity was encountered.