Ifosfamide/carboplatin/etoposide (ICE) regimen in small cell lung cancer

Abstract

Combination chemotherapy with ICE (ifosfamide/carboplatin/etoposide) has developed from the significant single-agent activity of the component drugs and the marked efficacy of two-drug combinations. The ICE regimen has been associated with 2-year survivals of ≥ 30% with minimum follow-up of 24 months. Patients populations in these studies were not staged intensively and the survival is therefore of considerable interest. The severe myelosuppression seen in the majority of patients requires close monitoring, and supportive care, particularly with antibiotics, is often required. The use of hematopoietic growth factors in the future should ameliorate this toxicity. It is also important to note, however, that the depression in blood count is transient and currently allows treatment to be given at 4- to 5-week intervals even without growth factor support. It is highly likely that outpatient treatment based on oral formulations of ifosfamide and etoposide with bolus injections of carboplatin soon will be possible. Oral platinum compounds are also in a late stage of development. Other techniques for outpatient-based ICE therapy include ambulatory pump infusions, which may be associated with less hematologic toxicity. Further developments of ICE-based chemotherapy regimens should provide an important avenue of progress in the future therapy of small cell lung cancer.