Combination Bleomycin, Ifosfamide, and Cisplatin Chemotherapy in Cervical Cancer

Abstract

We report a phase II study of bleomycin, ifosfamide, and cisplatin (BIP) in cervical cancer. Our aims were to assess response rate, toxicity, and survival in women treated with this combination. Among 49 patients, 34 objective responses (69%) were seen, with 10 complete responses (20%). Toxic effects were assessed in 186 treatment cycles. All patients had alopecia and nausea and vomiting. Other effects included myelosuppression, infection, reduction in renal function, and disturbance of consciousness. These data indicate that BIP is highly active against advanced and recurrent cervical cancer.

Phase I–II study of irinotecan (CPT-11) plus nedaplatin (254-S) with recombinant human granulocyte colony-stimulating factor support in patients with advanced or recurrent cervical cancer

“…Several combination chemotherapy regimens that contain cisplatin have been tested in phase II studies, and objective responses have been documented in 30 -70% of the patients, while the median overall survival time ranged between 7 and 12 months (Buxton et al, 1989;Murad et al, 1994;Long et al, 1995;Papadimitriou et al, 1997Papadimitriou et al, , 1999Rose et al, 1999). Although it is difficult to directly compare the relative merits of the combined regimens with the single agents, combination chemotherapy seems to be superior to single-agent therapy based on these phase II studies.…”

“…Many combination chemotherapy regimens have also been explored during the last two decades. High response rates have been obtained in some studies, but it is difficult to assess the relative merits of the various regimens because of differences in patient selection (Buxton et al, 1989;Papadimitriou et al, 1999).…”

Gynecologic oncology group trials of chemotherapy for metastatic and recurrent cervical cancer

“…Other non-GOG phase II trials in cervical cancer that are of considerable interest include that of Buxton et al [45], in which a combination of bleomycin, ifosfamide, and cisplatin yielded 34 objective responses (69%), including 10 complete responses, in a study group of 49 subjects. The regimen containing methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) has been the subject of two reports examining its role in advanced/recurrent cervical carcinoma: an overall response rate of 66% (including 21% complete responses) was observed in the study by Long et al [46], whereas objective responses were observed in 52% (including 11% complete responses) of subjects reported by Papadimitriou et al [47].…”

“…The papers by Fiorica et al [44], Buxton et al [45], and Long et al [46], together with the GOG-76 trials [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], laid the foundation for the phase III GOG experience in metastatic cervical carcinoma.…”

“…Ifosfamide was known to have less marrow toxicity but more bladder toxicity than cyclophosphamide, which required concomitant use of the uroprotector, mesna. The series of 49 patients from Buxton et al [45] treated with a combination of ifosfamide, cisplatin, and bleomycin yielded an impressive 69% response rate. The importance of bleomycin, however, was unclear, and because of its troublesome toxicity, which restricted its use to patients with good pulmonary function, it was excluded from protocol 110.…”