Bessho A, Ueoka H, Kiura K, Tabata M, Sunami K, Katayama Y, Yamane H, Hiraki A, Harada M
Second Department of Internal Medicine, Okayama University Medical School, Japan.
Anticancer Res. 1999 Jan-Feb;19(1B):693-8.
We investigated the feasibility and efficacy of high-dose chemotherapy consisting of ifosfamide, carboplatin and etoposide (HD-ICE) facilitated by autologous peripheral blood progenitor cell transplantation (ABPCT) for the treatment of small-cell lung cancer (SCLC).
Eleven patients aged 44 to 63 years old (5 with extensive disease [ED] and 6 with limited disease [LD]) were entered into this study. Induction chemotherapy consisted of 3 to 4 cycles of cisplatin and irinotecan for ED-SCLC, and cisplatin and etoposide for LD-SCLC. Patients with LD-SCLC received concurrent chest radiotherapy along with the first cycle of induction chemotherapy. After induction therapy, peripheral blood progenitor cells (PBPC) were collected following G-CSF administration during a recovery phase from high-dose etoposide (1,500 mg/m2). Eight patients (4 with ED and 4 with LD) with adequate organ function were treated with HD-ICE (15 g/m2 ifosfamide, 1,200 mg/m2 carboplatin and 1,500 mg/m2 etoposide) followed by ABPCT.
Hematologic recovery was rapid and non-hematological toxicities were acceptable without treatment-related mortality. In ED-SCLC, all of the 4 patients achieved complete response (CR) or near CR but developed a relapse of the disease. In LD-SCLC, 2 of 4 patients with LD-SCLC are alive in continuous CR for 18 and 21 months after the beginning of induction therapy.
Despite a limited number of patients and short follow-up time, these preliminary results indicate that marrow-ablative therapy (HD-ICE) supported by ABPCT is feasible in the treatment of elderly patients with LD- and ED-SCLC.
我们研究了由异环磷酰胺、卡铂和依托泊苷组成的大剂量化疗（HD-ICE）联合自体外周血祖细胞移植（ABPCT）治疗小细胞肺癌（SCLC）的可行性和疗效。
11例年龄在44至63岁之间的患者（5例广泛期疾病[ED]，6例局限期疾病[LD]）进入本研究。诱导化疗对于广泛期小细胞肺癌包括3至4周期的顺铂和伊立替康，对于局限期小细胞肺癌为顺铂和依托泊苷。局限期小细胞肺癌患者在诱导化疗的第一个周期同时接受胸部放疗。诱导治疗后，在从大剂量依托泊苷（1500mg/m²）恢复阶段给予粒细胞集落刺激因子（G-CSF）后采集外周血祖细胞（PBPC）。8例器官功能良好的患者（4例广泛期和4例局限期）接受HD-ICE（异环磷酰胺15g/m²、卡铂1200mg/m²和依托泊苷1500mg/m²）治疗，随后进行ABPCT。
血液学恢复迅速，非血液学毒性可接受，无治疗相关死亡。在广泛期小细胞肺癌中，4例患者均达到完全缓解（CR）或接近CR，但疾病复发。在局限期小细胞肺癌中，4例患者中有2例在诱导治疗开始后持续CR状态存活18个月和21个月。
尽管患者数量有限且随访时间短，但这些初步结果表明，ABPCT支持的骨髓清除疗法（HD-ICE）在治疗老年局限期和广泛期小细胞肺癌患者中是可行的。
