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Sarcoma
Volume 2011, Article ID 984340, 7 pages
http://dx.doi.org/10.1155/2011/984340
Clinical Study

Sequential Dose-Dense Doxorubicin and Ifosfamide in Advanced Soft-Tissue Sarcoma Patients in an Out-Patient-Basis Schedule

1Servico de Oncologia Clinica, Instituto de Radiologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, 05403-900 Sao Paulo, SP, Brazil
2Centro de Hematologia e Oncologia—CEHON, Avenida Araujo Pinho, 439 Canela, 40110-150 Salvador, BA, Brazil
3Servico de Anatomia Patologica, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, 05403-010 Sao Paulo, SP, Brazil
4Terceira Clinica Cirurgica, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, 05403-010 Sao Paulo, SP, Brazil
5Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, 05403-010 Sao Paulo, SP, Brazil
6Laboratorio de Anatomia Patologica, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, 05403-010 Sao Paulo, SP, Brazil

Received 8 August 2010; Revised 5 April 2011; Accepted 4 May 2011

Academic Editor: R. Pollock

Copyright © 2011 G. F. G. Almeida et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Aims. This phase II study explored activity/safety of front-line dose-dense chemotherapy in high-grade STS (soft tissue sarcoma) patients and tested ezrin as prognostic factor. Patients and Methods. The protocol consisted of three cycles of doxorubicin (DOXO) 30 mg/m2 on days 1–3 every 2 weeks, followed by three cycles of ifosfamide (IFO) 2.5 g/m2 two hours a day on days 1–5 every 3 weeks, with GCSF support. Ezrin was assessed immunohistochemically. Results. Twenty patients, 13 metastatic and 7 locally advanced, were enrolled. Median age was 39 years (25–60). Median dose intensities were 42 mg/m2/week and 3.6 g/m2/week for DOXO and IFO, respectively. Grade 3/4 toxicities occurred in 18 patients. Response rate was 15% (3 of 20) by RECIST. Patients younger than 45 years with locally advanced disease and synovial histology presented longer survival. A trend towards longer survival was observed among ezrin-positive patients. Conclusions. This dose-dense schedule should not be routinely used due to its high frequency of toxic events; however, a sequential strategy with DOXO and IFO may benefit selected patients and should be further explored with lower doses. The role of ezrin as a prognostic marker should be confirmed in a larger group of patients.