DOXORUBICIN, STREPTOZOCIN, AND 5-FLUOROURACIL CHEMOTHERAPY FOR PATIENTS WITH METASTATIC ISLET-CELL CARCINOMA

Metastatic islet-cell carcinoma is considered to be a slow-growing tum or. Patients are considered for systemic chemotherapy only when they a re symptomatic or have impending organ failure, and streptozocin has b een the chemotherapeutic agent of choice for the treatment of this dis ease. Chemotherapy regimens that include streptozocin have shown a hig her response rate and a longer duration of response when compared with streptozocin alone. This study evaluates the objective response, resp onse duration, and survival in patients having metastatic islet-cell c arcinoma treated with a combination of doxorubicin, streptozocin, and 5-fluorouracil (DSF). Between January 1993 and March 1996, 12 patients were treated with doxorubicin. 40 mg/m(2) intravenous bolus on day 1; streptozocin, 400 mg/m(2) intravenous bolus on days 1 through 5; and 5-FU, 400 mg/m(2) intravenous bolus on days 1 through 5. Courses were repeated every 28 days. Patients were required to have measurable dise ase, a Zubrod performance status less than or equal to 2, adequate ren al and liver function, and a survival expectancy of at least 12 weeks. Six (54.5%) of 11 evaluable patients achieved a partial response (dura tions in months: 1+, 3.5+, 13+, 17, 22, 26+); one had a minor response , two had stable disease, and two had progressive disease. One patient was lost to follow-up. No complete responses were observed. The media n response duration was 15+ months and the median survival 21+ months (range, 3 to 32.5 months). No grade 3 or 3 nonhematologic or hematolog ic effects were observed. The DSF regimen appears to have significant activity in patients who have metastatic pancreatic islet-cell carcino ma, and patient tolerance of the regimen is excellent, thus warranting further investigation.