VIP方案对EP、CE方案化疗失败肺癌病人的补救治疗39例近期疗效分析

目的：探讨ＥＰ、ＣＥ方案化疗失败肺癌病人的补救治疗。方法：本文采用由异环磷酰胺、顺铂、鬼臼已叉甙组成的ＶＩＰ方案治疗了３９例接受ＥＰ、ＣＥ方案化疗后无效或复发的小细胞肺癌患者,平均化疗３１周期。结果：完全缓解２例,部分缓解１８例,总有效率５１３％。进一步分析表明无效病例的有效率明显高于复发病例,而进展率则明显低于复发病例。主要不良反应为骨髓抑制和胃肠道反应,结论：ＶＩＰ方案具有较好的耐受性和安全性,在小细胞肺癌的补救治疗中具有一定的应用价值     

VIP方案治疗晚期非小细胞肺癌46例疗效观察

目的VIP方案治疗晚期非小细胞肺癌的近期疗效及毒副反应的观察.方法46例晚期非小细胞肺癌,其中初治30例,复治16例.结果VIP方案治疗非小细胞肺癌总有效率45.7%,初治病例有效率50.0%,复治37.5%.结论VIP方案治疗晚期非小细胞肺癌疗效较佳,用药安全.可做为一线及复治病人二线方案用药.     

CE-CAP方案治疗晚期非小细胞肺癌近期疗效观察

目的：评估CE－CAP方案治疗晚期非小细胞肺癌（NSCLC）的近期疗效。方法：观察1995年7月－1999年7月收治35例晚期非小细胞肺癌患者，化疗采用CE－CAP两方案交替，共96个周期。结果：完全缓解率（CR）为11.4%，部分缓解率为34.3%，总有效率（CR＋PR）45.7%。毒副反应主要为Ⅰ-Ⅱ度消化道反应，骨髓抑制及脱发。结论：CE－CAP方案化疗治疗晚期非小细胞肺癌的近期疗效较为满意，毒副反应轻。     

CE方案治疗小细胞肺癌的疗效观察

作者用CE(卡铂,鬼臼乙叉甙)方案治疗小细胞肺癌25例,获CR2例,PR18例,有效率为80％。以EP(鬼臼乙叉甙,顺铂)方案治疗24例作为对照,其中CR 3例,PR13例,有效率为66.6％。CE组和EP组的初治病例有效率分别为78％和80％。胃肠道反应:CE组反应较轻;肾脏毒性:CE与小剂量顺铂联用组(EP)相仿;血液毒性:CE组白细胞减少略比EP组明显。     

VIP化疗方案治疗小细胞肺癌的疗效观察

目的　评价VIP化疗方案 (异环磷酰胺 +顺铂 +鬼臼乙叉甙 )对小细胞肺癌 (SCLC)的治疗价值。方法　按入院顺序随机将 12 0例局限型SCLC初治患者分成VIP治疗组和EP治疗组 (顺铂 +鬼臼乙叉甙 ) ,分别治疗 3周期后评价各组的完全缓解 (CR)、部分缓解 (PR)、稳定 (SD)、进展 (PD)和总有效率 (RR) ,并比较各组的毒副反应发生率。此外 ,还对 2 5例EP方案治疗失败的SCLC患者 ,采用VIP方案解救治疗 ,观察其CR、PR、SD、PD和RR。结果　在 118例可评价的患者中 ,两方案对初治局限型SCLC患者的RR分别为89.6%和 78.3 % (P >0 .0 5 ) ,其毒性反应相当 ,但VIP方案的CR率为 43 .1% ,明显高于EP方案 ( 2 5 .0 % ) (P<0 .0 5 ) ;VIP方案对EP方案治疗无效或复发病例CR率为 13 .0 % ,PR率为 3 9.1% ,PD为 47.8% ,RR为5 2 .2 %。结论　VIP方案作为局限型SCLC患者的一线方案疗效优于标准EP方案 ,而且还可用于EP方案治疗失败病例的解救治疗。     

手术加NP方案化疗治疗非小细胞肺癌伴恶性胸腔积液的临床观察

目的：观察手术加NP方案化疗治疗非小细胞肺癌恶性胸腔积液的疗效和不良反应.方法：回顾性研究33例伴非小细胞肺癌恶性胸腔积液手术加NP方案化疗治疗的临床资料.结果：无围手术期死亡,并发症7例（21.2%）;症状改善总有效率90.9%～100%;胸腔积液缓解总有效率93.9%;1年存活率78.8%,2年存活率51.5%.结论：手术加NP方案化疗治疗伴癌性胸水的非小细胞肺癌疗效确切,能明显提高生存质量,延长生存期,有推广应用价值.     

