Cyclophosphamide, epirubicin and cisplatin (CEP) versus epirubicin plus cisplatin (EP) in stage Ic-IV ovarian cancer: a randomized phase III trial of the Gynecologic Oncology Group of the Comprehensive Cancer Center Limburg.

Cisplatin is the most important drug in the treatment of advanced ovarian cancer. The role of anthracyclines is controversial. We compared a combination of epirubicin plus cisplatin (EP) with a regimen of cyclophosphamide, epirubicin and cisplatin (CEP). Patients with stage Ic-IV ovarian cancer were randomized to receive either epirubicin 100 mg/m2 plus cisplatin 75 mg/m2 q 4 weeks or cyclophosphamide 500 mg/m2 plus epirubicin 75 mg/m2 plus cisplatin 50 mg/m2 q 4 weeks, which we considered the reference treatment based on our previous experience. Patients were initially debulked, followed by six cycles of chemotherapy, or in case primary debulking was insufficient or considered inappropriate, secondary debulking was attempted in selected cases after sufficient chemotherapy-induced regression. Optimal debulking was defined as residual lesions < or = 2 cm. A total of 210 patients (191 eligible) were randomized. Results did not show significant differences in all major endpoints (pathologically documented complete response and survival). The median survival for all patients was 34 months, for patients with stage III 26 months, for patients with stage IV 20 months and it has not been reached for patients with stage Ic-II. As no significant differences between an equitoxic regimen of EP and CEP were detected, it might be more useful to look again at the anthracyclines as part of combination chemotherapy instead of the alkylating agents.

Long-term survival of patients with advanced ovarian carcinoma treated with cisplatin-based chemotherapy regimens.

Long-term results of different studies employing cisplatin-based chemotherapy in advanced ovara in cancer are just beginning to be published. Available data suggest that the rate of relapse decreases but does not cease, and the question of whether cisplatin-based chemotherapy results in an improved cure in advanced ovarian cancer is still unanswered. The long-term survival results published so far are reviewed. Furthermore the impact of other drugs, especially doxorubicin, in addition to cisplatin is discussed.

Chemotherapy consisting of cisplatin, doxorubicin and cyclophosphamide as an adjunct to surgery in stage Ic-II epithelial ovarian carcinoma. Gynecologic Oncology Group of the Comprehensive Cancer Center Limburg.

Twenty-five patients with stage Ic-II ovarian cancer (8 stage Ic and 17 stage IIb-c) were treated with total removal followed by 6 cycles of chemotherapy consisting of cyclophosphamide, doxorubicin, and cisplatin intravenously on day 1, every 4 weeks (CAP-1). Of 18 patients in whom a second look was performed, 16 (89%) achieved a pathologically documented complete response and two patients had positive peritoneal washings at second look. Seven patients did not undergo second look laparotony, all of whom had clinically no evidence of disease. One patient with stage Ic relapsed and died after 40 months. Nine patients with stage II relapsed and died after a median of 29 months (range, 18-90 months). The overall relapse rate in all patients was therefore 40% (95% confidence interval: 21-61%). Median follow-up of all patients is 5 years (range, 40-90 months). The 5-year survival of patients with early stage ovarian cancer treated with cisplatin-based chemotherapy appears to be at least as good as that reported with the use of postoperative irradiation or intraperitoneal radioactive phosphate. Optimal treatment of these patients remains to be further defined.

Post-operative wound infection with Gardnerella vaginalis.

A case of wound infection after Caesarian section, in which Gardnerella vaginalis appeared to play a major role, is described.