Toxicity of the high-dose chemotherapy CTC regimen (cyclophosphamide, thiotepa, carboplatin): the Netherlands Cancer Institute experience
| Autor: | M. J. Holtkamp, J G Schrama, Joke W. Baars, Jan H. Schornagel, Sjoerd Rodenhuis |
|---|---|
| Přispěvatelé: | Other departments |
| Jazyk: | angličtina |
| Rok vydání: | 2003 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Cyclophosphamide medicine.medical_treatment Breast Neoplasms Hemorrhage ThioTEPA peripheral blood progenitor cell transplantation Infections Gastroenterology Drug Administration Schedule Carboplatin chemistry.chemical_compound Clinical Bone Marrow Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans solid tumours Netherlands Chemotherapy business.industry toxicity Middle Aged Nitrogen mustard Surgery Oncology Bone marrow suppression chemistry Toxicity Vomiting Germinoma medicine.symptom business Thiotepa high-dose chemotherapy medicine.drug Follow-Up Studies |
| Zdroj: | British Journal of Cancer British journal of cancer, 88(12), 1831-1838. Nature Publishing Group |
| ISSN: | 0007-0920 |
| DOI: | 10.1038/sj.bjc.6601001 |
| Popis: | High-dose chemotherapy (HD-CT) has a role in the potentially curative treatment of several tumours. The relative efficacies of the different regimens have not been studied in comparative trials, but it is clear that toxicities differ significantly between them. We analysed the immediate and long-term toxicity in the first 100 consecutive patients treated with the CTC regimen (cyclophosphamide 6000 mg m(-2), carboplatin 1600 mg m(-2) (or 20 mg ml(-1) min under the curve (AUC)) both as daily 1 h infusion, thiotepa 480 mg m(-2) as twice daily 30 min infusion, all divided over 4 consecutive days) followed by peripheral blood progenitor cell reinfusion (PBPC-Tx). Most patients had high-risk (n=86) or metastatic (n=4) breast cancer, or a germ cell tumour (n=8). Two patients (with a medulloblastoma and an aesthesioneuroblastoma, respectively) received CTC as off-protocol salvage regimen. The main toxicity was bone marrow suppression. Most patients had PBPC-Tx with granulocyte colony-stimulating factor (G-CSF), and the median time to neutrophil count 500 x 10(6) l(-1) and platelet count >20 x 10(9) l(-1) without transfusion independence was 10 (range 8-25) and 13 (8-60) days, respectively. The toxic death rate was 1%. Other frequent toxicities were neutropenic fever requiring antibiotics (n=65), central catheter-related infection (n=12) or a bleeding episode (n=48), mostly epistaxis (n=26). Reversible cardiac toxicity was seen in six patients and pulmonary events occurred in seven patients (infection (n=6), embolism (n=1)). Grade 3-4 gastrointestinal toxicity was frequent: nausea and vomiting 55%, diarrhoea 28% and mild liver toxicity (transaminase elevations) 9%. One patient pretreated with cisplatin had a kidney transplantation 8 years after HD-CT. Late complications included reversible radiation pneumonitis (n=12) and chronic heart failure (n=2). We found five second solid malignancies and two myelodysplasias. In conclusion, the CTC regimen is associated with a moderate, mainly reversible, toxicity. Future studies need to compare the efficacy and toxicity of the different HD-CT regimens. |
| Databáze: | OpenAIRE |
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