title: Dose-intensive first-line chemotherapy with epirubicin and continuous infusion ifosfamide in adult patients with advanced soft tissue sarcomas: a phase II study.
abstract: This phase II study was designed to verify the activity and safety of an intensive epirubicin/ifosfamide schedule in untreated soft tissue sarcoma (STS) patients by using both the agents at the identified maximal tolerated doses. 39 adult patients were treated with epirubicin at 55 mg/m2, on days 1 and 2 (total dose per cycle 110 mg/m2) combined with ifosfamide at 2.5 g/m2 days 1-4 (total dose per cycle 10 g/m2), with equidose mesna uroprotection and G-CSF support. Treatment was given on an ambulatory basis, at 3-week intervals. The overall objective response (OR) rate was 59% (95% confidence interval, CI, 43-72%), with 5 complete responses (13%) at 18 partial responses (46%); 12 partial responders were rendered disease-free following surgery. The median survival time was 19 months, being 23 and 13 months, respectively, for responding and non-responding patients. The median time to response was 40 days (range 21-60). Treatment-related toxicity was overall acceptable. The OR of 59% was the highest ever reported in our consecutive studies in advanced STS, confirming that improved therapeutic efficacy can be obtained with intensified regimens in such a disease; both the response duration and survival were also longer. The observed activity proved to be interesting with regard to the high response rate in the lung (86%), as well as the proportion of patients rendered disease-free by early surgery after the achievement of a partial response (55%). Both these findings may be important in the multimodality approach to patients with lesions potentially resectable for cure.
authors.affiliation: Department of Medical Oncology, University of Genoa, National Institute for Cancer Research, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Palumbo
authors.forename: C
authors.initials: C
authors.lastname: Neumaier
authors.forename: M
authors.initials: M
authors.lastname: Cosso
authors.forename: G
authors.initials: G
authors.lastname: Bertero
authors.forename: P
authors.initials: P
authors.lastname: Raffo
authors.forename: N
authors.initials: N
authors.lastname: Spadini
authors.forename: S
authors.initials: S
authors.lastname: Valente
authors.forename: G
authors.initials: G
authors.lastname: Villani
authors.forename: M
authors.initials: M
authors.lastname: Pastorino
authors.forename: S
authors.initials: S
authors.lastname: Toma
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D007262:Infusions, Intravenous; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012509:Sarcoma / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D015251:Epirubicin; D007069:Ifosfamide