ACCELERATED EPIRUBICIN-IFOSFAMIDE-DACARBAZINE REGIMEN IN PATIENTS WITH ADULT SOFT-TISSUE SARCOMAS

Background. Neutropenia and infections are the dose-limiting toxicitie s of the EID regimen and can cause dose reduction and/or delay in chem otherapy administration. The purpose of this study was to verify if EI D + G-CSF is feasible with an acceptable toxicity in a day hospital se tting and if G-CSF could allow an increase in the dose intensity of th e EID regimen by shortening the intervals between the courses. Patient s and Methods: 20 patients with inoperable primary, metastatic or resi dual disease after surgery or at high risk of recurrence after complet e resection, histologically confirmed adult soft tissue sarcoma, enter ed the study. The dose and schedule of the chemotherapy agents were ep idoxorubicin 30 mg/m(2) days 1, 2, 3, dacarbazine 300 mg/m(2) days 1, 2, 3, and ifosfamide 2500 mg/m(2) with mesna uroprotection days 1, 2, 3. G-CSF, 300 mu g/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 earl ier than 10 days from the previous course and at least 48 hours after the last G-CSF injection. Results: A total of 66 EID + G-CSF courses w ere administered. A G3 and G4 (WHO) neutropenia occurred in 66% of eva luables 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 c ourse of chemotherapy was 1.15 (range: 0.71-1.62). Conclusion: This st udy 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 a n improved response rate.