title: Phase I study of high-dose ifosfamide, carboplatin and etoposide with autologous hematopoietic stem cell support.
abstract: More effective high-dose combination regimens are needed which have broad cytotoxic activity, steep dose-response relations and non-overlapping non-hematologic toxicities (to allow administration of full doses of each agent). This study was designed to define the dose-limiting toxicities and maximum tolerated doses of ifosfamide, carboplatin and etoposide (ICE) with hematopoietic stem cell support. Ifosfamide and carboplatin were initially fixed at 75% and 80% of the single agent maximum tolerated doses, respectively, and etoposide added to the combination. After the dose-limiting toxicity of etoposide was reached, its dose was fixed and ifosfamide and carboplatin were individually dose escalated as tolerated. All agents were given by 96h continuous infusion (days -7 to -3). Autologous marrow, with or without peripheral blood progenitor cells, was reinfused on day 0. Forty eight adults with advanced malignancies were enrolled in cohorts of three to five patients. At the maximum tolerated doses of ifosfamide 16 g/m2, carboplatin 1.8 g/m2 and etoposide 1.2 g/m2, renal toxicity precluded further dose escalation. Two patients died of organ (renal, CNS) toxicity (4%). Renal toxicity was particularly prominent in patients with prior cisplatin exposure. An early chemotherapy-stopping rule was developed, supported by pharmacologic analysis, which resulted in immediate discontinuation of ifosfamide and carboplatin if the serum creatinine, monitored twice daily during chemotherapy, exceeded 1.5 mg/dl and was > 0.5 mg/dl above baseline. High-dose ICE is well tolerated if serum creatinines are carefully monitored during chemotherapy administration. The early chemotherapy-stopping rule may enhance safety of the regimen but requires validation by addition correlation with pharmacokinetic data for each of the chemotherapeutic agents.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Division of Clinical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Elias
authors.forename: L J
authors.initials: LJ
authors.lastname: Ayash
authors.forename: C
authors.initials: C
authors.lastname: Wheeler
authors.forename: G
authors.initials: G
authors.lastname: Schwartz
authors.forename: I
authors.initials: I
authors.lastname: Tepler
authors.forename: R
authors.initials: R
authors.lastname: Gonin
authors.forename: M
authors.initials: M
authors.lastname: McCauley
authors.forename: R
authors.initials: R
authors.lastname: Mazanet
authors.forename: L
authors.initials: L
authors.lastname: Schnipper
authors.forename: E
authors.initials: E
authors.lastname: Frei
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D004064:Digestive System / Q000187:drug effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D009420:Nervous System / Q000187:drug effects; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D012509:Sarcoma / Q000188:drug therapy*; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000188:drug therapy*; D014182:Transplantation, Autologous
chemical_list: D005047:Etoposide; D002945:Cisplatin; D007069:Ifosfamide