Two independent and consecutive randomized clinical trials, conducted by the American Gynecological Oncology Group and by an European-Canadian Intergroup, have shown superiority, in clinical response rate, progression-free survival, and overall survival, of a cisplatin-paclitaxel regimen over cisplatin-cyclophosphamide given as first-line chemotherapy for women with advanced epithelial ovarian cancer. The results of these studies, published with a median follow-up of about 3 years, have been updated with a 6.5-year follow-up: In each case, an 11% absolute gain in survival favoring the paclitaxel arm is shown; this advantage remains both statistically and clinically significant and supports a role for paclitaxel in frontline chemotherapy for advanced ovarian cancer.

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Two independent and consecutive randomized clinical trials, conducted by the American Gynecological Oncology Group and by an European–Canadian Intergroup, have shown superiority, in clinical response rate, progression-free survival, and overall survival, of a cisplatin–paclitaxel regimen over cisplatin–cyclophosphamide given as first-line chemotherapy for women with advanced epithelial ovarian cancer. The results of these studies, published with a median follow-up of about 3 years, have been updated with a 6.5-year follow-up: In each case, an 11% absolute gain in survival favoring the paclitaxel arm is shown; this advantage remains both statistically and clinically significant and supports a role for paclitaxel in frontline chemotherapy for advanced ovarian cancer.

Empitical therapy with cefoperazone was compared with cefoperazone plus amikacin in granulocytopenic and nongranulocytopenic febrile patients. In nonneutropenic patients the overall response rate to cefoperazone was 88%; 10 of 12 gram-negative bacteremic patients were cured. Cefoperazone plus amikacin resulted in an 88% overall response rate and cured 14 of 15 patients with bacteremia. In neutropenic patients the overall response rate was 77% with cefoperazone alone and 73% with cefoperazone plus amikacin; the cure rates for gram-negative bacteremias were 8 of 11 and 6 of 12 patientsj,espectively. Infection in cancer patients can rapidly become a lifethreatening situation, especially in the presence of gram-negative bacteremia and bone marrow failure (12). When sepsis is suspected, usually on the basis of fever, prompt antimicrobial therapy and adequate supportive care are needed before the nature and susceptibility of the pathogens are known. Empirical therapy should provide adequate coverage against all the likely pathogens. Gram-negative bacilli are the most common pathogens in severe infections of the immunocompromised host, especially neutropenic patients, and infection may be rapidly fatal under these conditions. Until now, a broad-spectrum activity could only be achieved with combinations of antimicrobial agents, namely, beta-lactam antibiotics and aminoglycosides; these combinations, which frequently have a synergistic action against members of the family Enterobacteriacae and Pseudomonas aeruginosa, have been shown to be associated with a better clinical outcome than single-drug therapy (6). However, antibiotic combination therapy is associated with an increased frequency of allergic and toxic reactions, a potentially difficult situation in cancer patients who are already exposed to the toxicity of their anti-cancer treatment.This is why the possibility of using a single drug for empirical therapy in febrile cancer patients appears appealing, provided a broad antimicrobial spectrum and an adequate bactericidal activity can be obtained. The introduction of the so-called "third-generation cephalosporins" offers a possibility for single-drug therapy in immunocompromised patients.The preliminary results of empirical therapy with the latest cephalosporins are encouraging (4); however, no final statement can be made at the present time as to whether this empirical monotherapy is more or less active than the aminoglycoside-containing combinations.Cefoperazone is a cephalosporin of the third generation. It has low minimal inhibitory and bactericidal concentrations against most aerobic gram-negative bacilli and a satisfactory * Corresponding author. activity against anaerobes (with the exception of Bacteroides fragilis) and Staphylococcus aureus. Its pharmacological properties and therapeutic effectiveness have recently been reviewed (2).We conducted a prospective randomized study to compare empirical therapy with cefoperazone alone with empirical therapy with cefoperazone plus amikacin in cancer patients, wheth...

One hundred thirty-three patients with advanced metastatic cancer were randomized to receive single-agent chemotherapy selected by either a medical oncologist or an in vitro capillary cloning system. Thirty-six of the 65 patients (55%) who were randomly assigned to selection of a drug by the clinician actually received a drug; these patients were able to be evaluated for clinical response. Of these 36 patients, one had a partial tumor response (3%). Only 19 of the 68 patients (28%) who were randomly assigned to selection of a drug by the capillary system actually received a drug; these patients were able to be evaluated for clinical response. Of these 19 patients, four (21%) had partial tumor responses. In the assessable patients (36 in the clinician's choice group, 19 in the capillary cloning group), the partial response rate was superior for drug selection by the capillary cloning system (P = .04). For all patients randomly assigned to a group (65 in the clinician's choice group, 68 in the capillary cloning group), the response rate was not significantly different (1.5% and 5.9%, respectively; P = .37). When overall survival rates for patients in the two groups were compared, there was no difference. We conclude that drug sensitivity testing in capillary tubes can improve the response rate for patients with advanced malignancies. This improved response rate, however, does not translate into improved survival times for these patients.