High-dose chemotherapy with autologous transplantation for persistent/relapsed ovarian cancer: a multivariate analysis of survival for 100 consecutively treated patients.

Stiff, Patrick J.; Bayer, Robert; Kerger, C.; Potkul, Ronald K.; Malhotra, Divye; Peace, David; Smith, David B.; Fisher, Susan G.

doi:10.1200/jco.1997.15.4.1309

Cited by 114 publications

(67 citation statements)

References 14 publications

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“…9,24 Retrospective and prospective non-randomized clinical trials of high-dose chemotherapy in epithelial ovarian cancer have confirmed high response rates and pathologic complete responses in chemotherapy-resistant patients. Furthermore, early reports of survival curves suggesting a plateau in progression-free and overall-survival at 24-48 months following treatment 6,7 have been confirmed in more recent publications of Stiff et al, 25 Legros et al 26 and Shinozuka et al 27 Prognostic factors have been examined by Stiff et al 25 They have shown that age, tumor bulk at the time of transplant, and platinum sensitivity, are predictive of longerterm survivals. Recent data from the European Intergroup (GINECO) study suggests a statistically significant median disease-free survival for patients receiving consolidation high-dose chemotherapy compared to patients receiving conventional-dose chemotherapy.…”

Section: Discussionmentioning

confidence: 70%

Phase II trial of high-dose intravenous doxorubicin, etoposide, and cyclophosphamide with autologous stem cell support in patients with residual or responding recurrent ovarian cancer

Morgan

Doroshow

Leong

et al. 2001

Bone Marrow Transplant

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Summary:This study was performed in order to evaluate the toxicities, progression-free and overall survival of patients with responsive residual or recurrent ovarian cancer treated with high-dose chemotherapy. Twenty-seven patients were treated. Doxorubicin, 165 mg/m 2 over 96 h (days −12 to −8), etoposide 700 mg/m 2 every day ×3 (days −6 to −4), and cyclophosphamide 4.2 g/m 2 on d −3 was followed by stem cells and granulocyte colonystimulating factor. The median days of granulocyte count Ͻ500/ l was 14 (range 10-42) and platelets Ͻ20 000/ l was 13 (range 2-80). Median numbers of red cell and platelet transfusions were 15 (5-16) and 14 (4-103). Toxicity included mucositis requiring narcotic analgesia in all patients. Asymptomatic decreases in ejection fraction to values Ͻ50% were observed in four patients. No clinical congestive heart failure was observed. One death due to sepsis was observed. Median progression-free survival is 7.5 months (1.0-56 months); five patients remain alive, two of whom remain progression-free at 19.5 and 24.5 months post transplant. Median overall survival is 14.0 months (1-68 months). We conclude that high-dose anthracyclines may be safely administered to ovarian cancer patients. The short overall and progression-free survivals observed in our population suggest that this combination is not optimal. Bone Marrow Transplantation (2001) 28, 859-863.

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Section: Discussionmentioning

confidence: 70%

Phase II trial of high-dose intravenous doxorubicin, etoposide, and cyclophosphamide with autologous stem cell support in patients with residual or responding recurrent ovarian cancer

Morgan

Doroshow

Leong

et al. 2001

Bone Marrow Transplant

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“…In recent studies, 1,2 treatment with high-dose chemotherapy and peripheral blood stem cell (PBSC) or bone marrow transplantation has shown promising results in selected patients. In a study by Stiff et al, 2 patients with recurrent, platinum-sensitive disease had approximately a 33% 5-year survival rate with this treatment approach. Transplantation of autologous PBSC is generally associated with more rapid hematological recovery than transplantation of bone marrow.…”

Section: Discussionmentioning

confidence: 99%

“…17,18 In other tumor types such as lymphoma and sarcoma, ifosfamide has been shown to have a significant dose-response relationship. The experience with high-dose ifosfamide comes mostly from studies done in patients with soft tissue or bone sarcomas where doses of up to 14 g/m 2 with filgrastim have been used successfully without the need for PBSC support. 19 Etoposide is a glycosidic derivative of epidophyllotoxin previously shown to be associated with a dose-related cell cycle perturbation in ovarian cancer cell lines.…”

Section: Discussionmentioning

confidence: 99%

High-dose ifosfamide and etoposide with filgrastim for stem cell mobilization in patients with advanced ovarian cancer