IVP方案治疗晚期非小细胞肺癌35例疗效分析

目的：观察IVP方案治疗晚期非小细胞肺癌的疗效。方法：35例非小细胞肺癌（NSCLC）采用IVP方案（IFO＋VDS＋DDP）化疗3周期。结果：初次化疗24例，CR2例（18．33％），总有效率54．20％（13／24）；复发转移11例，CR1例（9．09％），总有效率36．40％（4／11），全组病例CR8．57％，总有效率48．60％，鳞癌有效率60．00％，腺癌46．10％。仅4例（11．43％）出现四度骨髓抑制，无其他严重不良反应。结论：IVP方案可作为晚期及复发转移非小细胞肺癌化疗方案之一。     

卡铂联合足叶乙甙治疗小细胞肺癌40例回顾分析

目的探讨卡铂、足叶乙甙联合（CE方案）治疗小细胞肺癌的疗效及不良反应。方法收集法国波尔多大学医院呼吸科1996年1月至2003年12月收治的40例接受CE方案化疗的小细胞肺癌患者完整的病例资料，分析CE方案化疗的有效率、不良反应和患者的生存期。结果40例中，局限期（LD）15例，广泛期（ED）25例。化疗总有效率为60．0％．LD和ED的OR分别为73．3％和52．0％，中位无进展生存期分别为5．9个月和5．6个月，中住生存期分别为7．2个月和6．8个月，1年生存率分别为26．7％和16．0％。3—4度粒细胞减少、贫血、恶心呕吐发生率分别为55．0％，15．0％，17．5％。结论CE方案治疗小细胞肺癌疗效满意，患者耐受性好。     

不同联合化疗方案治疗晚期非小细胞肺癌的临床观察

背景与目的：已证实以铂类为基础的联合化疗对晚期非小细胞肺癌患者有益,但近十年来对化疗方案选择仍有争论。本研究观察比较MIP方案（MMC IFO DDP）、TP方案（泰素 DDP）和DP方案（泰索帝 DDP）联合治疗晚期非小细胞肺癌的近期疗效和耐受性。方法：92例晚期非小细胞肺癌分为3组,分别接受3种不同化疗方案治疗,MIP组32例,TP组30例,DP组30例;除DP组Ⅳ期病例较多并有复治病人外,3组病人其它因素均具有可比性。结果：MIP组有效率为43.8％,中位生存期为11个月,1年生存率为46％;TP组有效率为40.0％,中位生存期为10个月,1年生存率为40％;DP组有效率为46.7％,中位生存期为12个月,1年生存率为50％。3组有效率相似,主要不良反应为骨髓抑制、恶心呕吐和脱发。结论：本研究表明,3种化疗方案均对晚期非小细胞肺癌有相似的疗效,不良反应可耐受,但泰索帝每周方案骨髓抑制相对较少。     

CPE和CE方案治疗小细胞肺癌的疗效比较

目的　评价CPE(卡铂、顺铂、足叶乙甙)和CE(卡铂、足叶乙甙)方案治疗小细胞肺癌(SCLC)的疗效和毒性。方法　应用CPE和CE方案治疗32例SCLC患者,每组16例,CPE组和CE组中的复治病例分别为10例和7例。结果　CPE组和CE组的有效率分别为81.3%(13/16)和87.5%(14/16)(P>0.05)。CPE组与CE组中的复治病例有效率分别为60%(6/10)和42.9%(3/7)(P<0.05)。CPE组与CE组的骨髓抑制率分别为71.9%和93.8%(P<0.05)。两组间其它毒性反应差异无显著性(P>0.05)。结论　CPE方案治疗SCLC的疗效与CE方案相近,但CPE的骨髓抑制明显较CE轻;CPE对复治病例的疗效优于CE。     

VP-16 plus ifosfamide plus cisplatin as salvage therapy in refractory germ cell cancer

