High dose epirubicin and ifosfamide alternating with etoposide and cisplatin therapy with granulocyte macrophage colony stimulating factor in small cell lung cancer

Abstract

Forty-six previously untreated patients with small cell lung cancer (23 limited and 23 extensive) were enrolled into a study to test the feasibility of adding high dose epirubicin in combination alternating regimens with granulocyte macrophage colony stimulating factor (GM-CSF) support. Chemotherapy consisted of high dose epirubicin 40 mg/m2, ifosfamide 2 g/m2 with mesna protection for 3 days, alternating on day 22 with cisplatin 35 mg/m2 and etoposide 120 mg/m2 for 3 days. Whenever neutrophil count was found to be less than 1x109/L, GM-CSF 400 mg was started subcutaneously for at least 7 days until neutrophil count recovered. In the subsequent cycles GM-CSF was started in a prophylactic manner on day 7 for 7 days. Complete responders with limited disease also received thoracic 46 Gy irradiation. Thirty-nine patients were evaluable for response. The overall response rate was 84.5% including 48.7% complete responses. For limited disease the overall response was 90% including 60% complete responses. Toxicity evaluation could be made in 44 patients. Grade III and IV Ieucopenia was experienced by 65.2% of the patients. GM-CSF was required in 29 (63%) patients and in 18 patients GM-CSF was started following the first cycle. This regimen, though seems to be myelotoxic, appears to be quite active in small cell lung cancer. However, its impact on survival remains to be determined.