title: 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.
  
  
  METHODS
  22 patients (group A) received a 'concurrent' schedule of short-infusion IFO at total dose of 7.5-9 g/m(2) over 5 days plus iv bolus EPI at 90-120 mg/m(2)/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/m(2) for 2 cycles followed by bimonthly EPI at 120-160 mg/m(2)/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.
authors.affiliation: Regina Elena Institute for Cancer Research and Treatment, Division of Medical Oncology A, S. Raffaele Hospital, Rome, Italy. lserrone@hotmail.com
authors.forename: L
authors.initials: L
authors.lastname: Serrone
authors.forename: M
authors.initials: M
authors.lastname: Zeuli
authors.forename: P
authors.initials: P
authors.lastname: Papaldo
authors.forename: C
authors.initials: C
authors.lastname: Nardoni
authors.forename: U
authors.initials: U
authors.lastname: Pacetti
authors.forename: F
authors.initials: F
authors.lastname: Cognetti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012509:Sarcoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015996:Survival Rate
chemical_list: D015251:Epirubicin; D007069:Ifosfamide