Single center experience of a new intensive induction therapy for ewing's family of tumors: feasibility, toxicity, and stem cell mobilization properties.

To examine the feasibility, tolerability, and toxicity of an intensified induction regimen (vincristine, ifosfamide, doxorubicin, and etoposide [VIDE]) in patients with newly diagnosed Ewing's family of tumors (EFT); to assess ability to maintain dose-intensity, and predictability of peripheral-blood stem cell mobilization.
Thirty patients were treated with vincristine 1.4 mg/m2 (maximum 2 mg) on day 1, doxorubicin 20 mg/m2, ifosfamide 3 g/m2 plus mesna and etoposide 150 mg/m2 on days 1 to 3. Cycles were given every 21 days for up to six cycles.
One-hundred and seventy cycles of VIDE were given. The median treatment interval was 21 days (21 to 42) and nadir count: hemoglobin 8.3 (6.3 to 11.9), neutrophils 0.045 (0.0 to 2.1), and platelets 45 (3 to 343). There were 96 episodes of infection requiring hospitalization (56%). Growth factor support reduced infectious complications by 34%. Etoposide dose was reduced, or omitted, in 24% of cycles. Four patients did not complete six cycles due to unacceptable toxicity and one patient progressed on treatment. Twenty patients underwent peripheral-blood stem cell harvesting, 15 after cycle 3, and five after cycle 4. Median CD34+ yield was 4.6 x 106/kg per patient (1.8 to 14.5). Overall response to treatment, measured in 24 patients, was 88%. Seven of 11 patients undergoing surgery achieved greater than 90% necrosis of tumor (64%).
VIDE is an effective induction regimen with substantial but acceptable toxicity that allows predictable mobilization of stem cells. Maintenance of dose-intensity is feasible in the majority of patients. Growth factors play a role in maintaining dose-intensity and reduce infectious complications.
AuthorsS J Strauss, A McTiernan, D Driver, M Hall-Craggs, A Sandison, A M Cassoni, A Kilby, M Michelagnoli, J Pringle, J Cobb, T Briggs, S Cannon, J Witt, J S Whelan
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 21 Issue 15 Pg. 2974-81 (Aug 1 2003) ISSN: 0732-183X [Print] United States
PMID12885818 (Publication Type: Journal Article)
Chemical References
  • Vincristine
  • Etoposide
  • Doxorubicin
  • Mesna
  • Ifosfamide
  • Adolescent
  • Adult
  • Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
  • Child
  • Doxorubicin (administration & dosage)
  • Etoposide (administration & dosage)
  • Feasibility Studies
  • Female
  • Hematopoietic Stem Cell Mobilization
  • Humans
  • Ifosfamide (administration & dosage)
  • Male
  • Mesna (administration & dosage)
  • Neoplasm Staging
  • Sarcoma, Ewing (drug therapy)
  • Treatment Outcome
  • Vincristine (administration & dosage)

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