Combination chemotherapy with tamoxifen, ifosfamide, epirubicin and cisplatin in extensive-disease small-cell lung cancer

Background. A study of tamoxifen, ifosfamide, epirubicin and cisplatin (TIEP) chemotherapy was conducted in patients with extensive-disease, small-cell lung cancer (SCLC) to assess response and toxicity. Methods. From November, 1997, to February, 1999, 11 patients were treated, including six chemo-naive patients and five patients previously treated with cisplatin plus etoposide (EP). The treatment regimen included tamoxifen 60 mg twice daily orally on days 1 to 3, ifosfamide 3 g/m2 intravenous (IV) infusion for 60 minutes with mesna on day 2, epirubicin 50 mg/m2 IV bolus on day 2 and cisplatin 60 mg/m2 IV for 60 minutes on day 2, every 4 weeks for up to six cycles. Results. All patients were evaluated for toxicity and response rate. As expected, the major toxicity was myelosuppression. Grade 3 or 4 leukopenia or neutropenia occurred in all patients during treatment. Two patients (18.2%) experienced fever in association with the neutropenia, one of whom died of sepsis. Grade 3 anemia occurred in two patients (18.2%) during treatment. Toxicities other than neutropenia and anemia were limited. After two cycles of treatment, five of six chemo-naive patients (83%), and one of five previously treated patients (20%) attained a partial response (overall 54.5%, 95% confidence interval 25%-83.9%). Median survival time was 8.5 and 6 months in chemo-naive and previously EP-treated patients, respectively. The response rate and median survival time in chemo-naive patients did not improve compared with a previous study of ifosfamide plus etoposide undertaken 4 years earlier. Conclusions. Although TIEP is an active combination regimen with an acceptable toxicity profile in Chinese patients with extensive-disease SCLC, it showed no remarkable benefit compared with other regimens used in chemo-naive patients. The 20% response rate and median survival of 6 months in EP-treated patients deserve further study.