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PubMed2005

Phase I study of hepatic arterial melphalan infusion and hepatic venous hemofiltration using percutaneously placed catheters in patients with unresectable hepatic malignancies.

PURPOSE: We conducted a phase I study of a 30-minute hepatic artery infusion of melphalan via a percutaneously placed catheter and hepatic venous hemofiltration using a double balloon catheter positioned in the retrohepatic inferior vena cava to shunt hepatic venous effluent through an activated charcoal filter and then to the systemic circulation. The purpose of the study was to demonstrate feasibility in an initial cohort and subsequently determine the maximum tolerated dose and dose-limiting toxicity of melphalan. PATIENTS AND METHODS: The initial cohort (n = 12) was treated with 2.0 mg/kg of melphalan before dose escalation to 3.5 mg/kg (n = 16). Total hepatic drug delivery, systemic levels, and percent filter efficiency were determined. Patients were assessed for hepatic and systemic toxicity and response. RESULTS: A total of 74 treatments were administered to 28 patients. Twelve patients with primary and metastatic hepatic tumors received 30 treatments (mean, 2.5 per patient) at an initial melphalan dose of 2.0 mg/kg. At 3.5 mg/kg, a dose-limiting toxicity (neutropenia and/or thrombocytopenia) was observed in two of six patients. Transient grade 3/4 hepatic and systemic toxicity was seen after 19% and 66% of treatments, respectively. An overall radiographic response rate of 30% was observed in treated patients. In the 10 patients with ocular melanoma, a 50% overall response rate was observed, including two complete responses. CONCLUSION: Delivery of melphalan via this system is feasible, with limited, manageable toxicity and evidence of substantial antitumor activity; 3 mg/kg is the maximum safe tolerated dose of melphalan administered via this technique.

Adult↗
PubMed2005

Histamine combined with melphalan in isolated limb perfusion for the treatment of locally advanced soft tissue sarcomas: preclinical studies in rats.

PURPOSE: To evaluate the potential benefit of histamine combined with melphalan in the isolated limb perfusion (ILP) as an alternative to TNF-alfa and melphalan combination, for the treatment of irresectable soft tissue sarcomas of the limbs in Brown Norway (BN) rats. METHODS: 20 BN rats had small fragments of syngeneic BN-175 fibrosarcoma inserted on the right hind limb. In 7-10 days the tumor reached a median diameter of 12-15 mm and they were randomly divided in four groups (sham, melphalan, histamine and escalating doses of histamine combined to melphalan) being submitted to experimental ILP for 30 minutes. Tumors were measured daily with a caliper and the volume was calculated. RESULTS: Response curves showed a significant effect of the combination of histamine 200 mg/mL with melphalan, with 66% overall response, including 33% complete responses (p< 0.01). There were no systemic collateral effects and locally only mild temporary edema was observed for some animals treated with histamine. CONCLUSION: Histamine combined with melphalan had a promising effect in the ILP warranting future studies to better explore the mechanism of action as well as its potential use in organ perfusion.

Animals↗
PubMedDate not supplied

Hyperthermia, cyclosporine A and melphalan cytotoxicity and transport in multidrug resistant cells.

The ability of hyperthermia and cyclosporine A to modulate melphalan cytotoxicity and transport processes was investigated in a pleiotropic MDR Chinese hamster ovary cell line (CH(R)C5) and in the drug-sensitive parent line (AuxB1). Cyclosporine A increased cytotoxicity of melphalan in MDR cells, but not in drug-sensitive cells. In MDR cells, hyperthermia caused marked enhancement of melphalan cytotoxicity when cyclosporine A was present. The increased melphalan cytotoxicity in MDR cells was accompanied by changes in membrane permeability to the drug. Cyclosporine A caused an increase in melphalan uptake in MDR cells and a decrease in melphalan efflux out of cells, leading to an overall increase in intracellular drug accumulation. Drug transport processes were not affected by cyclosporine A in drug-sensitive cells.

Animals↗
PubMed1999

A phase I trial of intravenous melphalan, paclitaxel, and cisplatin plus granulocyte-colony stimulating factor in patients with suboptimal advanced epithelial ovarian carcinoma or peritoneal carcinoma.

