Randomized comparison of hexamethylmelamine, adriamycin, cyclophosphamide (hac) vs. cisplatin, adriamycin, cyclophosphamide (pac) in advanced ovarian cancer: long-term results

Abstract

Since the late 1970s hexamethylmelamine (H) and cisplatin (P) have been added to several combination chemotherapies in the treatment of advanced ovarian cancer. The main reasons for their inclusion were the higher complete response rate produced by the Hexa-CAF regimen over that of single agent L-PAM (9) and by the 300/b objective response rate achieved with P in patients resistant to alkylating agents (8). In 1978, we tested the activity of H and P, each in combination with adriamycin and cyclophosphamide (AC), a regimen for which promising preliminary results were already available (4). The first analysis of the study, performed at a median follow-up time of 36 months, showed that the HAC regimen was as effective as PAC in terms of response, duration of remission and survival (6). The occurrence of late relapses after negative second-look laparotomy suggests that early survival data may be prognostically inadequate in ovarian cancer and that the impact of a treatment is betterjudged on the basis of long-term analysis (2, 7). The present report summarises the results of the HAC vs. PAC study at a median follow-up time of 10 years (range, 107-140 months).