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JNCI Journal of the National Cancer Institute 1994 86(7):544-548; doi:10.1093/jnci/86.7.544
© 1994 by Oxford University Press
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Journal of the National Cancer Institute, Vol. 86, No. 7, 544-548, April 6, 1994
© 1994 Oxford University Press

Phase I Study of Escalating Targeted Doses of Carboplatin Combined With Ifosfamide and Etoposide in Treatment of Newly Diagnosed Pediatric Solid Tumors

Neyssa M. Marina, John H. Rodman, Daryl J. Murry, Sarah J. Shema, Laura C. Bowmans, Deborah P. Jones, Wayne Furman, William H. Meyer, Charles B. Pratt

Department of Hematology-Oncology, St. Jude Children's Research Hospital Memphis, Tenn. Department of Pediatrics, University of Tennessee Memphis
Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital; and Department of Clinical Pharmacy, University of Tennessee
Department of Biostatistics, St. Jude Children's Research Hospital
Department of Pediatrics and Department of Nephrology, University of Tennessee

Correspondence to: Neyssa M. Marina, M.D., St. Jude Children's Research Hospital, 332 N. Lauderdale, P. O. Box 318, Memphis, TN 38101-o318.

BACKGROUND: The combination of carboplatin, ifosfamide, and etoposide has shown promising activity in a variety of relapsed childhood solid tumors but has not been studied in newly diagnosed patients.

PURPOSE: The tolerance for and activity of escalating targeted doses of carboplating combined with infosfamide and etoposide (ICF) were assedssed in children with advanced germ cell tumors or other rare solid tumors for which no standard therapy exists.

METHODS: Fifteen children with newly diagnosed solid tumors received ICF chemotherapy. Individualized carboplatin doses were calculated to achieve a target area under the concertration X time curve (AUV) and adjusted for the glomerular filtration rate (estimated by 99mTc-labeled diethylenetriamine pentaacetic acid clearance). Cohorts of at least three patients received carboplatin at an initial target AUC of 6 mg . min/mL, with escalations of 2 mg . min/mL in subsequent cohorts. Carboplatin was given on day 1, followed by ifosfamide at 2 g/m2 per day and etoposide at 100 mg/m2 per day on days 2 through 4. All patients received at least two courses of therapy in the absence of progressive disease, and as many as eight courses could be given.

RESULTS: The 15 patients received a total of 46 assessable courses of ICE. Myelosuppression was the dominant toxicity; 30 courses (67%) resulted in hospitalization for febrile neutropenia. Neutropenia was dose limiting at the carboplatin target AUC of 12 mg . min/mL. One complete and eight partial responses were seen in the 14 assessable patients; two additional patients had at least partial responses documented at surgery or autopsy. Six patients are without evidence of disease at a median of 548 days after diagnosis.

CONCLUSION: ICE chemotherapy, with the carboplatin dose based on a target AUC of 10 mg . min/mL, is tolerable and has significant activity in a variety of rare malignancies, including extragonadal germ cell tumors.

IMPLICATIONS: The combination of carboplatin, etoposide, and ifosfamide holds promise in the treatment of rare pediatric malignancies. [J Natl Cancer Inst 86: 544–548, 1994]


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