Ifosfamide/carboplatin/etoposide (ICE) regimen in small cell lung cancer

Thatcher, Nicholas

doi:10.1016/0169-5002(93)90005-i

Cited by 11 publications

(8 citation statements)

References 29 publications

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“…As noted below, a number of studies have evaluated ifosfamide in combination with carboplatin and etoposide, with or without other agents, in previously untreated patients with SCLC ( Table 5). The ifosfamide/carboplatin/etoposide (ICE)containing regimens produced overall response rates of 79% to 94% in patients with LD [30][31][32][33][34]. The median duration of survival ranged from 16.6 to 19 months and two-year survival rates ranged from 24% to 32%.…”

Section: Carboplatin In Ifosfamide-containing Regimensmentioning

confidence: 99%

Carboplatin in the Treatment of Small Cell Lung Cancer

Brahmer¹,

Ettinger²

1998

The Oncologist

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Small cell lung cancer (SCLC) will account for approximately 20%‐25% of the 171,500 estimated new lung cancer cases in 1998. Combination cytotoxic therapies have yielded the best response rates in SCLC patients. Cisplatin in combination with etoposide is used routinely in the treatment of SCLC. Because of cisplatin's nonhematologic toxicities, carboplatin was developed and has far fewer nonhematologic toxicities. Carboplatin in combination with etoposide has been shown to be as effective as, but less toxic than, cisplatin/etoposide. Moreover, carboplatin/etoposide is a viable combination in the treatment of the elderly with SCLC, who can readily tolerate this combination. Concurrent radiation therapy with carboplatin and etoposide in patients with limited SCLC disease can be given safely and effectively. Carboplatin has been combined with several different chemotherapeutic agents, including ifosfamide, and, more recently, paclitaxel in hopes of improving the response rates and overall survival. In order to try to dose intensify carboplatin‐based regimens, peripheral blood stem cells have been used to decrease the hematologic toxicities. Further studies are warranted to investigate these therapies as well as newer carboplatin combinations.

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Section: Carboplatin In Ifosfamide-containing Regimensmentioning

confidence: 99%

Carboplatin in the Treatment of Small Cell Lung Cancer

Brahmer¹,

Ettinger²

1998

The Oncologist

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“…Although no optimal regimen has been Bone Marrow Transplantation identified, combinations of cisplatin, carboplatin, etoposide, ifosfamide or doxorubicin have been demonstrated to be active. [14][15][16][17][18] The combination of carboplatin-etoposideifosfamide (ICE), used in the current study, has been accepted world-wide as one of the standard chemotherapy regimens in the treatment of SCLC. 13,18 Despite these active regimens, curative therapy is only available to a small minority of patients with limited disease SCLC, while treatment of extensive disease is virtually always palliative.…”

Section: Discussionmentioning

confidence: 99%

A phase I dose escalation study of multicyclic, dose-intensive chemotherapy with peripheral blood stem cell support for small cell lung cancer

Takahashi

Yoshizawa

Tanaka

et al. 2000

Bone Marrow Transplant

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1,2 Models of the development of cytotoxic drug resistance suggest that maximal initial treatment will reduce the risk of relapse.3,4 Although small cell lung cancer (SCLC) is the histologic type most sensitive to combination chemotherapy, the majority of SCLC patients relapse with chemoresistant tumors. Circumvention of this secondary chemoresistance has been addressed using different treatment modalities.In a recent study, patients with limited-disease SCLC were randomly assigned to receive higher-or lower-dose cyclophosphamide and cisplatin during the first course of a cisplatin, etoposide, doxorubicin and cyclophosphamide regimen followed by five additional cycles at standard doses.5 A moderate increase in the cisplatin and cyclophosphamide doses during the first course resulted in a 17% increase in 2-year survival. However, myelosuppression is the limiting toxicity for this chemotherapy regimen.For the majority of drugs, myelosuppression is the initial dose-limiting toxicity. While hematopoietic growth factors have been utilized to reduce the toxicity and improve delivery of the planned dose, only a modest increase in dose intensity can be achieved.Recently, peripheral blood stem cells (PBSCs) have been used as a source of stem cells and shown to restore hematopoietic functions rapidly after PBSC autografting. Highdose chemotherapy with PBSC rescue has been used for leukemia and lymphoma, but for most chemosensitive solid tumors, a single high-dose chemotherapy as late intensification does not appear to prolong survival. 6 Since adjustments of the dose of cytotoxic drugs, as well as shortening of the intervals between courses, can increase dose intensity, multicyclic chemotherapy may offer the opportunity to maximize dose intensity of the treatment.

