Cyclophosphamide and ifosfamide combination as neoadjuvant chemotherapy for locally advanced nonsmall-cell lung cancer: A meta-analytic review

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Abstract
Twenty‐three patients with marginally resectable and unresectable nonsmall‐cell lung cancer (stages IIIA and IIIB) were treated by neoadjuvant chemotherapy. All patients received three cycles of preoperative chemotherapy with two alkylating agents, cyclophosphamide 2.5 g/m2 intravenously (i.v.) and ifosfamide 3.5 g/m2 i.v., mesna 12 g/m2 was given additionally to prevent drug hematuria. Six of 23 patients (26%) had partial response. Of the seven patients who underwent thoracotomy, two were completely resected, but with macroscopic residual disease. Mean time to progression for the whole group was 7 months. Fifteen patients had progression of disease, with local metastases only in six, and distant metastases in eight. After administering 52 chemotherapy cycles, cyclophosphamide‐ifosfamide doses were cut down, as eight of 16 patients required hospitalization for fever during neutropenia nadirs. This two‐ alkylating (non‐cisplatin) regimen, unlike cisplatin‐based regimens, was ineffective, and further trials are not recommended.