According to a recent article published in
The New England Journal of Medicine, the addition of Ifex® (ifosfamide) and etoposide (VePesid®) to the standard chemotherapy regimen appears to improve survival in patients with Ewing’s sarcoma that has not spread to distant sites in the body.
Ewing’s sarcoma is a cancer of the bone that occurs in children, adolescents and young adults. Standard chemotherapy for Ewing’s sarcoma includes the chemotherapy regimen consisting of doxorubicin (Adriamycin®), Oncovin® (vincristine), cyclophosphamide (Cytoxan®), and dactinomycin (Cosmegen®). Ifex® with or without VePesid® has demonstrated anti-cancer activity in patients with sarcoma of the bone and Ewing’s sarcoma who have a cancer recurrence following standard therapy. This prompted researchers to evaluate the addition of Ifex® and VePesid® to the standard chemotherapy combination as initial treatment in patients with Ewing’s sarcoma.
Researchers from the Children’s Cancer Group and the Pediatric Oncology Group conducted a clinical trial to compare the standard chemotherapy combination (doxorubicin, Oncovin®, cyclophosphamide, dactinomycin) with or without the addition of Ifex® and VePesid® to the standard combination in patients with newly diagnosed Ewing’s sarcoma. Patients also received radiation and/or surgery, depending upon the extent of the cancer. At 5 years, there was no difference in overall survival (approximately 34%) or event-free survival (22%), (an event being defined as cancer progression, a second cancer, or death), of the 120 patients with metastatic cancer (spread to distant sites in the body) between the two chemotherapy groups. However, among the nearly 400 patients who did not have metastatic cancer, the 5-year overall survival was 72% for patients treated with the addition of Ifex®/VePesid®, compared to 61% for patients treated with the standard chemotherapy regimen. The 5-year event-free survival in patients with non-metastatic cancer was 69% for patients treated with the addition of Ifex®/VePesid®, compared to 54% for patients treated with the standard chemotherapy combination.
These researchers concluded that the addition of Ifex® and VePesid® to the standard chemotherapy combination consisting of doxorubicin, Oncovin®, cyclophosphamide and dactinomycin improves survival in patients with Ewing’s sarcoma that has not spread to distant sites in the body. However, there was no improvement demonstrated with the additional chemotherapy in patients with metastatic Ewing’s sarcoma. Patients with non-metastatic Ewing’s sarcoma may wish to speak with their physician about the risks and benefits of the addition of Ifex® and VePesid® in patients to standard chemotherapy or the participation in a clinical trial evaluating other novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (
Reference: Grier H, Krailo M, Tarbell N, et al. Addition of ifosfamide and etoposide to standard chemotherapy for Ewing’s sarcoma and primitive neuroectomdermal tumor of bone.
The New England Journal of Medicine. 2003; 348: 694-701.