1. ¹Centre Léon Bérard, EA 4129 sis, 28 rue Laënnec, Lyon 69008, France
2. ²Centre hospitalier de l'Agglomération Montargeoise, 658 Rue des Bourgoins, Amilly 45200, France
3. ³Centre hospitalier, bd du Dr Verlhac, Brive la Gaillarde 19100, France
4. ⁴Polyclinique Bordeaux-nord, 15 rue Claude Boucher, Bordeaux 33300, France
5. ⁵Centre hospitalier, 1 avenue de Tresum, Annecy 74000, France
6. ⁶Hôtel-Dieu, Place du Parvis de Notre-Dame, Paris 75004, France
7. ⁷Centre hospitalier, 7 quai Hôpital, Chalon-sur-Saône 71100, France
8. ⁸Clinique Pasteur, 58 bd Pasteur, Evreux 27000, France
9. ⁹Hôpital Fleyriat, 900 route de Paris, Bourg en Bresse 01000, France
10. ¹⁰CMC de Bligny, 91640 Briis sous Forges, Hôpital Privé d'Antony, 1 rue Velpeau, Antony 92160, France
11. ¹¹Clinique Saint-Pierre, rue Jean Galia, Perpignan 66000, France

Correspondence: Dr I Ray-Coquard, E-mail: ray@lyon.fnclcc.fr

Received 23 May 2007; Revised 13 August 2007; Accepted 4 September 2007; Published online 9 October 2007.

Abstract

ICON3 trial results have suggested that CAP and carboplatin–taxol regimens as first-line treatment of advanced ovarian cancer (AOC) yield similar survival. We explored the impact of increased dose of cyclophosphamide in a modified CAP regimen on the disease-free survival (DFS) and overall survival (OS) of AOC patients. From February 1994 to June 1997, 164 patients were randomised to receive six cycles every 3 weeks of either standard CEP (S) combining cyclophosphamide (C), 500 mg m^-2, epirubicin (E) 50 mg m^-2, and cisplatin (P) 75 mg m^-2 or intensive CEP (I) with E and P at the same doses, but with (C) 1800 mg m^-2 and filgrastim 5 g kg^-1 per day 10 days. Response was evaluated at second-look surgery. Patient characteristics were well balanced. Except for grade 3–4 neutropaenia (S: 54%, I: 38% of cycles), Arm1 presented a significantly more important toxicity: infection requiring antibiotics, grade 3–4 thrombocytopaenia, anaemia, nausea-vomiting, diarrhoea, mucositis. Median follow-up was 84 months. DFS (15.9 vs 14.8 months) and OS (33 vs 30 months) were not significantly different between S and I (P>0.05). Increasing cyclophosphamide dose by more than 3 times with filgrastim support in the modified CAP regimen CEP induces more toxicity but not better efficacy in AOC.