Ifosfamide/carboplatin/etoposide (ICE) as front-line, topotecan/cyclophosphamide as second-line and oral temozolomide as third-line treatment for advanced neuroblastoma over one year of age
| Autor: | Raffaele Cozza, L. De Sio, Ilaria Ilari, Alessandro Jenkner, C. De Laurentis, Alberto Donfrancesco, Alessandro Inserra, Giuseppe Milano, Aurora Castellano, P. Fidani, Carlo Dominici, Giovanni Deb |
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| Rok vydání: | 2004 |
| Předmět: |
Oncology
Adult Male medicine.medical_specialty Palliative care Adolescent medicine.medical_treatment Carboplatin chemistry.chemical_compound Neuroblastoma Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Temozolomide Humans Ifosfamide Child Antineoplastic Agents Alkylating Cyclophosphamide Etoposide Chemotherapy business.industry Palliative Care Induction chemotherapy Infant General Medicine Surgery Dacarbazine Treatment Outcome chemistry Drug Resistance Neoplasm Child Preschool Pediatrics Perinatology and Child Health Topotecan Female Neoplasm Recurrence Local business medicine.drug |
| Zdroj: | Scopus-Elsevier |
| ISSN: | 0803-5253 |
| Popis: | Children affected by advanced neuroblastoma have a discouraging prognosis, but intensive induction chemotherapy may increase the complete response rate. The combination of ifosfamide, carboplatin and etoposide (ICE) was used for the first time as front-line regimen in patients with stage 4 neuroblastoma over the age of 1 y. Similarly, second-line treatment for children with relapsed neuroblastoma, particularly after high-dose chemotherapy, has been unsatisfactory. The combination of topotecan and cyclophosphamide was studied in resistant or relapsed solid tumors. Furthermore, there is a need for effective palliative treatment in patients failing therapy. Temozolomide, a new dacarbazine analog with optimal oral bioavailability, is being used in an ongoing phase II study as an alternative to oral etoposide. Seventeen patients with stage 4 neuroblastoma have entered the ICE study; 15/16 (94%) major responses after induction were observed and 6/16 (37%) evaluable patients are disease free after a median of 51 mo. Twenty-one patients with relapsed/refractory disease (of whom 13 neuroblastomas) entered the topotecan/cyclophosphamide study: 7/21 (33%) patients responded. Forty-one patients entered the temozolomide study (of whom 16 had neuroblastomas): stable disease and symptom relief were obtained in 15/30 (50%) evaluable patients. Intensive induction with ICE resulted in a faster response with high response rate; a larger study with longer follow-up is needed to confirm a survival advantage. Second-line treatment was effective in obtaining remissions, some of them long lasting. Third-line treatment did not elicit measurable responses in neuroblastoma, but achieved prolonged freedom from disease progression and excellent palliation in several patients. |
| Databáze: | OpenAIRE |
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