BACKGROUND: The primary purpose of this study was to establish the maximum tolerated dose (MTD) of intravenous melphalan in combination with paclitaxel and cisplatin plus granulocyte-colony stimulating factor (G-CSF) in patients with suboptimal advanced epithelial ovarian carcinoma or primary peritoneal carcinoma. METHODS: Patients with suboptimal (>2 cm residual tumor) Stage III or Stage IV epithelial ovarian carcinoma or peritoneal carcinoma were eligible for this Phase I study. In the first stage of the study, the doses of paclitaxel and cisplatin were fixed at 135 mg/m(2) and 75 mg/ m(2), respectively, and the dose of intravenous melphalan was escalated in consecutive cohorts of 3-6 patients depending on toxicity. The planned dose escalation levels of melphalan were 6 mg/m(2), 10 mg/m(2), and 14 mg/m(2). In the second stage of the study, the doses of cisplatin and melphalan were fixed at 75 mg/m(2) and the MTD level, respectively, and the dose of paclitaxel was escalated. The planned dose escalation levels of paclitaxel were 150 mg/m(2), 175 mg/m(2), 200 mg/m(2), 225 mg/m(2), and 250 mg/m(2). G-CSF was administered for 12-19 days with each cycle, and cycles were repeated every 4 weeks for a total of 6 cycles. Other end points included clinical or surgical response, progression free survival, and survival. RESULTS: Between January 1993 and May 1996, 34 women with untreated advanced stage epithelial ovarian carcinoma or primary peritoneal carcinoma were treated with 192 cycles of therapy. The MTD of melphalan was 10 mg/m(2), with the dose-limiting toxicity being thrombocytopenia. Paclitaxel was escalated to a dose level of 200 mg/m(2) with a toxicity rate of < 33%. The clinical response rate was 80% in 29 patients with measurable disease. Of 11 patients who underwent second-look surgery, 5 (45%) had a surgical pathologic complete response. The median progression free survival was 16.8 months and the median survival was 32.8 months. CONCLUSIONS: The combination of intravenous melphalan, paclitaxel, and cisplatin was found to have acceptable toxicity and good activity. A Phase II study of this combination appears to be warranted.

Adult↗
PubMedDate not supplied

Intermediate-dose (25mg/m2) IV melphalan for multiple myeloma with renal failure.

BACKGROUND: Multiple myeloma is a malignant plasma cell disorder which still bears a dramatic prognosis. Renal insufficiency is a frequent and severe complication directly related to prognosis. The aim of our study was to establish whether an intermediate dose of intravenous melphalan, 25 mg/m2, could be safely and efficiently administered to patients with multiple myeloma and renal impairment. METHODS: Between January 1990 and April 2000, 45 patients with multiple myeloma received a single intravenous dose of melphalan, 25 mg/m2. Survival was analysed, as well as the duration of response and potential toxicity. In addition, a melphalan pharmacokinetic study was performed. RESULTS: The overall median survival was 45 +/- 43 months after diagnosis. Based on the Cockcroft and Gault formula, 79% patients had renal impairment. For the 28 stage III patients, survival was no different whether renal insufficiency was present or not. Twenty-five out of 34 patients had leukopenia for an average of 13.8 +/- 12 days, and the most frequent adverse effect was infection. The pharmacokinetic study showed that the melphalan area under the curve was positively correlated to the degree of renal insufficiency. However, this was not clinically relevant since patients with the most altered renal function, including those undergoing dialysis, did not present more episodes of leukopenia. DISCUSSION: The present study shows that renal impairment is not a contraindication for aggressive myeloma chemotherapy, even for patients undergoing dialysis. Intravenous melphalan, 25 mg/m2, is associated with good survival and acceptable side-effects. A randomised trial seems needed to compare this melphalan dose with standard melphalan/prednisone or combination chemotherapies.

Adult↗
PubMed2006

[Establishment of EL4 tumor-bearing mouse models and investigation on immunological mechanisms of anti-tumor effect of melphalan].

