Efficacy of consolidation high-dose chemotherapy with ifosfamide, carboplatin and etoposide (HD-ICE) followed by autologous peripheral blood stem cell rescue in chemosensitive patients with metastatic soft tissue sarcomas

Oncology. 2006;71(1-2):32-9. doi: 10.1159/000100447. Epub 2007 Mar 5.


Background: Prognosis of patients with metastatic soft tissue sarcomas (MSTS) is poor even after response to doxorubicin-based chemotherapy. We report phase II data of high-dose chemotherapy and peripheral blood stem cell (PBSC) rescue in patients with MSTS responding to AI-G chemotherapy.

Patients and methods: From 1997 to 2002, 55 patients with MSTS were prospectively treated with 4 cycles of AI-G (doxorubicin 75 mg/m(2), ifosfamide 6 g/m(2) with G-CSF support). Responders received 2 further cycles of AI-G with collection of PBSCs. High-dose chemotherapy consisted of ifosfamide 12 g/m(2), carboplatin 1.2 g/m(2) and etoposide 1.2 g/m(2) (HD-ICE) followed by reinfusion of PBSCs.

Results: Twenty-one of 55 patients (38%) were assessed as responders (3 complete response, 18 partial response). All but 2 patients refusing treatment received high-dose chemotherapy with PBSC rescue leading to grade IV hematologic toxicity without severe infections in all patients. No toxic death occurred. After a median follow-up time of 30 months, the median progression-free time was 12 months and survival time was 22 months for the entire group. By intent-to-treat analysis the probability of 5-year progression-free survival was significantly higher for patients allocated to HD-ICE compared to patients receiving second-line chemotherapy after failure of AI-G (14 vs. 3%; p = 0.003). The estimated 5-year overall survival between the 2 groups was different (27% vs. not reached) but did not reach significance (p = 0.08).

Conclusion: HD-ICE is feasible and promising in patients with chemosensitive MSTS. A randomized phase III trial is warranted to further define the role of HD-ICE as consolidation treatment in these patients.

Publication types

  • Clinical Trial, Phase II
  • Multicenter Study

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Carboplatin / administration & dosage
  • Combined Modality Therapy
  • Etoposide / administration & dosage
  • Feasibility Studies
  • Female
  • Granulocyte Colony-Stimulating Factor / therapeutic use
  • Humans
  • Ifosfamide / administration & dosage
  • Male
  • Middle Aged
  • Peripheral Blood Stem Cell Transplantation*
  • Prospective Studies
  • Salvage Therapy
  • Sarcoma / secondary
  • Sarcoma / therapy*
  • Soft Tissue Neoplasms / pathology
  • Soft Tissue Neoplasms / therapy*
  • Survival Rate
  • Transplantation, Autologous


  • Granulocyte Colony-Stimulating Factor
  • Etoposide
  • Carboplatin
  • Ifosfamide

Supplementary concepts

  • ICE protocol 3