Forty-eight evaluable male patients with germ cell tumors (GCT) failing to be cured with first-line therapy were treated with VP-16 (75 mg/m2), ifosfamide (1.2 g/m2), and cisplatin (20 mg/m2) (VIP), all given daily for 5 consecutive days every 3 weeks. All patients either achieved an unresectable partial remission as their best response to induction chemotherapy (Group A), relapsed from complete remission (CR) less than or equal to 2 months after induction therapy (Group B), or had received cisplatin plus VP-16 as previous salvage therapy (Group C). Nine (19%) had extragonadal GCT, and 37 (77%) had advanced disease. Twenty-three (48%) of the patients had greater than or equal 2 prior treatment regimens. Sixteen of 48 (33%) achieved CR with VIP treatment alone or following surgical excision of residual disease. Six of 22 (27%), three of seven (43%), and seven of 19 (37%) patients from groups A, B, and C, respectively, attained a CR. The median survival time of all patients was 7 months (range 0 to 28+) with seven patients remaining continuously free of disease (four patients greater than 1 year). Myelosuppression was significant with a median WBC nadir of 900/mm2 and platelet nadir of 24,000/mm2. Fourteen (26%) had granulocytopenic fever, and renal insufficiency developed in 15%. VIP combination chemotherapy demonstrates activity in this highly unfavorable population of patients with germ cell tumors. The actual contribution of ifosfamide in this regimen is unclear, but these results compare favorably to our experience with similar patients treated with cisplatin plus VP-16 alone. Further studies with VIP as initial salvage therapy for patients with GCT are planned.     

Ifosfamide and doxorubicin combination chemotherapy for recurrent nasopharyngeal carcinoma patients

Background: We assessed the efficacy and toxicity of ifosfamide and doxorubicin combination chemotherapy(CT) regimen retrospectively in Turkish patients with recurrent or metastatic nasopharyngeal carcinoma (NPC)previously treated with platinum-based chemotherapy. Methods: A total of thirty patients who had receivedcisplatin based chemotherapy/chemoradiotherapy as a primary treatment received ifosfamide 2500 mg/m2 days1-3, mesna 2500 mg/m2 days 1-3, doxorubicin 60 mg/m2 day 1 (IMA), repeated every 21 days. Eligible patientshad ECOG PS< 2, measurable recurrent or metastatic disease, with adequate renal, hepatic and hematologicfunctions. Results: Median age was 47 (min-max; 17-60). Twenty six (86.7 %) were male. Median cycles ofchemotherapy for each patient were 2 (range:1-6). Twenty patients were evaluable for toxicity and response. Nopatient achieved complete response, with nine partial responses for a response rate of 30.0% in evaluable patients.Stable disease, and disease progression were observed in five (16.7%) and six (20.0%) patients, respectively.Clinical benefit was 46.7%. Median time to progression was 4.0 months. Six patients had neutropenic fever afterIMA regimen and there were one treatment-related death due to tumor lysis syndrome in first cycle of the CT.No cardiotoxicity was observed after CT and treatments were generally well tolerated. Conclusion: Ifosfomideand doxorubicin combination is an effective regimen for patients with recurrent and metastatic NPC. For NPCpatients demonstrating failure of cisplatin based regimens, this CT combination may be considered as salvagetherapy.     

VIP (etoposide, ifosfamide, cisplatin) in adult patients with recurrent or refractory Ewing sarcoma family of tumors

Despite the fact that Ewing sarcoma family of tumors (ET) is chemosensitive, long-term survival is extremely rare for patients with primary refractory or recurrent disease. There is no standard salvage chemotherapy regimen available in this context. In this study the authors reviewed their experience with the combination of etoposide, ifosfamide, and cisplatin in adult patients with recurrent or refractory disease. From February 1997 through December 2001, they evaluated the efficacy of etoposide (75 mg/m2/day for 5 days), ifosfamide (1,200 mg/m2/day for 5 days), and cisplatin (20 mg/m2/day for 5 days) combination chemotherapy (VIP regimen), as second-line salvage therapy in 27 patients with recurrent or refractory ET. All patients were evaluated for response, time to progression, and overall survival. Twenty-one male and 6 female patients with recurrent (n = 14) and refractory (n = 13) disease were treated with the VIP regimen. Median age was 18 years (range, 16-34 years). Twenty-two patients were previously treated with vincristine, Adriamycin, ifosfamide, and actinomycin-D; and 5 patients were treated with cyclophosphamide, Adriamycin, and vincristine. Sites of recurrent or progressive disease included local (n = 3), distant (n = 11), and both local and distant (n = 13). A total of 129 cycles of VIP were given (median, 5 cycles/patient; range, 1-14 cycles/patient). One patient (4%) had a complete response (CR) and 8 patients (30%) had a partial response (PR), for an overall response rate of 34%. The median number of cycles given to patients with CR + PR was 6 (range, 3-14 cycles). Nine patients (33%) had stable disease and 9 (33%) had disease progression. Median time to progression and median overall survival were 6.6 months and 8.1 months respectively for all patients, and 12.8 months and 14.2 months respectively for responders. There were no toxic deaths. Major toxicities included grade IV granulocytopenia in 19 patients and grades III/IV thrombocytopenia in 15 patients. At a median follow-up of 8 months (range, 2-56 months), 24 patients died of disease progression, 2 patients are alive with disease, and 1 patient is alive with no evidence of disease. The authors conclude that the VIP combination is active in patients with recurrent/refractory ET, with acceptable toxicity, and offers good palliation. Cisplatin-based combination chemotherapy merits further investigation, possibly as first-line treatment in this disease.     