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“…Dose Intensity Phase I/II Trial with Filgrastim in Small-Cell Lung Cancer Oncology 1997;54:363-370 stratcd to be active [12,[26][27][28][29], Various strategies have been explored in order to further improve the efficacy of available regimens. These include strategies to increase dose intensity per unit time by either dose escalation with or without hematopoietic growth factors or late intensification chemotherapy [30,31].…”

Section: Discussionmentioning

confidence: 99%

“…Sys temic chemotherapy is therefore the first-line treatment in patients with this tumor type [1], High single agent activity has been shown for carboplatin, ifosfamide, and ctoposide with response rates of 40-60% [2][3][4][5][6]. Although overall response rates were further increased with combi nation therapy, long-term survival has not been signifi cantly improved [7][8][9][10][11][12]. Attempts have been made to intensify treatment strategies by dose escalation or short ening of treatment intervals [13][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Dose Intensity Phase l/lI Trial with Carboplatin, Ifosfamide, Etoposide and Vincristine Combined with Filgrastim in Patients with Small-Cell Lung Cancer

et al. 1997

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Background: The purpose of the study was to evaluate the feasibility of increasing dose intensity by a stepwise reduction of the time intervals between chemotherapy cycles in separate patient cohorts with small-cell lung cancer. Patients received up to 6 courses of combination chemotherapy with carboplatin, etoposide, ifosfamide and vincristine followed by support with filgrastim. Dose intensity, incidence, duration and severity of neutropenic fever and infections, objective response to chemotherapy, and safety of filgrastim were determined. Patients and Methods: 29 patients with small-cell lung cancer (limited disease: 2, extensive disease: 27) were treated with a combination of carboplatin 250 mg/m² i.v. day 1, ifosfamide 2 g/m² and etoposide 120 mg/m² i.v. days 1 and 2, etoposide 120 mg/m² orally day 3, and vincristine 1.4 mg/m² day 14. Initially, filgrastim (5 μg/kg) was administered subcutaneously from day 7 to 16. With shorter treatment intervals, filgrastim was administered on days 4-16 or 4-14. Results: An overall increase in dose intensity by a factor of 1.44 was achieved after reducing the treatment interval from 27 to 17 days. Further reduction to 14 days was not feasible due to persistent thrombocytopenia. Six patients (21%) developed a total of 9 febrile episodes, and 14 patients (48%) had to be withdrawn from the study before the completion of six cycles of chemotherapy. The median duration of infectious episodes was 6 days. Overall, a total of 22 of 27 evaluable patients had an objective response. Longer treatment intervals resulted in a lower probability for objective response (≥23 days: 10/14 patients vs. ≤17 days: 7/7 patients). Conclusion: Filgrastim allows for the reduction of treatment intervals in patients with small-cell lung cancer and increased dose intensity with acceptable hematologic and nonhematologic toxicities.

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Ifosfamide/carboplatin/etoposide (ICE) regimen in small cell lung cancer

Cited by 11 publications

References 29 publications

Carboplatin in the Treatment of Small Cell Lung Cancer

Carboplatin in the Treatment of Small Cell Lung Cancer

A phase I dose escalation study of multicyclic, dose-intensive chemotherapy with peripheral blood stem cell support for small cell lung cancer

Dose Intensity Phase l/lI Trial with Carboplatin, Ifosfamide, Etoposide and Vincristine Combined with Filgrastim in Patients with Small-Cell Lung Cancer

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