Double-Cycle, High-Dose Ifosfamide, Carboplatin, and Etoposide Followed by Peripheral Blood Stem-Cell Transplantation for Small Cell Lung Cancer

Purpose To determine the tolerability and feasibility of double-cycle, high-dose chemotherapy followed by peripheral blood stem-cell transplantation (PBSCT) after conventional chemotherapy or chemoradiotherapy for small cell lung cancer (SCLC). Patients and methods Patients with previously untreated SCLC received two cycles of cisplatin, 80 mg/m 2 , and etoposide, 300 mg/m 2 (cisplatin-etoposide [PE]). Later, they were administered high-dose etoposide, 1,500 mg/m 2 , followed by granulocyte colony-stimulating factor for collection of peripheral blood stem cells. After two additional cycles of PE, the patients received high-dose ifosfamide, 10 g/m 2 , carboplatin, 1,200 mg/m 2 , and etoposide, 1,000 mg/m 2 (ifosfamide-carboplatin-etoposide [ICE]) followed by PBSCT twice at 3-month to 4-month intervals. Patients with limited disease (LD) concurrently received 50 Gy of irradiation with the last two cycles of PE. Results Eighteen patients, including 11 patients with LD, were enrolled. Fifteen patients could receive high-dose ICE followed by PBSCT twice, and 3 patients could receive it once. The median number of CD34+ cells collected was 13.11 × 10 6 /kg. The median numbers of days to neutrophil counts ≥ 500/μL and platelet counts ≥ 50,000/μL were 10 days and 14.5 days after the first PBSCT, and 10 days and 15 days after the second PBSCT, respectively. Grade 3 diarrhea occurred in one cycle, and grade 3 renal toxicity occurred in two cycles. The overall response rate was 100%, with an 83.3% rate of complete or near-complete response. The 2-year and 5-year survival rates were 72% and 55% in patients with LD and 43% and 0% in patients with extensive disease, respectively. Conclusion Double-cycle, high-dose ICE therapy followed by PBSCT is tolerable and feasible even after conventional chemotherapy or chemoradiotherapy in patients with SCLC.