Journal of Clinical Oncology, Vol 12, 544-552, Copyright © 1994 by American Society of Clinical Oncology
Ifosfamide, carboplatin, and etoposide: a new regimen with a broad spectrum of activity
KK Fields, PE Zorsky, JW Hiemenz, LE Kronish and GJ Elfenbein
Department of Internal Medicine, University of South Florida, H. Lee Moffut Cancer Center and Research Institute, Tampa 33612.
PURPOSE: To conduct a phase I/II evaluation of the combination of
ifosfamide, carboplatin, and etoposide (ICE) to determine toxicity and
activity in a variety of refractory malignancies. PATIENTS AND METHODS: Two
hundred four patients, 13 to 64 years of age, with a variety of
malignancies, including refractory breast cancer and Hodgkin's and non-
Hodgkin's lymphoma, were treated with two cycles of ICE, consisting of
intravenous ifosfamide 2 g/m2, carboplatin 400 mg/m2, and continuous
infusion etoposide 600 mg/m2 administered in divided doses over 2 days. The
regimen was repeated at approximately 28-day intervals. RESULTS: One
hundred ninety-one patients (94%) received two cycles at full doses and
were assessable for response and toxicity. Complete and partial responses
were seen in breast cancer (20%, n = 93), non-Hodgkin's lymphoma (30%, n =
37), Hodgkin's disease (60%, n = 10), melanoma (9%, n = 11), a variety of
sarcomas (20%, n = 10), and other malignancies (43%, n = 30).
Myelosuppression was prominent, with significant neutropenia requiring
frequent hospitalization for neutropenic fever, and thrombocytopenia and
anemia requiring frequent platelet and RBC transfusions. However, the
overall treatment-related mortality rate was only 3%. No other moderate to
severe organ toxicity was seen at a frequency of greater than 1%.
CONCLUSION: This regimen is active in a variety of refractory malignancies,
with significant but tolerable hematologic toxicity. The addition of
hematopoietic growth factors may allow further dose escalation.
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