Ifosfamide, carboplatin and etoposide (ICE) in metastatic and refractory breast cancer

Twenty-five patients with metastatic breast cancer were treated with ICE af ter failure of previous chemotherapy. Their median age was 50 years (range 36-73). All but 1 patient had multiple sites of metastases. Nineteen (76%) patients had undergone two or more chemotherapy regimens for metastatic dis ease prior to ICE. The performance status (PS) of the patients was Eastern Cooperative Oncology Group (ECOG) 0:6; 1:12; 2:5; 3:2. Ifosfamide 1.25 g/m( 2) over 3 h D1-3 along with mesna, etoposide 80 mg/m(2) D1-3 and carboplati n 300 mg/m(2) D1 were given every 3 weeks. We observed a partial response i n 10 patients (40%, 95% confidence interval 21-62%). The response duration ranged from 1 to 15 months with a median duration of 4.5 months. The surviv al of all 25 patients ranged from 10 days to 25 months, with a median of 9 months. All 25 patients were evaluable for toxicity. Thirteen patients (52% ) experienced grade 4 hematological toxicity, which improved after growth f actor support. Four patients had leukopenic fever, 1 had gram-negative seps is, while 2 had Clostridium difficile enterocolitis and another had herpes tester reactivation. Four patients (16%) experienced grade 3-4 gastrointest inal (G-I) toxicity. No hepatic or renal toxicity was observed (1 patient h ad microscopic hematuria). One patient died of G-I bleed, and another patie nt died at home of undetermined cause. We conclude that ICE is an effective salvage regimen in metastatic and refractory breast cancer, even in heavil y pretreated patients, and is a tolerable treatment when used with growth f actor.