European experience with ifosfamide in non-small cell lung cancer

Ifosfamide is one of the most effective cytostatics for the treatment of lung carcinomas. For non-small cell lung cancer (NSCLC), in particular, the administration of 1.5 to 2.0 g/m2 on five successive days at intervals of 3 to 4 weeks has been found optimal. Used in combination with one or two cytotoxic agents, ifosfamide has achieved higher remission rates and longer periods of remission than single-drug chemotherapy. This result also is reflected in the longer median survival of successfully treated patients. The results of chemotherapy with ifosfamide combinations are comparable with those using cisplatin combinations. Because of considerably better tolerance, ifosfamide combinations are preferred, particularly when cisplatin is used in a moderate to high dose. At our institution, 192 untreated patients with histologically verified NSCLC were treated in three phase-II studies with different chemotherapy regimens: ifosfamide, 2 g/m2 days 1 to 5, and cisplatin, 75 mg/m2 on day 1 (study I); ifosfamide, 2 g/m2 days 1 to 5, and etoposide, 120 mg/m2 days 1 to 3 (study II); and ifosfamide, 2 g/m2 days 1 to 5, and vindesine, 3 mg/m2 on days 1 and 8 (study III). All chemotherapy combinations were repeated every 4 weeks. At least two courses of therapy were necessary to evaluate remission rate. We observed complete remissions in five patients and partial remissions in 54, for a total remission rate. of 31%. The median duration of remission was 7 months, and the time to progression was 5 months. Median survival time of all 192 patients was 8.5 months. Performance status significantly influenced the remission rate and survival time. Sex and age as well as the tumor extent and histologic type had no influence on remission. No significant differences among the three therapy regimens were seen in remission rate and survival time. The ifosfamide/etoposide combination was the preferred regimen in terms of toxicity.