Cisplatin and etoposide alternating ifosfamide, vincristine, epirubicin in small cell lung cancer

OBJECTIVE: The aim of this study was to evaluate the effects and toxicity of alternating cisplatin+etoposide (EP) and ifosfamide+vincristine+epirubicin (IVE) combination regimen in patients with small cell lung cancer (SCLC).

METHODS: We have treated 38 SCLC patients with 6 courses of alternating chemotherapy consisting of cisplatin 100 mg/m2 on day one and etoposide 80 mg /m2 on the first, second and third days in courses of first, third and fifth, alternating with ifosfamide 4 g/m2, vincristine 2 mg/day and epirubicin 60 mg/m2 intravenously on day one in courses of second, forth and sixth. The courses were administrated every 3 weeks. After the sixth course of chemotherapy the patients with limited disease (LD) who had a complete response (CR) received concomitant chest irradiation. None of the patients had prophylactic cranial irradiation. The study was conducted between January 1997 and July 1997 in the Department of Chest Disease at Ondojuz Mayis University Hospital, Samsun, Turkey.

RESULTS: The mean age of the 3 female and 35 male patients was 59.5 (33-72) years. Eighteen of which had LD and 20 had extensive disease (ED). Twenty patients had Eastern Cooperative Oncology Group (ECOG) 1 and 18 had ECOG 2 performance status. Objective response (OR) was obtained in 26 (68%) of the patients. While 13 patients had a CR rate, 6 patients remained stable (16%). The OR rate was observed to be 100% (CR 61%, partial response [PR] 39%) in patients with LD, whereas it was 40% (CR 10%, PR 30%) in patients with ED. The median survival was 9 months in LD and 6 months in ED. Relapses after CR occurred in 11 patients with LD (local relapse in 8; one in the brain; one in the liver; one in the bone) and one patient with ED (in the brain). The observed toxicities were grade III-IV leukopenia 13%, grade III-IV nausea and vomiting 8%, and 39% alopecia.

CONCLUSION: We conclude that the described regimen is a well-tolerated, less toxic therapy for SCLC.