Hematopoietic Cytokines to Support Repeated Doses of Dose-Intensive Chemotherapy with Cyclophosphamide, Etoposide, and Cisplatin (DICEP)

Abstract

The last two decades have witnessed fundamental changes in the practice of clinical oncology. Perhaps the most important is the acknowledgement that partial, or in many cases even complete, clinical remissions do not usually result in substantial survival benefit. The degree of tumor reduction obtainable with present standard therapy regimens is not sufficient to prolong survival in most patients. The importance of dose intensity in achieving a higher response rate’ and, arguably, survival² has encouraged some oncologists, usually in a clinical trials milieu, to accept absolute but reversible granulocytopenia as a justifiable side effect of chemotherapy. This change in attitude has been fostered by the successes of bone marrow transplantation as well as by the development of improved supportive agents and approaches. Concurrently, several hematopoietic cytokines capable of ameliorating hematologic toxicity and the side-effects of dose-intensive therapy have become clinically available. These changes are the basis for a series of trials conducted over the last six years at the University of New Mexico Cancer Center attempting to achieve even greater dose rate intensity and total dose intensity than that used in most transplantation programs. The results of those trials are the substance of this report.