Failure of bleomycin to improve the therapeutic effects of a combination of cyclophosphamide, doxorubicin, and cisplatin (CAP) in advanced sarcomas.

Fifty-eight adults with unresectable metastatic sarcomas received monthly courses of bleomycin, cylcophosphamide, doxorubicin, and cisplatin (BCAP) in combination. Following four courses of BCAP, alternating monthly courses of vincristine, cyclophosphamide, dactinomycin and vincristine, doxorubicin, and dacarbazine were begun. Treatment was continued until disease progression or the achievement of disease resectability, with elimination of doxorubicin after a total dose of 520 mg/m2 had been received. Ten patients electively stopped treatment prematurely. One other patient was removed from treatment because of significant pulmonary toxicity. Of the 58 patients 20 (34%) achieved partial regression of disease including 10 of 18 with leiomyosarcoma, 2 of 8 with malignant fibrous histiocytomas, 3 of 8 with osteosarcoma, 3 of 7 with fibrosarcoma, 1 of 2 with epithelioid sarcoma, and 1 of 1 with mesenchymal chondrosarcoma. Median time to disease progression was 174 days and median survival was 341 days. The percentage of patients achieving disease regression on this study was nearly the same as the percentage achieving disease regression on study of CAP in advanced sarcomas.