Salvage chemotherapy for lymphoma with VP-16, ifosfamide, and cisplatin

Between 1983 and 1985, we conducted a phase II clinical trial using VP-16, ifosfamide, and cisplatin (VIP) in patients with refractory lymphoma. Twenty-eight patients with bidimensional measurable disease were treated with VP-16 (75 mg/m2), ifosfamide (1.2 g/m2), and cisplatin (20 mg/m2) as daily intravenous infusions for 5 consecutive days. N-Acetylcysteine, 2 g orally every 6 h, was given as a uroepithelial protective agent. All patients had received extensive combination chemotherapy prior to beginning VIP (median number of regimens = 2). Of the 25 patients evaluable for response, 2 patients achieved complete remission and 7 achieved partial remission for an overall objective response rate of 36%. The length of responses ranged from 2 months to 13 months. The predominant toxicity of VIP was myelosuppression. Of 23 patients receiving more than one course of VIP, 17 (73%) had dose reductions or delays related to poor hematologic tolerance of therapy. Uroepithelial and renal toxicity were mild. VIP demonstrates therapeutic activity in refractory lymphoma and appears comparable to other ifosfamide/VP-16 based salvage regimens.