A threefold dose intensity treatment with ifosfamide, carboplatin, and etoposide for patients with small cell lung cancer: a randomized trial.

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Serval ID
serval:BIB_5EB746C016AC
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
A threefold dose intensity treatment with ifosfamide, carboplatin, and etoposide for patients with small cell lung cancer: a randomized trial.
Journal
Journal of the National Cancer Institute
Author(s)
Leyvraz S., Pampallona S., Martinelli G., Ploner F., Perey L., Aversa S., Peters S., Brunsvig P., Montes A., Lange A., Yilmaz U., Rosti G., Marrow Transplantation
Working group(s)
Solid Tumors Working Party of the European Group for Blood
Contributor(s)
Marrow Transplantation, Aversa S., Brunsvig P., Buxhofer V., Crown J., De Bock R., Demirer T., Kühr T., Lange A., Leyvraz S., Martinelli G., Montes A., Piazza E., Ploner F., Rosti G., Rudolf C., Schneider CP., van Klaveren R., Yilmaz U., Parmar M., Thatcher N., Hansen H.
ISSN
1460-2105 (Electronic)
ISSN-L
0027-8874
Publication state
Published
Issued date
04/2008
Peer-reviewed
Oui
Volume
100
Number
8
Pages
533-541
Language
english
Notes
Publication types: Clinical Trial, Phase III ; Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
BACKGROUND: The dose intensity of chemotherapy can be increased to the highest possible level by early administration of multiple and sequential high-dose cycles supported by transfusion with peripheral blood progenitor cells (PBPCs). A randomized trial was performed to test the impact of such dose intensification on the long-term survival of patients with small cell lung cancer (SCLC).
METHODS: Patients who had limited or extensive SCLC with no more than two metastatic sites were randomly assigned to high-dose (High, n = 69) or standard-dose (Std, n = 71) chemotherapy with ifosfamide, carboplatin, and etoposide (ICE). High-ICE cycles were supported by transfusion with PBPCs that were collected after two cycles of treatment with epidoxorubicin at 150 mg/m(2), paclitaxel at 175 mg/m(2), and filgrastim. The primary outcome was 3-year survival. Comparisons between response rates and toxic effects within subgroups (limited or extensive disease, liver metastases or no liver metastases, Eastern Cooperative Oncology Group performance status of 0 or 1, normal or abnormal lactate dehydrogenase levels) were also performed.
RESULTS: Median relative dose intensity in the High-ICE arm was 293% (range = 174%-392%) of that in the Std-ICE arm. The 3-year survival rates were 18% (95% confidence interval [CI] = 10% to 29%) and 19% (95% CI = 11% to 30%) in the High-ICE and Std-ICE arms, respectively. No differences were observed between the High-ICE and Std-ICE arms in overall response (n = 54 [78%, 95% CI = 67% to 87%] and n = 48 [68%, 95% CI = 55% to 78%], respectively) or complete response (n = 27 [39%, 95% CI = 28% to 52%] and n = 24 [34%, 95% CI = 23% to 46%], respectively). Subgroup analyses showed no benefit for any outcome from High-ICE treatment. Hematologic toxicity was substantial in the Std-ICE arm (grade > or = 3 neutropenia, n = 49 [70%]; anemia, n = 17 [25%]; thrombopenia, n = 17 [25%]), and three patients (4%) died from toxicity. High-ICE treatment was predictably associated with severe myelosuppression, and five patients (8%) died from toxicity.
CONCLUSIONS: The long-term outcome of SCLC was not improved by raising the dose intensity of ICE chemotherapy by threefold.
Keywords
Adult, Aged, Antineoplastic Agents, Alkylating/administration & dosage, Antineoplastic Agents, Alkylating/adverse effects, Antineoplastic Agents, Phytogenic/administration & dosage, Antineoplastic Agents, Phytogenic/adverse effects, Antineoplastic Combined Chemotherapy Protocols/adverse effects, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Carboplatin/administration & dosage, Carboplatin/adverse effects, Carcinoma, Small Cell/drug therapy, Carcinoma, Small Cell/mortality, Dose-Response Relationship, Drug, Drug Administration Schedule, Etoposide/administration & dosage, Etoposide/adverse effects, Female, Hematologic Diseases/chemically induced, Humans, Ifosfamide/administration & dosage, Ifosfamide/adverse effects, Incidence, Lung Neoplasms/drug therapy, Lung Neoplasms/mortality, Male, Middle Aged, Odds Ratio, Prognosis, Research Design, Survival Analysis, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
12/02/2009 10:45
Last modification date
25/09/2019 7:09
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