Paclitaxel, cisplatin and etoposide combination chemotherapy: a comparison of dose intensity in two multifractionated...

66 patients with a variety of tumour types received the multifractionated TPE three drug regimen in a non-random allocation as a 5 day schedule (schedule A) or as a twice weekly schedule (schedule B). The dose per fraction for each component drug was 35, 40 or 50 mg/m2 for both paclitaxel and etoposide and for cisplatin, the dose per fraction was 15 mg/m2. The total paclitaxel and etoposide dose was 175, 200, 250 mg/m2 3 week cycle. For schedule A, grade 3 or 4 neutropenia was observed in 70/114 cycles (61%) with two treatment related deaths from 50 treated patients. For schedule B, grade 3 neutropenia was observed in 1 of 30 courses (3%) with one drug related death from 19 treated patients. Dose intensity was increased by 20% for both paclitaxel and etoposide with the twice weekly schedule and at all dose levels, with haematological toxicity substantially reduced relative to schedule A. Using multifractionated schedules, a twice weekly open ended schedule results in an approximately 20% greater dose intensity and less toxicity compared with a 5 day schedule repeated every 3 weeks. The recommended dose schedule for TPE is paclitaxel 40 mg/m2; cisplatin 15 mg/m2 and etoposide 40 mg/m2 twice weekly for 3 weeks repeated every 4 weeks.