AIM: To establish mouse lymphoma EL4 tumor-bearing mouse models in wild type C57BL/6 mice and nude C57BL/6 mice respectively, and to further investigate the immunological mechanisms of anti-tumor effect of melphalan. METHODS: Mouse lymphoma EL4 cells were inoculated subcutaneously into wild type C57BL/6 mice (immune-competent mice). Twelve days later, melphalan of different doses were administered intraperitoneally to treat these wild type C57BL/6 tuomr-bearing mice. Tumor sizes were observed and recorded subsequently to find out the minimal dose of melphalan that could cure the tuomr-bearing mice. Then the same amount of EL4 tumor cells were inoculated subcutaneously into wild type C57BL/6 mice and nude C57BL/6 mice (T cell-deficient mice) simultaneously, which had the same genetic background of C57BL/6. Twelve days later, melphalan of the minimal dose was given intraperitoneally to treat both the wild type and nude C57BL/6 tuomr-bearing mice. Tumor sizes were observed and recorded in these two different types of mice subsequently. RESULTS: A single dose of melphalan (7.5 mg/kg) could cure EL4 tumor-bearing wild type C57BL/6 mice, but could not induce tumor regression in EL4 tumor-bearing nude C57BL/6 mice. CONCLUSION: A single dose of melphalan has obvious anti-tumor effect on mouse lymphoma EL4 tumor-bearing wild type C57BL/6mice, which requires the involvement of T lymphocytes in the host probably related to their killing functions.

Animals↗
PubMed1991

Development and characterization of a melphalan-resistant human multiple myeloma cell line.

We present data describing a human myeloma cell line (8226/LR-5) selected for resistance to melphalan which exhibits a 7-fold level of resistance to melphalan and is partially cross-resistant to other bifunctional alkylators and X-irradiation. Melphalan resistance is relatively unstable with a decrease in resistance observed within 17 weeks in the absence of drug. The resistance observed in this cell line is not mediated by reduced intracellular melphalan accumulation. DNA interstrand cross-linking at equivalent intracellular drug accumulation is significantly reduced in the resistant subline. Whether this reduction is the result of a decrease in the formation of this lesion or to an increased rate of removal of the lesion remains to be determined. Growth characteristics and cell cycle kinetics, including S phase, were similar between sensitive and resistant cell lines. Intracellular nonprotein thiols were found to be significantly elevated in the resistant 8226/LR-5 cells; as cells revert or lose resistance, intracellular nonprotein sulfhydryl levels decline. Prior treatment of the cells with buthionine sulfoximine significantly reduced nonprotein sulfhydryl levels and enhanced melphalan cytotoxicity in both the sensitive and resistant cell lines. Thiols appear to play a role in mediating melphalan resistance.

Alkylating Agents↗
PubMed1988

Enhanced melphalan cytotoxicity following buthionine sulfoximine-mediated glutathione depletion in a human medulloblastoma xenograft in athymic mice.

The effect and therapeutic consequences of buthionine-(SR)-sulfoximine (BSO)-mediated depletion of glutathione in the human medulloblastoma-derived cell line, TE-671, growing as s.c. xenografts in athymic nude mice were examined. The glutathione content of the s.c. xenografts was 1.11 +/- 0.15 mumol/g (7.79 +/- 1.61 nmol/mg of protein). Administration i.p. to tumor-bearing mice of D,L-BSO (two doses at 12-h intervals; 5 mmol/kg) depleted the glutathione content of the xenografts to 25.7% of control. Administration of a 30 mM solution of L-BSO in drinking water for 96 h depleted the glutathione content to 17.4% of control. Depletion of glutathione with these regimens resulted in a significant increase in the s.c. tumor growth delay over that produced by melphalan alone: 17.2 days versus 12.6 days for D,L-BSO (i.p.) plus melphalan versus melphalan and 22.9 days versus 16.6 days for L-BSO (p.o.) plus melphalan versus melphalan. These studies demonstrate the increased cytotoxicity of melphalan resulting from BSO-mediated depletion of glutathione in human medulloblastoma and support further efforts to modulate the chemosensitivity and radiosensitivity of this tumor by modulation of glutathione.

Animals↗
PubMed1987

Glucocorticoid effect on melphalan cytotoxicity, cell-cycle position, cell size, and [3H]uridine incorporation in one of three human melanoma cell lines.

Three human melanoma cell lines of known content of specific glucocorticoid-binding sites were studied for colony formation after a microM dose of glucocorticoid combined with melphalan. In one of the three cell lines, M-5A, subcloned from M-5 (formerly designated RPMI 8322), the effect of combined treatment was markedly increased compared to that of melphalan even if the glucocorticoid was applied for 1 h only, 10 h before the melphalan. Semilogarithmic dose-effect plots for a reduction of final plating efficiency by glucocorticoid were curvilinear, according to a receptor-mediated process. The effects of glucocorticoid, melphalan, and their combination were linearized by bilogarithmic median-effect plotting which allowed the quantitation of a synergism which was more marked in case of glucocorticoid pretreatment, for 1 or 24 h, than on simultaneous exposure. According to sequential DNA per cell cytophotometry, melphalan abolished in M-5A a glucocorticoid-induced arrest in the G1 phase of the cell cycle. The cytotoxic synergism correlated with an apparent stimulation by glucocorticoid of the rate of acid-insoluble incorporation of [3H]uridine and [14C]leucine and an increase in cell size and protein content in M-5A cells but not in the other two cell lines. The way in which glucocorticoids induce an enhanced susceptibility to melphalan is not clear. Our results appear compatible with a hypothesis that chromatin in a transcriptionally activated state is more vulnerable to cytotoxic attack by an alkylating agent than under average conditions.

