Multiple courses of high-dose ifosfamide, carboplatin, and etoposide with peripheral-blood progenitor cells and filgrastim for small-cell lung cancer: A feasibility study by the European Group for Blood and Marrow Transplantation.

Details

Serval ID
serval:BIB_1076697FFE3F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Multiple courses of high-dose ifosfamide, carboplatin, and etoposide with peripheral-blood progenitor cells and filgrastim for small-cell lung cancer: A feasibility study by the European Group for Blood and Marrow Transplantation.
Journal
Journal of Clinical Oncology
Author(s)
Leyvraz S., Perey L., Rosti G., Lange A., Pampallona S., Peters R., Humblet Y., Bosquée L., Pasini F., Marangolo M.
ISSN
0732-183X
Publication state
Published
Issued date
1999
Peer-reviewed
Oui
Volume
17
Number
11
Pages
3531-3539
Language
english
Abstract
PURPOSE: To determine the feasibility and safety of multiple sequential courses of high-dose chemotherapy and peripheral-blood progenitor cells (PBPCs) administered in a multicenter setting to patients with small-cell lung cancer. PATIENTS AND METHODS: Sixty-nine patients (limited disease, n = 30; extensive disease, n = 39) treated at 15 European centers were scheduled to receive three courses of high-dose chemotherapy with ifosfamide 10 g/m(2), carboplatin 1200 mg/m(2), and etoposide 1200 mg/m(2) (ICE) divided over 4 days at 28-day intervals. PBPCs were harvested before treatment and mobilized with epirubicin 150 mg/m(2) administered via an intravenous bolus divided over 2 days and filgrastim 5 microg/kg/d administered subcutaneously. RESULTS: The performed leukaphereses (one to five per patient) yielded a median of 16.6 x 10(6)/kg (range, 1.0 to 96.6 x 10(6)/kg) CD34(+) cells, which was sufficient for three reinfusions. Fifty patients (72%) completed the treatment according to schedule. Nine patients completed two courses, and six patients completed one course of treatment. The increase in dose-intensity was 290% that of a standard ICE regimen. The median duration of myelosuppression was similar between courses, namely 4 days (range, 1 to 12 days) for leukocytes less than 0.5 x 10(9)/L and 4 days (range, 0 to 22 days) for thrombocytes less than 20 x 10(9)/L. Febrile neutropenia developed in 66% of courses, severe diarrhea in 14%, mucositis in 10%, and nausea and vomiting in 21% of courses. There were six cases of toxic death (9%), most of which occurred in the first year of accrual and thus were attributable to the learning curve. The antitumor effect of the regimen was reflected in an 86% remission rate (95% confidence interval [CI], 74% to 93%), with 51% of patients achieving a complete response (95% CI, 38% to 63%). Median overall survival was 18 months for patients with limited disease and 11 months for patients with extensive disease. CONCLUSION: This multiple sequential high-dose ICE regimen could be safely administered on a multicenter basis to patients with small-cell lung cancer. The dose-intensity could be increased to 290% that of standard ICE regimen. The benefit of this approach is currently being tested in a randomized trial that aims to double the long-term rate of survival for patients with small-cell lung cancer.
Keywords
Adult, Aged, Antineoplastic Combined Chemotherapy Protocols/adverse effects, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Carcinoma, Small Cell/drug therapy, Carcinoma, Small Cell/pathology, Cisplatin/administration & dosage, Cisplatin/adverse effects, Dose-Response Relationship, Drug, Etoposide/administration & dosage, Etoposide/adverse effects, Europe, Feasibility Studies, Female, Filgrastim/therapeutic use, Hematopoietic Stem Cells/metabolism, Humans, Ifosfamide/administration & dosage, Ifosfamide/adverse effects, Logistic Models, Lung Neoplasms/drug therapy, Lung Neoplasms/pathology, Male, Middle Aged, Neoplasm Metastasis
Pubmed
Web of science
Create date
28/01/2008 8:32
Last modification date
20/08/2019 12:37
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