A phase II study of ifosfamide and cisplatin chemotherapy for metastatic or relapsed carcinoma of the cervix

Summary A total of 44 women received a combination of ifosfamide (1.5 g/m² daily x5) and cisplatin (50 mg/m² on day 1 only) as first-line chemotherapy for recurrent or metastatic carcinoma of the cervix. In all, 12/42 (38%) evaluable patients responded, with the median duration of response being 7 months. Bone marrow and gastrointestinal toxicity were frequently severe. There were 3 septic death. Although cisplatin plus ifosfamide is an active combination against this disease, these results suggest that it is no more so than either drug used alone.The London Gynaecology Oncology Group (LGOG) comprising the Departments of Medical Oncology     

A phase III randomized trial comparing vindesine and cisplatin with or without ifosfamide in patients with advanced non-small-cell lung cancer: long-term follow-up results and analysis of prognostic factors

In order to evaluate the activity and toxicity of a three-drug combination of vindesine, ifosfamide and cisplatin (VIP) for inoperable non-small-cell lung cancer (NSCLC), we conducted a randomized trial comparing VIP with a two-drug combination of cisplatin and vindesine (VP). Between September 1987 and March 1992, a total of 132 patients with stage III or IV NSCLC were randomly allocated to either VIP or VP. The VIP regimen consisted of vindesine (VDS 3 mg/m(2) on days 1 and 8), ifosfamide (IFX 1300 mg/m(2) on days 1-5), and cisplatin (CDDP 20 mg/m(2) on days 1-5). The VP regimen consisted of VDS and CDDP with the same dose and schedule as the VIP regimen. Both regimens were repeated every 4 weeks. Objective response rates were 49.3% (95% confidence interval: 95%CI, 43.1-55.4%) in the VIP arm and 44.6% (95%CI, 38.4-50.2%) in the VP arm; the difference was not significant (P=0.5390). Median response duration, median survival time, and two-year survival rates were 26.5 weeks, 49.6 weeks, and 14.9% in the VIP arm and 28.7 weeks, 37.1 weeks, and 12.3% in the VP arm, respectively. There were also no significant differences between these two treatment arms. In comparison with the VP regimen, however, a survival advantage of the VIP regimen could be confirmed when the data were evaluated with Cox's multivariate analysis (P=0.0131). In both arms, the principal toxicity was myelosuppression, which was significantly more frequent in the VIP arm, although generally well tolerated. CONCLUSION: This study suggested the survival advantage of the VIP regimen over the VP regimen for treatment of patients with advanced NSCLC.     

Salvage therapy with high-dose chemotherapy and autologous bone marrow support in the treatment of primary nonseminomatous mediastinal germ cell tumors.

The authors reported their experience with the use of high-dose chemotherapy and autologous bone marrow rescue (ABMR) as salvage therapy in the treatment of patients with recurrent and refractory primary nonseminomatous mediastinal germ cell tumors (PMGCT). Since 1987, the authors have treated 12 patients with PMGCT with high-dose carboplatin (1500 mg/m2 to 1800 mg/m2) and etoposide (1200 mg/m2 to 1350 mg/m2) (in two patients ifosfamide [10 g/m2] was added) with ABMR. Patients were either in second relapse or cisplatin refractory (progression within 4 weeks of last cisplatin dosing). They had received a median of two prior chemotherapy regimens (range, one to three), all had had prior cisplatin therapy, and most had failed ifosfamide-based therapy. Six patients were cisplatin refractory and of these only one achieved a partial response (PR) that was of short duration. It was planned that all patients would undergo two rounds of therapy; however, only 5 of 12 patients received two courses. The remainder had only one round of therapy either because of inadequate response (three patients) or excessive toxicity (four patients). There were four patients who died in the peritransplant period due to sepsis (two patients) or bleeding (two patients). The median survival of the group was 107 days (range, 14 days to 347 days). No patient achieved a complete remission, but there were six partial remissions, four with stable disease, and two with progressive disease. The use of high-dose carboplatin and etoposide with or without ifosfamide and ABMR was not effective in the treatment of this group of patients with PMGCT who were in second relapse or cisplatin refractory.     

