A toxicity, dose, and schedule study of intraperitoneal (ip)
cisplatin and
alpha-interferon was conducted as a
salvage therapy for patients with persistent, advanced
epithelial ovarian cancer after primary systemic
therapy with
cisplatin-
combination chemotherapy. Twenty-four patients were entered into this prospective, nonrandomized phase I-II trial conducted at two institutions following a uniform protocol.
Cisplatin doses were escalated from 45 to 90 mg/m2, and
alpha-interferon doses were escalated from 10 to 50 x 10(6) IU.
At protocol entry, 4 (16%) patients had microscopic residual disease at second-look
laparotomy, 5 (21%) had
minimal residual disease less than 5 mm, 7 (30%) had residual disease 5-20 mm, and 8 (33%) had bulky residual disease greater than 20 mm. Toxicity was acceptable overall. Hematopoietic toxicity included a grade 3 total white cell count in 12% of courses when the
cisplatin dose was equal to or greater than 60 mg/m2. Renal toxicity was modest with grade 2 toxicity in 20% of courses with a
cisplatin dose greater than 60 mg/m2. Gastrointestinal toxicity, especially
nausea and
vomiting was seen in most courses; however, it was grade 3 and dose-limiting in greater than 30% of courses with
cisplatin 75-90 mg/m2. General malaise,
fever, flu-like symptoms,
chills, and myalgias were seen in most courses, but it was dose-limiting (grade 3) toxicity in 6-11% of cycles when the dose of
interferon was 25-50 x 10(6) IU. There was no grade 4 toxicity. Thus, the maximum tolerated dose (MTD) of the combination is 60 mg/m2
cisplatin and 25 x 10(6) IU
interferon. Eighteen patients were evaluable for response, 15 of whom had responded to prior
cisplatin therapy and 3 had not. Of the 10 patients evaluable for clinical response, one patient (10%) achieved a complete response (CCR), and one (10%) had a partial response (PCR). The progression free interval (PFI) and survival were 11 months and 19 months, respectively, for the CCR patient, 6 and 11 months, respectively, for the PCR patient, and the mean survival for nonresponders was 8 months. The other 8 patients underwent a reassessment
laparotomy: 2 (25%) achieved a complete pathologic response (
CPR), and 3 (38%) had a partial pathologic response (PPR). Both pathologic responses were in patients with
minimal residual disease less than 5 mm.(ABSTRACT TRUNCATED AT 400 WORDS)