Cell Cycle↗
PubMed1986

I.v. melphalan in carcinoma of the lung: effect of cyclophosphamide priming on hematopoietic toxicity.

Thirty-six patients with lung cancer, 24 with prior chemotherapy and 12 without prior chemotherapy, received iv melphalan at doses ranging from 20 to 40 mg/m2 of body surface area. Patients who showed moderate myelosuppression and remained in the study were also investigated to determine if cyclophosphamide (300 mg/m2) administered 1 week before the identical dose of i.v. melphalan modified the hematopoietic toxicity of melphalan (cyclophosphamide priming). In this study, the activity of melphalan was minimal, four minor responses with no partial or complete responses. Three of these minor responses were in previously untreated patients. The major toxicity was hematopoietic and the maximum tolerated i.v. dose was 20 mg/m2 in the patients previously treated with chemotherapy and 30 mg/m2 in those without prior chemotherapy. Cyclophosphamide priming did not reduce the myeloid toxicity. Myelosuppression was more severe in the course that included cyclophosphamide. Recovery, however, appeared to be similar in both courses. I.v. melphalan at these doses has minimal activity in lung cancer. Cyclophosphamide administered 1 week before i.v. melphalan does not decrease the myelosuppression but should be investigated further for its effect on the rate of wbc and neutrophil count recovery.

Adult↗
PubMed1987

Sensitivity to melphalan as a function of transport activity and proliferative rate in BALB/c 3T3 fibroblasts.

Melphalan transport by exponentially dividing BALB/c 3T3 mouse fibroblasts was approximately 3-fold greater at the steady-state than that observed with resting cells at drug concentrations ranging from 1 to 100 microM. Both the rate of incorporation of [3H]thymidine and the percentage of S-phase cells estimated by a fluorescent cell sorter provided evidence of higher DNA synthetic activity in logarithmic phase cells. Transport of melphalan by BALB/c 3T3 fibroblasts was mediated by the two amino acid transport systems, the DL-beta-2-aminobicyclo(2,2,1)heptane-2-carboxylic acid-sensitive sodium-independent system preferring leucine as substrate and the sodium-dependent system preferring alanine, serine, and cysteine as substrates. At low drug concentrations (about 1 microM) the sodium-dependent mechanism predominated, but at high concentrations of melphalan (100 microM) a shift occurred from the sodium-dependent to the sodium-independent system. Both transport systems were markedly affected by the proliferative state of the cells and became progressively less active the longer cells remained in the stationary phase. Stationary-phase cells were also less sensitive to the cytotoxic action of melphalan than exponentially dividing cells. Serum deprivation experiments showed that unidirectional melphalan influx decreased about 40% when fibroblasts previously in exponential growth were shifted from normal medium to serum-depleted medium 24 h prior to drug transport studies. Thus, serum deprivation and maintenance of cells in stationary phase growth had parallel effects on drug influx. These experiments emphasize the importance of the proliferative state of the cell as a determinant of melphalan transport and cytocidal activity.

Animals↗
PubMed1985

Pharmacokinetics of melphalan in clinical isolation perfusion of the extremities.

The pharmacokinetics of melphalan in clinical hyperthermic isolation perfusion was studied in 16 patients with malignant melanoma. Analysis by computer-generated lines of best fit showed that the loss of melphalan from perfusate conforms best to a biexponential equation. The initial loss with a half-life (t1/2) of approximately 5 to 10 min is interpreted as rapid uptake of melphalan by the tissue of the perfused extremity. The terminal portion of the curve with a half-life of approximately 35 to 50 min is interpreted as due predominantly to the hydrolysis of melphalan, with a lesser component of loss due to absorption of melphalan to the filters and tubing of the perfusion apparatus. Determination of the area under the curve suggests that there is no appreciable uptake of melphalan by the tissue of the perfused extremity after 30 min.

