Doxorubicin, streptozocin, and 5-fluorouracil chemotherapy for patients with metastatic islet-cell carcinoma

Abstract

Metastatic islet-cell carcinoma is considered to be a slow-growing tumor. Patients are considered for systemic chemotherapy only when they are symptomatic or have impending organ failure, and streptozocin has been the chemotherapeutic agent of choice for the treatment of this disease. Chemotherapy regimens that include streptozocin have shown a higher response rate and a longer duration of response when compared with streptozocin alone. This study evaluates the objective response, response duration, and survival in patients having metastatic islet-cell carcinoma treated with a combination of doxorubicin, streptozocin, and 5-fluorouracil (DSF). Between January 1993 and March 1996, 12 patients were treated with doxorubicin, 40 mg/m2 intravenous bolus on day 1; streptozocin, 400 mg/m2 intravenous bolus on days 1 through 5; and 5-FU, 400 mg/m2 intravenous bolus on days 1 through 5. Courses were repeated every 28 days. Patients were required to have measurable disease, a Zubrod performance status < or = 2, adequate renal and liver function, and a survival expectancy of at least 12 weeks. Six (54.5%) of 11 evaluable patients achieved a partial response (durations in months: 1+, 3.5+, 13+, 17, 22, 26+); one had a minor response, two had stable disease, and two had progressive disease. One patient was lost to follow-up. No complete responses were observed. The median response duration was 15+ months and the median survival 21+ months (range, 3 to 32.5 months). No grade 3 or 4 nonhematologic or hematologic effects were observed. The DSF regimen appears to have significant activity in patients who have metastatic pancreatic islet-cell carcinoma, and patient tolerance of the regimen is excellent, thus warranting further investigation.