Outcome of pediatric recurrent and refractory malignant solid tumors following ifosfamide/carboplatin/etoposide (ICE): A phase II study in a pediatric oncology centre in Brazil.
BACKGROUND
Therapeutic trials using ifosfamide,carboplatin, and etoposide (ICE) regimen have suggested many patients with refractory/relapsed solid tumors may be rendered free of disease using this combination. The aim of this study was to assess the feasibility, response and toxicity of this regimen in a Brazilian Pediatric Oncology Centre.


METHODS
ICE, consisting of ifosfamide 3 g/m(2)/day x3 plus Mesna, etoposide 160 mg/m(2)/day x3, and carboplatin 400 mg/m(2)/day x2 was given at 21-28 days intervals. G-CSF was used for patients with hematological recovery greater than 4 weeks.


RESULTS
Twenty-one patients younger than 18 years of age treated with this regimen were studied between July 1996 and November 2000. A total of 93 courses of ICE were administered. Leucopenia/neutropenia grades 3/4 were the most frequent severe adverse effects (82%). Grade 3/4 thrombocytopenia occurred in 73% of cycles, and anemia was common (61%). The most common grade 3/4 non-hematologic toxicities were fever and proved infection occurring in 25% and 14% of the courses, respectively. Two patients developed renal tubular damage. Other less common grade 3/4 non-hematologic toxicities included nausea and vomiting, hepatotoxicity, and stomatitis. The overall response rate (complete response/partial response) was 53%. The median progression-free interval was 15.3 months, with a median survival of 24.2 months.


CONCLUSIONS
Although ICE was associated with severe myelosuppression it produced objective response in about half of the cases. The most important non-hematological toxicity was severe renal tubular damage. This regimen should only be used whenever hematological and infectious supportive care is available.
Loss
Jiseh Fagundes
JF
Pediatric Oncology Centre, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Brazil.
Santos
Pedro Paulo Albino
PP
Leone
Luciane Di
LD
Brunetto
Algemir Lunardi
AL
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001938:Brazil; D016190:Carboplatin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005047:Etoposide / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome
D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide; D016190:Carboplatin; D007069:Ifosfamide