Efficacy and safety of ifosfamide in combination with carboplatin and etoposide in small cell lung cancer

Purpose Ifosfamide, a potent alkylating agent, is rarely incorporated into small cell lung cancer (SCLC) treatment. The aim of this study was to assess the efficacy and safety of ifosfamide in combination with carboplatin and etoposide (ICE) in previously untreated patients with SCLC. Methods From January 2002 to January 2014, we consecutively enrolled 69 patients with SCLC who were treated with ICE as initial chemotherapy at Kangbuk Samsung Hospital. The modified ICE regimen consists of ifosfamide 1200 mg/m 2 /day on days 1, 2, and 3 with mesna, etoposide 80 mg/m 2 /day on days 1, 2, and 3, and carboplatin AUC 6 on day 1. Treatment was repeated every 3 weeks and continued for up to nine cycles. Response assessments were performed every three cycles with computed tomography. Results Among 69 patients with SCLC, the median age was 69 years (range 51–88 years). Sixteen (23 %) patients had limited disease (LD), and 53 (77 %) had extensive disease (ED). The overall response rate was 73 %. Stable disease rate was 20 %. The median overall survival was 11.3 months [95 % confidence interval (CI) 8.9–14.1] in the overall population, 20.6 months (95 % CI 14.2–21.2) for LD and 9.1 months (95 % CI 7.8–11.6) for ED. The median number of administered cycles was 6 (range 1–9). Grade ≥3 hematological toxicities included neutropenia (34 %), anemia (59 %), and thrombocytopenia (31 %). Grade ≥3 non-hematological toxicities included peripheral neuropathy in 2 %. Conclusion In chemonaïve patients with SCLC, modified ICE is well tolerated and shows favorable efficacy.