Current treatment of small cell lung cancer utilizes chemotherapy and/or radiation therapy. Achieving a remission of cancer with current treatment strategies occurs in the majority of patients with small cell lung cancer; however, most patients ultimately experience cancer recurrence. Current treatment options for recurrent small cell lung cancer are not very effective. Because small cell lung cancer is very sensitive to treatment with chemotherapy, many doctors believe that higher doses of chemotherapy have a better chance of inducing a remission and ultimately curing patients than lower doses of chemotherapy. Preliminary studies evaluating high-dose chemotherapy and autologous stem cell transplantation for the treatment of small cell lung cancer were conducted in the late 1980's and produced encouraging results; however, the toxicity of therapy was significant with almost 20% of patients dying from complications of therapy. Over the last decade, the delivery of high-dose chemotherapy has become safer and current techniques have reduced the severity of side effects and mortality from treatment.
In the November issue of
Blood, physicians in the European Group for Blood and Marrow Transplantation report the results of 69 patients with small cell lung cancer receiving treatment with 3 cycles of ifosfamide, carboplatin and etoposide (ICE) supported by autologous peripheral blood stem cells. Peripheral blood stem cells were collected following treatment with epirubicin chemotherapy and Neupogen®. Fifty patients completed all 3 scheduled courses of ICE chemotherapy, 9 completed 2 courses, and 6 patients were only able to complete 1 course. The increase in dose intensity of ICE was almost 3 times that of conventional doses.
Six patients died from treatment-related causes most of which occurred during the first year. Fifty-one percent of patients achieved a complete remission, 70% for patients with limited disease and 36% for patients with extensive disease. The average duration of survival was 18 months for patients with limited disease and 11 months for patients with extensive disease. Approximately 20% of patients with limited disease survived 3 years from treatment.
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These physicians concluded that more intensive therapy with ICE could be administered safely to patients with small cell lung cancer. Clinical studies continuing to refine treatment of high-dose chemotherapy for patients with small cell lung cancer and studies directly comparing high-dose chemotherapy to lower or conventional-dose chemotherapy are ongoing at this time. (
Journal of Clinical Oncology, Vol 17, Issue 11, pp 3531-3539, 1999)
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