Researchers associated with the Solid Tumors Working Party of the European Group for Blood and Marrow Transplantation have reported that increasing the dose intensity of ICE (ifosfamide, carboplatin, and etoposide) by threefold by using peripheral blood stem cell support did not improve outcomes of patients with limited or extensive stage small cell lung cancer (SCLC). The details of this study appeared in an early online publication in the Journal of the National Cancer Institute on April 8, 2008.¹

Small cell lung cancer accounts for approximately 13–20% of all lung cancers, and the percentage of patients with SCLC appears to be declining. Small cell lung cancer is an aggressive and fast-growing type of cancer that is very responsive to chemotherapy. Although initial anticancer responses to chemotherapy may be substantial, long-term survival for patients with SCLC remains poor. Researchers continue to evaluate treatment options that may improve duration of survival for these patients while maintaining their quality of life.

A previous randomized Phase III study reported that intensified doses of ICE  administered with autologous stem cell and Neupogen® (filgrastim) support improved median survival compared with standard doses of ICE for the treatment of patients with SCLC who had responded to initial chemotherapy (see first item of related news). This study randomly allocated 83 patients with good prognosis SCLC to receive intensified ICE with stem cell and Neupogen support or conventional doses of ICE. These authors reported a doubling of median survival and a 16% increase in overall survival with intensified doses of ICE. These researchers concluded that intensified doses of ICE improve median survival and delayed cancer progression. Intensified doses of ICE, however, required increased platelet and red blood cell transfusions compared with standard doses of ICE for the consolidation therapy of responding patients with SCLC.

The current study involved 140 patients with extensive or limited SCLC who were randomly allocated to receive dose-intensive ICE with stem cell support or standard doses of ICE.

Hematologic toxicity was more severe and frequent in both groups; 4% of patients in the standard dose group and 8% in the dose-intense group died of treatment-related toxicities. These authors concluded that dose-intensive therapy was not beneficial in SCLC.

Comments: These data are at odds with the previous randomized study that showed a clear benefit of dose-intense consolidation therapy supported by autologous stem cells and Neupogen. These conflicting results would suggest that the issue of dose-intensity in SCLC is not as settled as the current study implies. One interpretation is that high-dose therapy as consolidation is of benefit in responding patients but initial treatment of all patients with SCL with dose-intense regimens is not of benefit.

Related News:

Dose-Intensive Chemotherapy with Stem Cell and Neupogen® Support Improves Survival in SCLC (2/5/2007)

Paraplatin®, Camptosar® Supported by Neupogen® Well Tolerated in Elderly with Small Cell Lung Cancer (8/4/2006)

Shorter Duration of Treatment Improves Survival with Small-Cell Lung Cancer (3/13/2006)

Neupogen® Plus Antibiotics Decrease Febrile Neutropenia in Small Cell Lung Cancer (11/8/2005)

Camptosar®/Platinol® Equivalent to VePesid®/Platinol® in Extensive-Stage Small Cell Lung Cancer (5/17/2005) 

Reference:

¹ Leyvraz S, Pampallona S, Martinelli G, et al. A threefold dose intensity treatment with ifosfamide, carboplatin, and etoposide for patients with small cell lung cancer: A randomized trial. Journal of the National Cancer Institute (early online publication0. April 8, 2008.