Preliminary Report of Ifosfamide plus Epirubicin in Platinum - Resistant Epithelial Ovarian Cancer

Abstract

Objective To determine the efficacy and toxicity of ifosfamide plus epirubicin in platinum - resistant epithelial ovarian cancer.

Patients and Methods Platinum - resistant disease was defined as progressive or persistent disease while receiving a platinum - based regimen or recurrence within 6 months after completing therapy. Eligibility criteria included : age 18 – 70 years; measurable disease; Zubrod – ECOG – WHO performance status 0 - 2; prior chemotherapy regimens, one of which had to contain a platinum agent; adequate hematological, renal and hepatic function and no significant cardiac disease. Patients received intravenous infusion of ifosfamide 1.5 g/m2 delivered over 3 hours each day for 3 days, intravenous bolus of mesna 300 mg/m2 delivered every 4 hours for three doses following ifosfamide and intravenous bolus of epirubicin 70 mg/m2 delivered on the first day. Subsequent cycle was repeated every 21 days.

Results Ten patients were assessable for responses and toxicity. Three patients (30%) had objective responses. One responder continued to respond over 10 months until the time of report. Two patients had partial responses; one died of sepsis after the third cycle and the other loss follow up after the sixth cycle of treatment. For toxicities, grade 3 or grade 4 neutropenia was observed in all patients at the first cycle of chemotherapy (grade 3 40%, grade 4 60%) and grade 4 neutropenia was observed in one patient at the second cycle of chemotherapy. G-CSF prophylaxis was used in 15 treatment cycles (39.5%). Grade 3 alopecia was observed in almost all patients (90%). One treatment - related death occurred from sepsis, originating from skin infection.

Conclusion This regimen is active in platinum - resistant epithelial ovarian cancer at the cost of major toxicities.