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SHR Neuro Cancer Cardio Lipid Metab Microb

Leyvraz, S; Pampallona, S; Martinelli, G; Ploner, F; Perey, L; Aversa, S; Peters, S; Brunsvig, P; Montes, A; Lange, A; Yilmaz, U; Rosti, G; Solid Tumors Working Party of the European Group for Blood and Marrow Transplantation.
A threefold dose intensity treatment with ifosfamide, carboplatin, and etoposide for patients with small cell lung cancer: a randomized trial.
J Natl Cancer Inst. 2008; 100(8): 533-541. Doi: 10.1093/jnci/djn088 [OPEN ACCESS]
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Co-authors Med Uni Graz: Ploner Ferdinand
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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.
Find related publications in this database (using NLM MeSH Indexing): Adult -; Aged -; Antineoplastic Agents, Alkylating - administration and dosage; Antineoplastic Agents, Phytogenic - administration and dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Carboplatin - administration and dosage; Carcinoma, Small Cell - drug therapy; Dose-Response Relationship, Drug -; Drug Administration Schedule -; Etoposide - administration and dosage; Female -; Hematologic Diseases - chemically induced; Humans -; Ifosfamide - administration and dosage; Incidence -; Lung Neoplasms - drug therapy; Male -; Middle Aged -; Odds Ratio -; Prognosis -; Research Design -; Survival Analysis -; Treatment Outcome -