Pilot study of ambulatory infusional delivery of a multidrug regimen: ifosfamide, carboplatin and etoposide (ICE)

Abstract

Purpose: To determine the feasibility for administering ICE (ifosfamide, carboplatin, and etoposide) using an ambulatory infusional schedule for each of the three agents in a design that sequentially alternates those agents that are not compatible as an admixture.

Patients and methods: Forty-one patients received ICE administered as follows: ifosfamide (500 mg/M2/day) without mesna days 1 to 7 and 14 to 21; carboplatin (30 or 40 mg/M2/day) and etoposide (30 to 40 mg/M2/day) admixed as a single solution infused day 7 to 14. Patients were monitored weekly and cycles repeated at five-week intervals.

Results: Seventy-nine courses of therapy were analyzed. Forty-one patients received a median of two cycles with a range of one to five cycles. The only significant toxicity was hematologic with 11 patients experiencing grade III neutropenia and 7 patients grade III thrombocytopenia (18%). Eleven patients did develop significant anemia requiring transfusion and/or the use of erythropoietin. Tumor responses were observed in 7 of 24 evaluable patients, 4 of whom had lung cancer, 2 with small cell with no prior therapy and 2 with nonsmall cell with prior chemotherapy.

Conclusion: Ambulatory infusion of ICE using an alternating sequence is feasible, and although the dose per cycle of carboplatin and etoposide is less than that of conventional bolus schedules for either single agent or combination programs, the ability to deliver this combination of agents in an ambulatory setting and without mesna substantially reduces the cost. Phase II studies of ambulatory infusion ICE in nonsmall cell lung cancer, lymphoma, and sarcoma are a reasonable next step.