Cisplatin plus etoposide with and without ifosfarnide in extensive small-cell lung cancer: A hoosier oncology group study

Patrick J. Loehrer, Patrick Loehrer, René Gonin, Frank Monaco, William Fisher, Alan Sandler, Lawrence Einhorn

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Abstract

Purpose: To determine whether the addition of ifosfamide to cisplatin plus etoposide improves the response rate, time to disease progression, or overall survival in previously untreated patients with extensive-stage small-cell carcinoma of the lung (SCLC). Patients and Methods: Patients with extensive SCLC with a Karnof sky performance score (KPS) s 50 and adequate renal function and bone marrow reserve were eligible. Patients with CNS metastases were eligible and received concurrent whole-brain radiotherapy. Patients were randomized to receive cisplatin (20 mg/m2) plus etoposide (100 mg/m2) (VP) both given intravenously (IV) on days 1 to 4 or cisplatin (20 mg/m5), ifosfamide (1.2 g/m2), and etoposide (75 mg/m2) (VIP) all given IV on days 1 to 4. Cycles were repeated every 3 weeks for four cycles. Results: From May 1989 through March 1993, 171 patients were randomized (84 to VP and 87 to VIP). The median follow-up duration is 26 months. All patients were assessable for survival; 163 were fully assessable for response and 162 for roxicity. Myelosuppression was greater with VIP. Objective responses were observed in 55 of 82 (67%) and 59 of 81 (73%) assessable patients treated with VP and VIP, respectively (difference not significant). The difference in the median time to progression was statistically different (P = .039). The median survival times on VP and VIP were 7.3 months and 9.0 months, respectively (P = .045 for survival curves by stratified log-rank test) with 2-year survival rates of 5% versus 13%, respectively. Conclusion: VIP combination chemotherapy is associated with an improved time to progression and overall survival over VP therapy in patients with extensive SCLC.

Original languageEnglish
Pages (from-to)2594-2599
Number of pages6
JournalJournal of Clinical Oncology
Volume13
Issue number10
StatePublished - Oct 1995

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Small Cell Lung Carcinoma
Etoposide
Cisplatin
Survival
Ifosfamide
Disease Progression
Radiotherapy
Survival Rate
Bone Marrow
Neoplasm Metastasis
Kidney
Brain

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Cisplatin plus etoposide with and without ifosfarnide in extensive small-cell lung cancer : A hoosier oncology group study. / Loehrer, Patrick J.; Loehrer, Patrick; Gonin, René; Monaco, Frank; Fisher, William; Sandler, Alan; Einhorn, Lawrence.

In: Journal of Clinical Oncology, Vol. 13, No. 10, 10.1995, p. 2594-2599.

Research output: Contribution to journalArticle

Loehrer, Patrick J. ; Loehrer, Patrick ; Gonin, René ; Monaco, Frank ; Fisher, William ; Sandler, Alan ; Einhorn, Lawrence. / Cisplatin plus etoposide with and without ifosfarnide in extensive small-cell lung cancer : A hoosier oncology group study. In: Journal of Clinical Oncology. 1995 ; Vol. 13, No. 10. pp. 2594-2599.
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abstract = "Purpose: To determine whether the addition of ifosfamide to cisplatin plus etoposide improves the response rate, time to disease progression, or overall survival in previously untreated patients with extensive-stage small-cell carcinoma of the lung (SCLC). Patients and Methods: Patients with extensive SCLC with a Karnof sky performance score (KPS) s 50 and adequate renal function and bone marrow reserve were eligible. Patients with CNS metastases were eligible and received concurrent whole-brain radiotherapy. Patients were randomized to receive cisplatin (20 mg/m2) plus etoposide (100 mg/m2) (VP) both given intravenously (IV) on days 1 to 4 or cisplatin (20 mg/m5), ifosfamide (1.2 g/m2), and etoposide (75 mg/m2) (VIP) all given IV on days 1 to 4. Cycles were repeated every 3 weeks for four cycles. Results: From May 1989 through March 1993, 171 patients were randomized (84 to VP and 87 to VIP). The median follow-up duration is 26 months. All patients were assessable for survival; 163 were fully assessable for response and 162 for roxicity. Myelosuppression was greater with VIP. Objective responses were observed in 55 of 82 (67{\%}) and 59 of 81 (73{\%}) assessable patients treated with VP and VIP, respectively (difference not significant). The difference in the median time to progression was statistically different (P = .039). The median survival times on VP and VIP were 7.3 months and 9.0 months, respectively (P = .045 for survival curves by stratified log-rank test) with 2-year survival rates of 5{\%} versus 13{\%}, respectively. Conclusion: VIP combination chemotherapy is associated with an improved time to progression and overall survival over VP therapy in patients with extensive SCLC.",
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