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  • Title: Outcome of pediatric recurrent and refractory malignant solid tumors following ifosfamide/carboplatin/etoposide (ICE): A phase II study in a pediatric oncology centre in Brazil.
    Author: Loss JF, Santos PP, Leone LD, Brunetto AL.
    Journal: Pediatr Blood Cancer; 2004 Feb; 42(2):139-44. PubMed ID: 14752877.
    Abstract:
    BACKGROUND: Therapeutic trials using ifosfamide,carboplatin, and etoposide (ICE) regimen have suggested many patients with refractory/relapsed solid tumors may be rendered free of disease using this combination. The aim of this study was to assess the feasibility, response and toxicity of this regimen in a Brazilian Pediatric Oncology Centre. PROCEDURE: ICE, consisting of ifosfamide 3 g/m(2)/day x3 plus Mesna, etoposide 160 mg/m(2)/day x3, and carboplatin 400 mg/m(2)/day x2 was given at 21-28 days intervals. G-CSF was used for patients with hematological recovery greater than 4 weeks. RESULTS: Twenty-one patients younger than 18 years of age treated with this regimen were studied between July 1996 and November 2000. A total of 93 courses of ICE were administered. Leucopenia/neutropenia grades 3/4 were the most frequent severe adverse effects (82%). Grade 3/4 thrombocytopenia occurred in 73% of cycles, and anemia was common (61%). The most common grade 3/4 non-hematologic toxicities were fever and proved infection occurring in 25% and 14% of the courses, respectively. Two patients developed renal tubular damage. Other less common grade 3/4 non-hematologic toxicities included nausea and vomiting, hepatotoxicity, and stomatitis. The overall response rate (complete response/partial response) was 53%. The median progression-free interval was 15.3 months, with a median survival of 24.2 months. CONCLUSIONS: Although ICE was associated with severe myelosuppression it produced objective response in about half of the cases. The most important non-hematological toxicity was severe renal tubular damage. This regimen should only be used whenever hematological and infectious supportive care is available.
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