Efficacy of consolidation high-dose chemotherapy (HDCT) with ifosfamide, carboplatin and etoposide followed by peripheral blood stem cell rescue (PBSCR) in chemosensitive patients with metastatic soft tissue sarcomas

Abstract

9014 Background: Prognosis of patients (pts) with metastatic soft tissue sarcomas (STS) is poor even after an objective clinical response to intensive doxorubicin based chemotherapy (response rate (RR) 23–45 %, median survival 13–15 months). Whether HDCT and PBSCR improves these results is an open question. We report phase II data of response to AI-G chemotherapy regime in pts with metastatic STS and the efficacy of HDCT and PBSCT. Patients and methods: From 1997 to 2003, 55 pts with metastatic STS were prospectively treated with 4 cycles of AI-G (adriamycin 75mg/m2, ifosfamide 6g/m2 with G-CSF support) as induction chemotherapy. After assessment of response pts with CR or PR received 2 further cycles AI-G with collection of peripheral blood stem cells (PBSCs). HDCT consisted of ifosfamide (12g/m2), etoposide (1,2g/m2) and carboplatin (1,2g/m2) (HD-ICE) followed by reinfusion of PBSCs. Results: Of 55 pts 20 pts (RR 36%) were assessed as responders (3CR;17PR) and all but two pts, who refused, received HDCT with PBSCR. The 18 pts receiving HD-ICE experienced grade IV hematologic toxicity while no severe infectious complications were observed and no toxic death occured. By intent to treat analysis (20 pts) the 2-year and 5-year-overall survival (OS) are 50% and 26 %, the median survival is 23 months (median follow-up 21 months). Of nine pts being alive four pts are alive with NED at 11+, 22+, 42+,79+ months and five pts are alive with disease at 11+, 14+, 17+, 31+, 37+ months. 11 pts have died. Conclusion: Survival of pts with chemosensitive metastatic STS seems to be significantly prolonged by HDCT and PBSCR. No significant financial relationships to disclose.