Feasibility of multiple courses of high-dose cyclophosphamide, thiotepa, and carboplatin for breast cancer or germ cell cancer.

Rodenhuis, S.; Westermann, Anneke M.; Holtkamp, M. J.; Nooijen, W. J.; Baars, Joke W.; Wall, Elsken van der; Slaper-Cortenbach, I. C. M.; Schornagel, J. H.

doi:10.1200/jco.1996.14.5.1473

Cited by 89 publications

(55 citation statements)

References 15 publications

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“…Toxicity of the high-dose CTC regimen JG Schrama et al (Rodenhuis et al, 1996). Patients who receive more than a single course of CTC may, however, develop major organ toxicity, including severe haemorrhagic cystitis, veno-occlusive disease and haemolytic uraemic syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…The procedures of bone marrow harvesting and leucoytaphoris have been described previously (van der Wall et al, 1995;Rodenhuis et al, 1996Rodenhuis et al, , 1998Rodenhuis et al, , 1999Rodenhuis et al, , 2000.…”

Section: Treatment Regimenmentioning

confidence: 99%

“…The peripheral blood progenitor cell reinfusion (PBPC-Tx) was performed 2 days after the end of the chemotherapy. The prophylactic use of antiemetics and antibiotics of the separate studies have been described elsewhere (Rodenhuis et al, 1992(Rodenhuis et al, , 1996van der Wall et al, 1995). Briefly, all patients received antiemetics prophylactically, consisting of dexamethasone and serotonin antagonist and/or metoclopramide.…”

Section: Treatment Regimenmentioning

confidence: 99%

“…It contains the same agents as STAMP-V, but the carboplatin dose is twice as high and the agents are administered as short-term infusions rather than as continuous infusions. CTC has been used in several randomised and nonrandomised studies in high-risk (van der Wall et al, 1995;Rodenhuis et al, 1996Rodenhuis et al, , 1998Rodenhuis et al, , 1999Rodenhuis et al, , 2000Schrama et al, 2002) and in stage IV breast cancer (Schrama et al, 2001;De Gast et al, 2002) and, moreover, in the salvage therapy of germ cell cancer (Rodenhuis et al, 1996.…”

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Toxicity of the high-dose chemotherapy CTC regimen (cyclophosphamide, thiotepa, carboplatin): the Netherlands Cancer Institute experience

et al. 2003

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High-dose chemotherapy (HD-CT) has a role in the potentially curative treatment of several tumours. The relative efficacies of the different regimens have not been studied in comparative trials, but it is clear that toxicities differ significantly between them. We analysed the immediate and long-term toxicity in the first 100 consecutive patients treated with the CTC regimen (cyclophosphamide 6000 mg m À2 , carboplatin 1600 mg m À2 (or 20 mg ml À1 min under the curve (AUC)) both as daily 1 h infusion, thiotepa 480 mg m À2 as twice daily 30 min infusion, all divided over 4 consecutive days) followed by peripheral blood progenitor cell reinfusion (PBPC-Tx). Most patients had high-risk (n ¼ 86) or metastatic (n ¼ 4) breast cancer, or a germ cell tumour (n ¼ 8). Two patients (with a medulloblastoma and an aesthesioneuroblastoma, respectively) received CTC as off-protocol salvage regimen. The main toxicity was bone marrow suppression. Most patients had PBPC-Tx with granulocyte colony-stimulating factor (G-CSF), and the median time to neutrophil count 500 Â 10 6 l À1 and platelet count 420 Â 10 9 l À1 without transfusion independence was 10 (range 8 -25) and 13 (8 -60) days, respectively. The toxic death rate was 1%. Other frequent toxicities were neutropenic fever requiring antibiotics (n ¼ 65), central catheter-related infection (n ¼ 12) or a bleeding episode (n ¼ 48), mostly epistaxis (n ¼ 26). Reversible cardiac toxicity was seen in six patients and pulmonary events occurred in seven patients (infection (n ¼ 6), embolism (n ¼ 1)). Grade 3 -4 gastrointestinal toxicity was frequent: nausea and vomiting 55%, diarrhoea 28% and mild liver toxicity (transaminase elevations) 9%. One patient pretreated with cisplatin had a kidney transplantation 8 years after HD-CT. Late complications included reversible radiation pneumonitis (n ¼ 12) and chronic heart failure (n ¼ 2). We found five second solid malignancies and two myelodysplasias. In conclusion, the CTC regimen is associated with a moderate, mainly reversible, toxicity. Future studies need to compare the efficacy and toxicity of the different HD-CT regimens.