Neoadjuvant etoposide, ifosfamide, and cisplatin for the treatment of olfactory neuroblastoma

BACKGROUND: The optimal chemotherapy regimen for the treatment of olfactory neuroblastoma has not been clearly defined. The purpose of the current study was to evaluate the efficacy of neoadjuvant chemotherapy with the combination of etoposide, ifosfamide, and cisplatin (VIP) for patients with olfactory neuroblastoma. METHODS: Eleven consecutive patients with newly diagnosed olfactory neuroblastoma were treated with etoposide (75 mg/m2), ifosfamide (1000 mg/m2), and cisplatin (20 mg/m2) all administered intravenously on Days 1-5. Cycles were repeated every 21 days. Patients were excluded from analysis if they had previously received surgery or radiotherapy. RESULTS: Nine patients achieved objective responses (objective response rate, 82%; 95% confidence interval, 52-95%), which included 2 complete responses and 7 partial responses. The major side effect was hematologic toxicity, with Grade 3/4 neutropenia observed after the receipt of 37% of all cycles and febrile neutropenia observed after the receipt of 2 cycles. All toxic events were reversible, and no chemotherapy-related deaths were documented. The median survival period was 18 months (range, 3-45 months). CONCLUSIONS: Neoadjuvant VIP chemotherapy was active in the treatment of olfactory neuroblastoma.     

Cisplatin, gemcitabine, and ifosfamide as weekly therapy: a feasibility and phase II study of salvage treatment for advanced transitional-cell carcinoma.

PURPOSE: We investigated the feasibility, safety, and antitumor activity of weekly gemcitabine given in combination with low doses of cisplatin and ifosfamide in previously treated patients with advanced transitional-cell carcinoma (TCC) of the urothelium. PATIENTS AND METHODS: Patients with measurable, metastatic or unresectable TCC who had received one or two prior chemotherapy regimens were eligible. On a 28-day course, doses of cisplatin 30 mg/m(2), gemcitabine 800 mg/m(2), and ifosfamide 1 g/m(2) were given on day 1 and then repeated on day 8 and day 15 unless there was dose-limiting hematologic toxicity. RESULTS: Fifty-one patients were registered; 10 patients participated in a pilot study, after which 41 patients were registered onto the phase II protocol. Forty-eight patients (94.1%) had dose-limiting hematologic toxicity on day 8 or day 15. Nonhematologic toxicity of grade 3 or greater consisted mainly of nausea and vomiting (seven patients, 13.7%) and infection (seven patients, 13.7%). Responses could be assessed in 49 of 51 eligible patients; two complete responses (4.1%) and 18 partial responses (36.7%) were observed for an overall response rate of 40.8% (exact 95% confidence interval, 27% to 56%). CONCLUSION: This regimen of cisplatin, gemcitabine, and ifosfamide is not feasible for weekly administration because of hematologic toxicity. Nevertheless, there was promising activity with only two doses per 28-day cycle. On the basis of these results, we have initiated a phase II trial of this combination given as a single dose every 14 days in patients with untreated, metastatic urothelial carcinoma.     

Etoposide, ifosfamide, and cisplatin in extensive small cell lung cancer.

From December 1987 through April 1989, 40 patients with extensive-stage small cell carcinoma of the lung were enrolled in a Hoosier Oncology Group (HOG) trial using etoposide, ifosfamide, and cisplatin (VIP). Patients with extensive disease were eligible if they had not received prior chemotherapy, had a Karnofsky performance status of 50 or more, and had adequate renal function (creatinine, less than 1.5 mg/dl) and bone marrow reserve (granulocyte count, greater than or equal to 2500/microliters; platelets, greater than or equal to 125,000/microliters). Doses of therapy were: etoposide 75 mg/m2/day on days 1 to 5, ifosfamide 1.2 g/m2/day on days 1 to 5, and cisplatin 20 mg/m2/day on days 1 to 5. The first 11 patients received a 5-day course; this was repeated every 21 days for four cycles, but therapy was shortened to 4 days when unacceptable toxicity was noticed in these patients. Overall, 14 (37%) had a complete remission (overall response rate, 71.1%) with a median survival of 42 weeks (28 weeks on 5-day regimen and 45 weeks on 4-day regimen). There were five early deaths. Although toxic, VIP produces a high complete remission rate in patients with extensive disease and warrants further evaluation. A prospective randomized trial comparing cisplatin and etoposide to the VIP regimen is underway through HOG.