A study was conducted to evaluate the impact of
cisplatin,
doxorubicin,
cyclophosphamide and
etoposide (PACE) with
granulocyte colony-stimulating factor (
G-CSF) on advanced
thymoma or
thymic cancer. Between August 1989 and December 1994, 14 patients with invasive, metastatic or recurrent
thymoma or
thymic cancer were treated with
cisplatin (80 mg/m2, on day 1),
doxorubicin (45 mg/m2, on day 1),
cyclophosphamide (800 mg/m2, on day 1) and
etoposide (80 mg/m2, on day 1-3) with
G-CSF (90 micrograms/m2, on day 5-18) at the National
Cancer Center Hospital, Tokyo. Courses were repeated every 3 or 4 weeks for a maximum of 4 cycles. Twelve patients were treated with 2 or more courses of PACE. Two patients were treated with only one course, one refused and another required emergency thoracic
radiotherapy after one course of PACE. Six patients had partial responses (3
thymomas and 3
thymic cancers) but there were no complete remissions (response rates, 42.9%; 95% confidence interval, 17.7% to 71.1%). Moderate hematological toxicities were observed: grade 3 or 4
leukopenia,
neutropenia,
anemia and
thrombocytopenia in 10, 13, 8 and 6 patients, respectively. Six patients developed
infections that required
antibiotics. Surgical resection or thoracic
radiotherapy after PACE treatment was performed in 2 and 7 patients, respectively. The overall median survival time was 14.7 months (range, 5.9 to 59.7 months). For 9 patients who had received no prior treatment before
chemotherapy, the median survival time was 8.9 months, and one patient survived for 4 years and is still alive. In conclusion, PACE with
G-CSF frequently produces objective remissions in patients with advanced
thymoma or
thymic cancer. A large-scale intergroup study is necessary to determine the impact of this regimen on advanced
thymoma and
thymic cancer.