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Section: Discussionmentioning

confidence: 99%

Section: Treatment Regimenmentioning

confidence: 99%

Section: Treatment Regimenmentioning

confidence: 99%

mentioning

confidence: 99%

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Toxicity of the high-dose chemotherapy CTC regimen (cyclophosphamide, thiotepa, carboplatin): the Netherlands Cancer Institute experience

et al. 2003

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“…The availability of peripheral blood haematopoietic progenitor cells (PBPCs) from different harvesting techniques and the possibilities of storage have raised interest in the administration of repetitive, closely spaced cycles of dose-intensive chemotherapy, each with PBPC rescue (Benjamin et al, 1995;Leyvraz et al, 1995;Pettengell et al, 1995;Vahdat et al, 1995;Rodenhuis et al, 1996). It was previously reported that autologous whole blood (without processing through a cell separator) 'primed' with chemotherapy and granulocyte colony-stimulating factor (G-CSF) provided sufficient PBPCs for myelosupportive effects (Pettengell et al, 1994(Pettengell et al, , 1995Preti et al, 1994;Ossenkoppele et al, 1996).…”

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A phase I/II study of multicyclic dose-intensive chemotherapy supported with G-CSF, or G-CSF and haematopoietic progenitor cells in whole blood, in two consecutive cohorts of patients

Wit

Kruit²,

Lamers³

et al. 1998

Br J Cancer

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A phase /11 study of multicyclic dose-intensive chemotherapy supported with G-CSF, or Summary We investigated the reconstitutive potential of haematopoietic progenitor cells collected in autologous whole blood during multicycle dose-intensified chemotherapy. Forty patients with metastatic solid tumours were treated with up to six cycles of cisplatin and escalating doses of ifosfamide every 14 days. Cisplatin was administered in 3% sodium chloride over 3 h, followed by ifosfamide over 24 h and mesna over 36 h. The first cohort of patients received granulocyte colony-stimulating factor (G-CSF) days 4-14. Once dose-limiting toxicity was reached in cohort 1, the study continued with a second cohort of patients, in whom, in addition to G-CSF on days 4-14, 500 ml of G-CSF and chemotherapy-primed' whole blood was collected on day 15, i.e. on day 1 of treatment cycles two to six, before cisplatin administration. This volume of blood was kept unprocessed at 40C and reinfused 20-24 h after the completion of ifosfamide. In cohort 1, dose-limiting toxicity (DLT) was reached at ifosfamide 6.0 g m-2 with two out of six of the patients developing neutropenic fever. Although in cohort 2 no neutropenic fever was encountered, neither the frequency nor the duration of grade 4 neutropenia and thrombocytopenia were reduced. Cumulative asthenia resulted in DLT at 7.0 g m-2. The median number of CD34+ cells in 500 ml of whole blood after the first cycle (i.e. at start of cycle 2) was 1.15 x 106 kg-1. This number was significantly greater after the second cycle (2.06 x 106 kg-', P = 0.01) and then gradually decreased after cycles three to six. After storing whole blood, the number of CD34 + cells had not decreased (median + 10%). We conclude that the method of combined bone marrow support by G-CSF and haematopoietic progenitor cells in autologous whole blood collected before each cycle of a 2-weekly regimen of cisplatin-ifosfamide does not result in clinically measurable reduced bone marrow toxicity compared with what can be expected by the use of G-CSF alone.

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Feasibility of sequential high-dose chemotherapy and peripheral blood stem cell support for pediatric central nervous system malignancies

Jakacki

Jamison

Heifetz

et al. 1997

Med. Pediatr. Oncol.

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Background The outlook for many brain tumors remains poor. Increased dose intensity has been correlated with response rate and survival in many solid tumors. Patients and Methods Ten children with recurrent or newly diagnosed brain tumors were treated with four sequential courses of high‐dose single agent chemotherapy with peripheral blood stem cell (PBSC) support. PBSC harvesting was undertaken prior to chemotherapy and following the first course of chemotherapy (3.6 g/m2 etoposide). Each course of chemotherapy consisted of a single drug followed 48 hours later by PBSC reinfusion. Three patients were treated on Regimen A: etoposide, carboplatinum 1.95 g/m2, cyclophosphamide 5 g/m2, and thiotepa 300 mg/m2; three patients were treated on Regimen A′ with carmustine 600 mg/m2 replacing cyclophosphamide; four patients received Regimen B: etoposide, carboplatinum 1.95g/m2, cyclophosphamide 7 g/m2, and thiotepa 900 mg/m2. Results No course of chemotherapy was complicated by >14 days of neutropenia. Platelet recovery was more prolonged, particularly in patients who had previously received craniospinal irradiation. Non‐hematologic toxicity was severe with three toxic deaths including two patients who developed hemolytic‐uremic syndrome and respiratory failure. Two of three patients with primitive neuroectodermal tumors had a partial response; no responses were observed in patients with high‐grade gliomas. Conclusions Administration of multiple courses of high‐dose chemotherapy with PBSC support is feasible in this patient population and successfully mitigates hematologic toxicity. Non‐hematologic toxicity becomes prohibitive as chemotherapy doses are escalated. Med. Pediatr. Oncol. 29:553–559, 1997. © 1997 Wiley‐Liss, Inc.

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Feasibility of multiple courses of high-dose cyclophosphamide, thiotepa, and carboplatin for breast cancer or germ cell cancer.

Cited by 89 publications

References 15 publications

Toxicity of the high-dose chemotherapy CTC regimen (cyclophosphamide, thiotepa, carboplatin): the Netherlands Cancer Institute experience

Toxicity of the high-dose chemotherapy CTC regimen (cyclophosphamide, thiotepa, carboplatin): the Netherlands Cancer Institute experience

A phase I/II study of multicyclic dose-intensive chemotherapy supported with G-CSF, or G-CSF and haematopoietic progenitor cells in whole blood, in two consecutive cohorts of patients

Feasibility of sequential high-dose chemotherapy and peripheral blood stem cell support for pediatric central nervous system malignancies

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