Chemotherapy, Cancer, Regional Perfusion↗
PubMedDate not supplied

Different melphalan toxicity and DNA cross-linking in human melanoma cells as compared to phytohaemagglutinin-stimulated lymphocytes.

The cytotoxic effect of melphalan, measured as drug induced inhibition of cellular 3H-thymidine incorporation, was lower in RPMI 8322 melanoma cells than in phytohaemagglutinin-stimulated lymphocytes. Melphalan induced a 1.8-fold higher level of total cross-linking and a 1.5-fold higher level of DNA interstrand cross-linking in the phytohaemagglutinin-stimulated lymphocytes compared to the RPMI 8322 melanoma cells. In addition, higher levels of cross-linking were found in the newly synthesized DNA of lymphocytes in S-phase, as compared to S-phase RPMI 8322 cells. The cellular incorporation of 3H-melphalan was about four times higher in RPMI 8322 cells than in phytohaemagglutinin-stimulated lymphocytes. Thus, the lower toxicity of melphalan in RPMI 8322 cells and the lower levels of melphalan induced DNA cross-linking in these cells is due to intracellular factors rather than a lower cellular uptake of melphalan.

Cell Line↗
PubMed1980

L-phenylalanine mustard (melphalan) uptake and cross-linking in the RPMI 6410 human lymphoblastoid cell line.

L-Phenylalanine mustard (melphalan) induced a time- and concentration-dependent arrest of cycling RPMI 6410 cells in the G2 phase of the cell cycle as evidenced by flow cytofluorometry. A melphalan exposure of 1 microgram/ml for 1 hr caused a temporary G2 blockage which was overcome by 48 hr. Higher concentrations or longer exposures lead to irreversible blockages. Melphalan caused DNA cross-linking which was monitored by the alkaline elution method. The cross-linking was shown to be between DNA and protein. The degree of DNA cross-linking increased for approximately 4 hr after a 1-hr drug exposure of 1 microgram/ml. At 36 to 48 hr after the drug exposure, the cells overcame the G2 block and were dividing. The DNA cross-links have apparently been repaired as they are no longer detected by alkaline elution. The extent of melphalan cross-linking was dependent on both drug dosage and exposure time. Using a culture medium lacking amino acids, it was shown that melphalan uptake into RPMI 6410 cells was inhibited by leucine, isoleucine, or glutamine. The increased uptake of melphalan and the increased cross-linking in amino acid-deficient media were reduced by readdition of the aforementioned amino acids.

Amino Acids↗
PubMed1981

Selection and characterization of Chinese hamster ovary cell mutants resistant to melphalan (L-phenylalanine mustard).

Melphalan (Alkeran) is an alkylating agent commonly used in the treatment of multiple myeloma and other neoplasia. We have isolated melphalan-resistant (MelR) Chinese hamster ovary cells in vitro. Stably resistant clones were observed with a frequency of about 10(-7) after a single drug exposure. Two clones, MelR1 and MelR6, were studied in detail, and their phenotypes were compared to a colchicine-resistant membrane permeability mutant (CHRC5) isolated previously by Ling and Thompson (J. Cell Physiol., 83: 103-116, 1974), which was cross-resistant to melphalan. The MelR cones were cross-resistant to the nitrogen mustard class of alkylating agents, such as melphalan, nitrogen mustard, and chlorambucil, but not to alkylating agents, such as methanesulfonic acid:ethyl ester or mitomycin C. The MelR clones differed from CHRC5 in their lack of cross-resistance to puromycin and Adriamycin. Studies with [14C]melphalan showed CHRC5, but not the MelR clones, to be defective in drug accumulation into whole cells. The mechanism of melphalan resistance in CHRC5 is attributed to reduced drug accumulation due to a plasma membrane alteration. In the MelR clones, investigation of drug distribution into cell subfractions revealed reduced accumulation into the nucleus compared to the parental cell line. We therefore propose that the mechanism of resistance in the MelR cells results from a nuclear alteration(s) specific to a subclass of alkylating agents.

Animals↗
PubMedDate not supplied

Kinetic analysis of the reaction of melphalan with water, phosphate, and glutathione.

