Phase I-II study of two consecutive courses of high-dose epipodophyllotoxin, ifosfamide, and carboplatin with autologous bone marrow transplantation for treatment of adult patients with solid tumors.

Abstract

We describe a phase I-II study of two consecutive 5-day courses of a three-drug regimen of ifosfamide (IFM), carboplatin (CBDCA), and either etoposide (VP-16) (regimen 1) or teniposide (VM-26) (regimen 2) in high doses together with autologous bone marrow transplantation (ABMT), for previously treated patients with ovarian carcinoma (OC), germ cell tumors (GCT), gestational trophoblastic disease (GTD), or oat cell carcinoma (OCC). Forty-four patients entered the study. Two patients with OC received regimen 1, and 22 were given regimen 2. Sixteen patients with GCT, two with GTD, and two with OCC were treated with regimen 1. Six patients (13%) died of toxicity. Nephropathy and esophagitis were the dose-limiting toxic effects. The maximum-tolerated doses (MTDs) were 1,500 and 200 mg/m2/d for 5 days for IFM and CBDCA, respectively, in combination with VP-16 250 mg/m2/d for 5 days (regimen 1), and 150, 1,500, and 200 mg/m2/d for 5 days for VM-26, IFM, and CBDCA, respectively (regimen 2). The response rate of patients with OC was 78% (complete response [CR], 14%). For patients previously resistant to chemotherapy, the response rate was 70%. There were no long-term disease-free survivors among patients with OC. The response rate of patients with GCT was 60% (CR, 33%). All responders with GCT were resistant to previous chemotherapy. Unmaintained CRs lasted 2, 6, 8+, 27+, and 37+ months. Of the two patients with GTD, one with previous resistance to chemotherapy attained a CR of 18+ months. One patient with OCC attained a CR lasting 6 months. The regimen possesses great antitumor activity. It produced CRs of long duration in a number of patients with GCT and GTD who were previously resistant to chemotherapy.

Double dose-intensive chemotherapy with autologous stem cell support for relapsed and refractory testicular cancer: the University of Michigan experience and literature review

“…[33][34][35][36][37][38][39][40][41][42] Unlike other solid tumors (eg breast, ovary) in which a clinical complete response prior to BMT is associated with prolonged progression-free survival, some testicular cancer patients with chemoresistant or refractory disease may be cured with attainment of CR after BMT and surgical resection of residual masses. Approximately one-third (range, 23-55%) of patients achieve CR after high-dose chemotherapy +/− surgery, and half of those responses are durable.…”

“…Approximately one-third (range, 23-55%) of patients achieve CR after high-dose chemotherapy +/− surgery, and half of those responses are durable. [33][34][35][36][37][39][40][41][42][43][44][45][46][47][48][49] Conversely, failure to achieve CR results in disease relapse for most patients.…”

“…35,36,[39][40][41][42]46 Theoretically, a second high-dose treatment may consolidate a CR or allow achievement of CR if induced drug resistance is minimal after first BMT. Analysis of the literature is complicated however, by the fact that although a tandem transplant is planned, only about 60% actually receive both high-dose courses (Table 4).…”

Tandem transplant of peripheral blood stem cells for patients with poor-prognosis Hodgkins’s disease or non-Hodgkin’s lymphoma

“…Currently, little information has been published concerning procedure-related morbidity or NHL outcome after tandem or second transplants and available data are mostly from patients with solid tumors or myeloma. [15][16][17][27][28][29][30] The most difficult problems are to individualize a poor prognosis group of patients who can benefit from tandem transplants and to find two myeloablative conditioning regimens with acceptable toxicities. The purpose of this study was to determine the different toxicities encountered in tandem transplants performed in poor prognosis lymphoma; early and late hematological recoveries, extra-hematological toxicities and to assess failure-free survival in this population.…”

High-dose chemotherapy with autologous peripheral blood stem cell transplantation for choriocarcinoma: A case report and literature review

“…After excluding male cases or non-gestational choriocarcinoma, our search yielded 21 cases in 11 articles between 1991 and 2013 (Table II) (7,8,(10)(11)(12)(13)(14)(15)(16)(17)(18). Two cases reported by Jean-Pierre Lotz in 1991 (11) were included in the 5 cases reported in 1995 by the same author (8).…”