Role of chemotherapy dose intensification in the treatment of advanced ovarian cancer.

Cisplatin (Platinol) has been the most active agent against ovarian cancer. The question of a relationship between platinum dose and response remains unresolved. Eight prospective, randomized studies have examined the role of platinum dose intensity in the front-line management of newly diagnosed ovarian cancer. In none of these studies did the dose intensities achieved exceed twice that of a standard regimen. Additionally, none of these studies addressed the role of truly high-dose therapy requiring hematologic support. Recent evidence supports the idea that more substantial intensification of platinum drug delivery may be achieved by intraperitoneal administration. Similarly, very-high-dose platinum-based chemotherapy with autologous bone marrow transplantation has been shown to produce high levels of response in patients refractory to conventional-dose platinum. However, these high response rates have been achieved at the cost of considerable morbidity and generally have been of short duration. The use of peripheral blood progenitor cells may now allow us to evaluate further the role of platinum dose intensification and is currently under investigation.