Ifosfamide and Epirubicin Combination in Untreated Sarcomas: Two Treatment Schedules

Abstract

Background : The Epirubicin (EPI) and ifosfamide (IFO) combination has been widely tested in soft tissue sarcomas, even though the optimal schedule of drug administration has still to be defined. In this article, we reviewed the activity and the toxicity of two EPI- and IFO-based schedules in newly diagnosed sarcomas. Material and Methods: 22 patients (group A) received a ‘concurrent’ schedule of short-infusion IFO at total dose of 7.5–9 g/m² over 5 days plus iv bolus EPI at 90–120 mg/m²/cycle, repeated every 3 weeks. The other 22 patients (group B) received a ‘sequential’ schedule of dose-intense, continuous infusion IFO at a total dose of 14–18 g/m² for 2 cycles followed by bimonthly EPI at 120–160 mg/m²/cycle. Application of growth factors was planned for each course of treatment. Results: Since 1994, 44 consecutive patients have been treated. The overall response rate was 35% with no significant differences between the two treatment groups in terms of response rate (group A: 33%, group B: 37%), time to progression (group A: 7 months, group B: 8 months), and overall survival (group A: 12 months, group B: 15 months). General tolerance to treatment was better in group A. Gastrointestinal symptoms occurred significantly more often with the sequential regimen. Severe hematologic toxicity was common but no toxic deaths were observed. Conclusions: Based on this limited experience, a concurrent schedule of EPI and IFO seems to be an appropriate management strategy in the front-line therapy of advanced sarcomas. Nevertheless, a randomized trial is warranted to define the optimal dosages to be used for further clinical trials.

Comprehensive analysis of published studies involving systemic treatment for chondrosarcoma of bone between 2000 and 2013

“…This is in line with previous studies and the current opinion is that mesenchymal CS is a chemotherapy sensitive tumor and that patients therefore benefit from chemotherapy treatment [25,29]. For the other CS subtypes it has generally been thought that they are insensitive to conventional chemotherapy, although for dedifferentiated CS activity was shown in individual cases and it is still undefined if chemotherapy treatment is effective [3,12,49]. A retrospective study with 337 dedifferentiated CS patients shows that the prognosis remains dismal, however an improvement of survival, not significant, in patients receiving chemotherapy who are under 60 years of age and had limb salvage treatment was found [13].…”

New emerging drugs in soft tissue sarcoma

“…At this dose level, all of 13 assessable patients achieved a major response. These results are consistent with those observed in other studies [11,16]. In particular, a clinical study evaluated a dose-intensive chemotherapy with a full-dose of ifosfamide (2.5 g/m 2 /day as a continuous infusion on days [1][2][3][4][5] and epirubicin (45 mg/m 2 /day as a continuous infusion on days 2 and 3) every 3 weeks, in 45 patients with advanced STS.…”

Evaluation of cytotoxic properties of organometallic ferrocifens on melanocytes, primary and metastatic melanoma cell lines

“…However, metastatic malignant melanoma does not respond to current therapies, and therefore has a very poor prognosis, with a median survival rate of 6 months and 5-year survival rate of less than 5% [1][2][3][4][5]. To date, the only FDA (USA)-approved chemotherapy for melanoma is the alkylating agent Dacarbazine, which gives clinical response in 5-10% of cases and cures approximately 1% of patients [6]. In addition, many different immunotherapies have been tested, but so far none of these approaches has received FDA regulatory approval.…”