Intensive Chemotherapy for Anaplastic Thyroid Carcinoma: Combination of Cisplatin, Doxorubicin, Etoposide and Peplomycin with Granulocyte Colonystimulating Factor Support

The Japanese Society of Thyroid Surgery undertook a pilot studyof treatment for anaplastic thyroid carcinoma in a cooperativesetting. The treatment consisted of cisplatin 40 mg/m² dripintravenous infusion (div), day 1, adriamycin 60 mg/m² iv, day1, etoposide 100 mg/m²/day div, days 1–3, peplomycin 5mg/body/day sc, days 1–5 and granulocyte colony-stimulatingfactor (GCSF) 2 µg/kg/day sc, days 6–14. This wasscheduled to be repeated every 3 weeks. Local radiation therapywas added for patients in whom it was indicated. A total of17 patients (mean age, 66 yr) were enrolled. Ten patients hadadvanced disease with measurable lesions and 2 patients experiencedpartial remission lasting 2 and 3 months, respectively. Sixof 7 patients were treated with the same modality of treatmentas an adjuvant. Three died of progressive disease after 3–7months and three others have survived for 3–11 months.The toxicities of the chemotherapy were mainly bonemarrow suppression,despite G-CSF support. Transient liver dysfunction was alsonoticed. These results indicate that this combined a treatmentcan be given to patients with acceptable toxicity. The degreeof leukopenia was greater than expected, partly due to the advancedage of the patients and the low dose of G-CSF. In addition,8 available thyroid specimens were examined for the mdr 1 geneand P-glycoprotein, but all were negative. Further study ofanaplastic thyroid carcinoma by this cooperative group willbe carried out.