Hexamethylmelamine, cyclophosphamide, adriamycin, cis-platinum chemotherapy as initial and second-line treatment of advanced ovarian carcinoma.

Thirty-six patients with advanced/recurrent epithelial ovarian carcinoma were treated with a combination of hexamethylmelamine, cyclophosphamide, adriamycin, and cis-platinum. In the group of 23 previously untreated patients, 10 of 12 (83%) with measurable disease had objective responses (7 complete, 3 partial). The median survival of the 23 patients exceeded 18 months. After approximately 1 year of chemotherapy, 9 patients with no clinical evidence of disease had a 'second look' laparotomy; 6 of these patients were disease-free. Two of the 6 patients with surgically documented complete responses had bulky (greater than 5 cm) disease prior to initiation of chemotherapy and remained disease-free at 22 and 50 months. One of the 6 patients relapsed 5 months after a negative second look. The other patients were alive and disease-free at 18, 46, and 51 months. Only 4 of 13 melphalan-resistant patients (31%) demonstrated an objective response to the 4-drug combination. The median survival was 13 months.