According to an article recently published in the Journal of Thoracic Oncology, intensified doses of the chemotherapy regimen referred to as ICE (ifosfamide, carboplatin, and etoposide) improve median survival compared to standard doses of ICE in the treatment of small cell lung cancer (SCLC).
Small cell lung cancer accounts for approximately 20–25% of all lung cancers. Small cell lung cancer is an aggressive and fast-growing type of cancer that is very responsive to chemotherapy. However, although initial anticancer responses to chemotherapy may be substantial, long-term survival for patients with SCLC remains poor. Researchers continue to evaluate treatment options that may improve duration of survival for these patients while maintaining their quality of life.
Due to the high responses achieved with chemotherapy, researchers speculate that intensifying the doses may improve outcomes further. Unfortunately, intensified doses increase side effects associated with treatment. Specifically, intensified doses of ICE are associated with low levels of immune cells and platelets, which can lead to life-threatening infection and bleeding. To counter these potentially life-threatening side effects, agents such as Neulasta® (pegfilgrastim) or Neupogen® (filgrastim) are often used. These agents stimulate the production and maturation of immune cells, ultimately reducing the threat of infection in these patients. As well, collection of immature blood cells from the patient prior to therapy and re-infusion following therapy (a procedure called an autologous stem cell transplant) can help to restore levels of platelets and immune cells further.
Researchers recently conducted a clinical trial comparing intensified doses of ICE to standard doses of ICE in the treatment of SCLC. One group of patients in this trial was treated with intensified doses of ICE in addition to Neupogen and autologous stem cell transplant, and the other group of patients was treated with standard doses of ICE.
- Median survival was 30.3 months for those treated with intensified ICE, compared with 18.5 months for those treated with standard doses of ICE.
- At two years survival was 55% for patients treated with intensified ICE and 39% for those treated with standard doses of ICE.
- Cancer progression was delayed to 15 months for those treated with intensified ICE, compared with 11 months for those treated with standard doses of ICE.
- Anticancer responses occurred in 100% of patients treated with intensified ICE and 88% of patients treated with standard doses of ICE.
- Platelet and red blood cell transfusions were increased in the group of patients treated with intensified ICE.
The researchers concluded that intensified doses of ICE improve median survival and delay cancer progression but require increased platelet and red blood cell transfusions compared with standard doses of ICE for the treatment of SCLC.
Patients diagnosed with SCLC may wish to speak with their physician regarding intensified doses of chemotherapy or the participation in a clinical trial evaluating novel therapeutic approaches for the treatment of their disease. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov) and www.eCancerTrials.com.
Reference: Buchholz E, Manegold C, Lothar P, et al. Standard versus dose-intensified chemotherapy with sequential reinfusion of hematopoietic progenitor cells in small cell lung cancer patients with favorable prognosis. Journal of Thoracic Oncology. 2007; 2: 51-58.