High-dose carboplatin, cyclophosphamide, etoposide with hematological growth factors, without stem cell support in...

Peripheral blood progenitor cell (PBPC) transplantation, introduced into clinical practice to decrease the hematological toxicity of high-dose chemotherapy (HDCT), is both a costly procedure and a potential source of tumor cell reinfusion. The maximum tolerated dose of carboplatin (CB), cyclophosphamide (CT) and etoposide (VP) administered with growth factors without PBPC was determined in a previous phase I study. The aim of this phase II study was to evaluate the activity and toxicity of HDCT with CB, CT and VP administered with growth factors, without PBPC in a group of patients with advanced solid tumors.

Forty patients with a median age of 52 years received two consecutive courses of chemotherapy every four weeks, consisting of CT 1500 mg/m2, VP 400 mg/m2 and CB AUC of 7-8. Following chemotherapy, hematological growth factors were administered for 14 days.

Grade 4 leukopenia and thrombocytemia occurred in 40 and 21 patients, respectively. An overall response rate of 72.5% was achieved. After a median 81 months follow-up, median time to progression and overall survival were 29 and 38 months, respectively.

These data indicate that HDCT chemotherapy may be delivered safely without PBPC support. Prolonged responses were observed in patients that had few therapeutic options.