Phase II trial of oral altretamine for relapsed ovarian carcinoma: evaluation of defining response by serum CA125.
OBJECTIVE
A phase II study was performed of oral altretamine in 71 patients with ovarian carcinoma who entered clinical complete remission with CA125 levels less than 35 U/mL after initial or second-line chemotherapy, and relapsed more than 6 months later. Response was compared between standard and CA125-based criteria.


METHODS
Altretamine 260 mg/m2 was given in divided doses daily for 14 days per month. Response was evaluated according to European Organization for Research and Treatment of Cancer (EORTC) criteria in 45 of 66 eligible patients. Response was assessed according to precise CA125 criteria in 51 patients based on either a confirmed > or = 50% or > or = 75% decrease in CA125 levels.


RESULTS
A combination of domperidone, dexamethasona, and chlorpromazine at night controlled toxicity in most patients, which was mainly nausea (National Cancer Institute criteria grade 2 or 3 in 27), vomiting (grade 2 or 3 in 19, grade 4 in one), and tiredness (grade 2 or 3 in 15). Responses (complete plus partial) were seen in 18 (40%; 95% confidence interval [CI], 25.4% to 54.6%) of those evaluated according to EORTC criteria and in 20 (39%; 95% CI, 25.5% to 52.9%) of those evaluated according to CA125 level. The overall response rate was 26 of 57 (45.6%) and was related to treatment-free interval: 6 to 12 months, 35%; 12 to 24 months, 52%; and greater than 24 months, 67%. The medium duration of response was 8 months.


CONCLUSIONS
Oral altretamine is a useful agent in patients-who relapse after previously responsive ovarian cancer. Response evaluation by a strict CA125 definition gave a similar estimate of the efficacy of altretamine as EORTC criteria.
Rustin
G J
GJ
Centre for Cancer Treatment, Mount Vernon Hospital, Middlesex, United Kingdom. rustin@mtvern.cj.uk
Nelstrop
A E
AE
Crawford
M
M
Ledermann
J
J
Lambert
H E
HE
Coleman
R
R
Johnson
J
J
Evans
H
H
Brown
S
S
Oster
W
W
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006585:Altretamine / Q000008:administration & dosage*; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D002277:Carcinoma / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood*; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000188:drug therapy*; D010051:Ovarian Neoplasms / Q000097:blood* / Q000188:drug therapy*
D018906:Antineoplastic Agents, Alkylating; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D009363:Neoplasm Proteins; D006585:Altretamine