Accelerated epirubicin-ifosfamide-dacarbazine regimen in patients with adult soft tissue sarcomas

Neutropenia and infections are the dose-limiting toxicities of the EID regimen and can cause dose reduction and/or delay in chemotherapy administration. The purpose of this study was to verify if EID + G-CSF is feasible with an acceptable toxicity in a day hospital setting and if G-CSF could allow an increase in the dose intensity of the EID regimen by shortening the intervals between the courses.

20 patients with inoperable primary, metastatic or residual disease after surgery or at high risk of recurrence after complete resection, histologically confirmed adult soft tissue sarcoma, entered the study. The dose and schedule of the chemotherapy agents were epidoxorubicin 30 mg/m2 days 1, 2, 3, dacarbazine 300 mg/m2 days 1, 2, 3, and ifosfamide 2500 mg/m2 with mesna uroprotection days 1, 2, 3. G-CSF, 300 micrograms/day subcutaneously, was administered from day 7 for a maximum of 14 days and discontinued when WBC was greater than 10 x 10(9)/L. Courses were repeated "as soon as possible," but never earlier than 10 days from the previous course and at least 48 hours after the last G-CSF injection.

A total of 66 EID + G-CSF courses were administered. A G3 and G4 (WHO) neutropenia occurred in 66% of evaluables courses. Nonhematological toxicity was mild. The median number of G-CSF injections required during any interval between courses was 9 (range: 4-14 injections) and the median interval between courses was 21 days (range: 13-36 days). The median dose intensity at the third course of chemotherapy was 1.15 (range: 0.71-1.62).

This study shows that G-CSF allows a moderate increase in the delivered dose intensity of chemotherapy with an acceptable toxicity. Further studies are needed to investigate if this increase in DI may translate into an improved response rate.