hexamethylmelami 150 mg/day orally from day 1 to day 14.
cytoxan......... 150 mg/day orally from day 1 to day 14.
methotrexate.... 40 mg/sqm IV on day 1 and day 8.
fluorouracil.... 600 mg/sqm IV on day 1 and day 8.
FREQUENCY....... Repeat cycle every 28 days.
Young RC. Chabner BA. Hubbard SP. Fisher RI. Bender RA.
Anderson T. Simon RM. Canellos GP. DeVita VT Jr. Advanced
ovarian adenocarcinoma. A prospective clinical trial of
melphalan (L-PAM) versus combination chemotherapy. New England
Journal of Medicine. 299(23):1261-6, 1978 Dec 7.
Eighty patients with advanced ovarian adenocarcinoma were
treated in a prospective, randomized trial comparing a
four-drug combination--hexamethylmelamine, cyclophosphamide,
methotrexate and 5-fluorouracil--with the oral alkylating
agent, melphalan. Treatment with the four-drug combination was
associated with a significantly increased overall response
rate (75 vs. 54 per cent) (P less than 0.05), more complete
remissions (33 vs. 16 per cent) and longer median survival (29
vs. 17 months) (P less than 0.02) but more severe toxicity
than occurred with melphalan. Patients with minimal residual
disease had a significantly higher overall response rate than
patients with extensive residual disease (84 vs. 53 per cent)
(P less than 0.05). Patients with advanced disease who
achieved a complete remission documented by peritoneoscopy or
laparotomy (or both) have a median survival that will exceed
three years. The four-drug regimen is more effective than
melphalan in the management of advanced ovarian