Treatment of advanced ovarian carcinoma with high-dose cyclophosphamide after failure on melphalan

The efficacy of CTX as initial chemotherapy in advanced ovarian carcinoma has been well documented. Its apparently greater response rate when administered in a high-dose bolus has prompted its application to patients who have failed on melphalan. Piver et al. reported only one partial response lasting 1 month among seven patients with ovarian cancer refractory to alkylating drug therapy. Three of his patients had received low-dose CTX in combination with actinomycin D and 5-FU or methotrexate prior to receiving high-dose CTX. Although none of our patients had received prior CTX, the response rate was comparable (two of ten patients, 20%) with no complete responses. Toxicity from this drug regimen was considerable. In our study four of 13 patients (30%) had severe or life-threatening leukopenia with two of four (50%) complicated by septicemia. In Piver's group six of eight patients (75%) had severe leukopenia with five manifesting septicemia. It is clear that the risks of high-dose bolus CTX therapy for ovarian carcinoma resistant to melphalan outweigh the potential benefits.