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Clinical Investigations: LUNG CANCER |

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

Yoshinobu Iwasaki, MD, PhD; Kazuhiro Nagata, MD; Masaki Nakanishi, MD; Atsushi Natuhara, MD; Yutaka Kubota, MD; Mikio Ueda, MD; Taichiro Arimoto, MD, PhD; Hiroshi Hara, MD, PhD
Author and Funding Information

*From the Division of Pulmonary Medicine, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Correspondence to: Yoshinobu Iwasaki, MD, PhD, Division of Pulmonary Medicine, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602, Japan; e-mail: yiwasaki@koto.kpu-m.ac.jp



Chest. 2005;128(4):2268-2273. doi:10.1378/chest.128.4.2268
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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/m2, and etoposide, 300 mg/m2 (cisplatin-etoposide [PE]). Later, they were administered high-dose etoposide, 1,500 mg/m2, 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/m2, carboplatin, 1,200 mg/m2, and etoposide, 1,000 mg/m2 (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 × 106/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.

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