Doxorubicin and cyclophosphamide, alternated with bleomycin and mitomycin c as a second-line regimen in advanced ovarian carcinoma resistant to cisplatin-based chemotherapy

Fourteen patients with advanced ovarian carcinoma (FIGO stages 111-IV) resistant to cisplatin were submitted to an alternating regimen with doxorubicin (A), cyclophosphamide (C), bleomycin (B) and mitomycin C (M). All patients had measurable disease on entry into the study. No responses were observed while 3 patients, previously showing no change in cisplatin, had disease stabilization lasting 3, 4 and 6 months, respectively. All but 1 patient died with a median survival from the start of ACBM therapy of 7 months (range 6-11). ACBM-induced toxicity was remarkable with 50% grade 11-111 myelotoxicity which required a dose reduction in 43%, treatment delays in 64% and treatment discontinuation in 14%. All patients suffered from mild to moderate nausea and vomiting while reversible alopecia was seen in 42.8%. The lack of response and the substantial toxicity observed suggest that the ACBM regimen in the doses and schedule employed is not phamide in combination with adriamycin [10]; (4) each drug has a somewhat different mechanism of action, pharmacology and pattern of therapeutic toxicity; (5) no drug has shown substantial neurotoxicity, and (6) the alternating administration of the drugs may reduce toxicity and increase the number of cycles that could be given.