Ifosfamide, carboplatin and etoposide for good prognosis small cell lung cancer: are four courses inadequate?

THATCHER AND associates [l] reported promising results using six courses of ifosfamide, carboplatin, etoposide, midcycle vincristine and thoracic radiotherapy for good prognosis small cell lung cancer (SCLC). Treatment produced significant toxicity, but the actual 2-year survival rate was 33%. The optimum duration of therapy has not been established [2, 31. Attempting to decrease toxicity, we gave four courses of chemotherapy (omitting midcycle vincristine) to patients with favourable prognosis SCLC [4]. The doses and schedule of all other agents were identical. Patients with histologically proven SCLC, with a maximum of two adverse features described by Cerny [4], were eligible for this study. Those aged over 75 years of previously treated for SCLC were excluded. Ifosfamide 5 g/m2 and mesna 5 g/m2 were given as a 24-h infusion, with mesna 3 g/m2 infused over the next 12 h. Carboplatin 300 mgim’ was infused on day 1. Etoposide 120 mglm2 was given intravenously on days 1 and 2, then orally (240 mgim2) on day 3. All patients had intravenous hydration and routine antiemetic prophylaxis. Treatment was repeated every 4 weeks and toxicity recorded according to WHO criteria [5]. Dose reductions were made for patients who experienced life-threatening complications of myelosuppression. The complete responders received external beam radiotherapy treatment to the primary site and mediastinum, using megavoltage or cobalt machines (a midplane dose of 40 Gy given in 15 fractions). These patients were considered for prophylactic cranial radiation. Those who progressed on chemotherapy were withdrawn, and the partial responders and patients with stable disease were observed after completing treatment. All patients were offered further palliative treatment when indicated. Non-haematological toxicity was mild, but one death occurred secondary to neutropenic sepsis, 7 patients were withdrawn