Donato

Gershenson

Ippoliti

et al. 2000

Bone Marrow Transplant

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Summary:High-dose chemotherapy combined with autologous peripheral blood stem cell transplantation has shown promise as treatment for recurrent or persistent epithelial ovarian cancer. We evaluated the stem cell mobilization regimen of high-dose ifosfamide plus etoposide in 32 patients with epithelial ovarian cancer, who had a positive second-look laparatomy or recurrent disease. Ifosfamide was given at 10 g/m 2 by continuous i.v. from days 1 to 3. Etoposide was given at 150 mg/m 2 every 12 h for six doses on days 1-3. Filgrastim was given at 10 g/kg/d s.c. from day 5 until the completion of peripheral blood stem cell harvest. Fourteen of 32 patients had measurable or evaluable disease before mobilization therapy and were assessed for response. In nine (64%) of the 14 patients, treatment response was demonstrated, and these patients received a second cycle of mobilization therapy. The target CD34 + cell dose (Ͼ8 × 10 6 cells/kg) was achieved with a median of one apheresis (range 1-5). A median of 25.1 (range 8.0-122.5) × 10 6 CD34 + cells/kg body weight was collected. Non-hematologic toxicity was limited to grade 2 renal dysfunction in one patient and grade 2 hepatic dysfunction in three patients. In this patient group, high-dose ifosfamide plus etoposide with filgrastim support was well tolerated, lead to successful stem cell harvest and had antitumor activity. Bone Marrow Transplantation (2000) 25, 1137-1140. Keywords: ovarian cancer; stem cell collection; ifosfamide; etoposide Patients with recurrent or persistent epithelial ovarian cancer have a poor prognosis and there are few long-term survivors. In recent studies, 1,2 treatment with high-dose chemotherapy and peripheral blood stem cell (PBSC) or bone marrow transplantation has shown promising results in selected patients. In a study by Stiff et al, 2 patients with recurrent, platinum-sensitive disease had approximately a

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“…Cure of patients with acute leukemia [8][9][10], lymphoma [11][12][13][14][15], testicular cancer [16][17][18][19][20][21], and ovarian cancer [22][23][24][25] by transplantation strategies is predicated on achieving a complete response. Adjuvant chemotherapy for breast cancer has established that the elimination of micrometastases is achievable, even with regimens noncurative in metastatic disease [26][27][28][29][30].…”

Section: Basis For Hdc and Pbpctmentioning

confidence: 99%

High-Dose Chemotherapy and Peripheral Blood Progenitor Cell Transplantation in the Treatment of Breast Cancer

et al. 2000

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Each year in the USA, 180,000 new cases of breast cancer are diagnosed and about 44,000 women die of the disease. Current primary treatment consists of adjuvant chemotherapy and hormone therapy, and statistics show that combination chemotherapy favorably influences the outcomes in both node-negative and node-positive primary disease. However, a significant number of breast cancer patients succumb to the disease, and nearly every patient diagnosed with metastatic breast cancer will be dead within five years.High-dose chemotherapy (HDC) and peripheral blood progenitor cell transplantation (PBPCT) are based upon laboratory and clinical observations of the ability to modify growth properties of quiescent and replicating cancer cells. A large number of HDC and PBPCT regimens have been evaluated for treatment of metastatic breast cancer, and recent autologous bone marrow transplantation data indicate that three HDC regimens (CPB, CTCb and cytoxan and thiotepa) predominate. Unfortunately, negative media coverage surrounding and subsequent to the presentation of preliminary findings reported at the May 1999 American Society of Clinical Oncologists, that were not allowed adequate follow-up time for full analysis of treatment results, has had a detrimental effect on the ability to conduct trials in this area.Several randomized trials have been conducted in both the metastatic and high risk primary disease settings. Thorough analysis of these studies indicates an evaluable improvement in favor of HDC and PBPCT in three of the four randomized studies performed in metastatic breast cancer and two of the four high risk primary studies. Also, initial evaluations found that quality of life appeared comparable in patients receiving either HDC or not. Each randomized trial studied asks a different question and, depending on the intensity of HDC regimen, the intensity and duration of the standard dose chemotherapy control and the schedule of events in relation to induction chemotherapy, the outcomes may be quite variable. Still, certain general trends are indentifiable. HDC alone will not completely cure breast cancer and should be considered as part of an overall therapeutic plan. In some of these studies, significantly longer follow-up is required before definitive analysis can be completed. The Oncologist 2000;5:1-13

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High-dose chemotherapy with autologous transplantation for persistent/relapsed ovarian cancer: a multivariate analysis of survival for 100 consecutively treated patients.

Cited by 114 publications

References 14 publications

Phase II trial of high-dose intravenous doxorubicin, etoposide, and cyclophosphamide with autologous stem cell support in patients with residual or responding recurrent ovarian cancer

Phase II trial of high-dose intravenous doxorubicin, etoposide, and cyclophosphamide with autologous stem cell support in patients with residual or responding recurrent ovarian cancer

High-dose ifosfamide and etoposide with filgrastim for stem cell mobilization in patients with advanced ovarian cancer

High-Dose Chemotherapy and Peripheral Blood Progenitor Cell Transplantation in the Treatment of Breast Cancer

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