The reaction kinetics of the hydrolysis, phosphatolysis, glutathionyl conjugation, and alpha-glutathione-S-transferase (GST)-catalyzed glutathione conjugation of [3H-ring]melphalan were investigated at pH 6.5 and 7.4. The distribution of products relative to the initial parent compound radioactivity over time was measured by HPLC and analyzed by nonlinear regression techniques using a system of rate and distribution equations that describe the complete precursor-product pathways applicable to each reaction condition. The kinetic parameters calculated in the analysis were the first- and second-order rate constants of formation and the product ratios of the aziridinium intermediates. The second-order rate constants were normalized to those obtained for the hydroxylation reactions to yield relative rate constants. The first-order rate constants of aziridinium ion formation from melphalan and from all the monosubstituted melphalan species, except chloro, hydroxyl melphalan, were similar under all reaction conditions. The relative second-order rate constant for nonenzymatic glutathionylation of the aziridinium intermediate was 7 times larger at pH 7.4 than at pH 6.5. GST was found to react only with the aziridinium intermediate formed from melphalan and to dissociate slowly from the resultant GST-product complex (dissociation half-life, 1 hr at pH 7.4 and 3.5 hr at pH 6.5). The kinetic parameter estimates found in this study can be used to make preliminary calculations of the impact that cellular phosphate, glutathione, and GST concentrations will have on the intracellular detoxication of melphalan.

Glutathione↗
PubMed1994

[Effect of carboplatin on the pharmacokinetics of melphalan administered intravenously].

In order to perform melphalan dosage adjustment, the linearity of melphalan kinetics was studied, in the case of previous carboplatin administration. Eleven patients with various solid tumors entered the present study. Carboplatin was administered during 5 days over 1-hour infusions; the day after, the melphalan test-dose was administered and followed 24 hours after by the complement dose. Melphalan kinetics were determined from only three plasma samples by using bayesian estimation. The present study showed that previous carboplatin administrations induced wide variations of melphalan pharmacokinetic parameters between the two administrations. As part of this protocol, the order of drug administration should be taken into account, in order to perform melphalan dosage adjustment.

Adolescent↗
PubMed1996

Randomized trial of initial therapy with melphalan versus cisplatin-based combination chemotherapy in patients with advanced ovarian carcinoma: initial and long term results--Eastern Cooperative Oncology Group Study E2878.

BACKGROUND: Following surgical debulking, most patients with international Federation of Gynecology and Obstetrics (FIGO) Stage III or IV carcinoma of the ovary receive treatment with combination chemotherapy. However, the optimal postsurgical therapy for ovarian carcinoma remains to be defined. METHODS: To define better the role of initial therapy with a cisplatin-based chemotherapy regimen, the Eastern (Cooperative Oncology Group (ECOG) initiated a randomized, Phase III trial, EST 2878, comparing initial therapy with a single, orally administered alkylating agent, melphalan, versus a complex regimen employing cyclophosphamide, hexamethylmelamine, doxorubicin, and cisplatin (CHAD). Women who failed treatment with melphalan were crossed-over to treatment with CHAD minus the cyclophosphamide (HAD). Study endpoints included response to therapy, time to treatment failure, and overall survival. RESULTS: Between October, 1978, and November, 1980, EST 2878 accrued 253 patients with advanced epithelial carcinoma of the ovary. There were 118 eligible patients initially treated with melphalan and 126 with CHAD. Two patients experienced lethal toxicities, including gastrointestinal hemorrhage (1 patient) and neutropenic sepsis (1 patient), and 22 patients experienced life-threatening toxicities, including hematologic toxicity (21 patients) and anaphylaxis (1 patient). Response to treatment and clinical complete response rates were higher in women receiving CHAD (60% and 38%, respectively) versus melphalan (42% and 21%, respectively) (P = 0.037 and P = 0.024, respectively), but these differences were confined to women older than 50 years of age. Likewise, time to treatment failure was significantly longer in women receiving CHAD (P = 0.014), but the difference was again confined to women older than 50 years of age and to women suboptimally debulked at the time of surgery. Survival did not differ between the two arms (median survivals of 17.5 months with initial melphalan therapy and 19.5 months with CHAD), probably because women treated initially with melphalan received salvage therapy with HAD). Twenty-three patients survived longer than 10 years. Among 18 long term survivors who had retrospective pathologic review, 8 had borderline tumors of the ovary. CONCLUSIONS: In women with advanced ovarian cancer, initial therapy with a cisplatin-based combination chemotherapy regimen resulted in higher clinical complete response rates and longer time to failure compared with initial therapy with a single, oral alkylating agent; however, the benefits of this approach were confined to women older than 50 years of age at diagnosis, and there was no significant difference in survival.

Adult↗