Treatment of gynecological malignancies with a combination of cisplatin, adriamycin and ifosfamide.

Histogenetic similarities in the female genital system suggest that a group of cancers from the coelomic epithelium may have a common sensitivity to cytotoxic treatment. A total of 24 patients with evaluable gynecologic cancer were treated with a new combination regimen consisting of cisplatin (50 mg/m2), Adriamycin (50 mg/m2), and ifosfamide (1 g/m2 X 5 days) (PAI) given in five courses at 4-week intervals. The tumors included ten cervical, four endometrial, seven ovarian, and three peritoneal cancers. In all, 20 of our patients had recurrent disease and had previously received other cytotoxic treatment, including radiation (11 cases), cisplatin-containing chemotherapy (8 cases), or both (1 case). As a schedule modification, PAI plus bleomycin (20 mg/m2, on days 1 and 8) was recommended for tumors containing squamous components. According to the response criteria of the International Union Against Cancer (UICC), a 96% response rate was obtained (cervical, 9/10; endometrial, 4/4; ovarian, 7/7; peritoneal, 3/3). Of 23 responders 8 (35%) achieved a complete remission. The dose-limiting side effect of the PAI regimen was hematologic toxicity: grade 4 leukopenia was observed in 92% of patients, and grade 4 thrombocytopenia was seen in 17%. However, the myelosuppression reversed spontaneously within 3 weeks, and none of the patients was incapable of completing the planned treatment courses. The results suggest that PAI combination chemotherapy is effective and can be used in the management of patients with gynecologic malignancies derived from the coelomic epithelium (müllerian tumor group).