Highly effective induction therapy for stage 4 neuroblastoma in children over 1 year of age
| Autor: | Samuel Yeh, J Eddy, N. S. Rosenfield, Mary Ann Bonilla, Glenn Heller, William L. Gerald, Brian H. Kushner, N K Cheung, Karen L. Lindsley, Michael P. LaQuaglia |
|---|---|
| Rok vydání: | 1994 |
| Předmět: |
Male
Cancer Research Vincristine Cyclophosphamide medicine.medical_treatment Platelet Transfusion Infections Neuroblastoma Antineoplastic Combined Chemotherapy Protocols Granulocyte Colony-Stimulating Factor medicine Humans Doxorubicin Child Etoposide Neoplasm Staging Retrospective Studies Cisplatin Chemotherapy business.industry Remission Induction Thoracic Neoplasms medicine.disease Combined Modality Therapy Hematologic Diseases Anti-Bacterial Agents Granulocyte colony-stimulating factor Oncology Abdominal Neoplasms Child Preschool Anesthesia Female business medicine.drug |
| Zdroj: | Journal of Clinical Oncology. 12:2607-2613 |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.1994.12.12.2607 |
| Popis: | PURPOSE To test the efficacy of a protocol for poor-risk neuroblastoma that builds on the following: (1) our favorable previously reported results with dose-intensive use of cyclophosphamide; (2) our retrospective analysis of neuroblastoma chemotherapy reports, which supported the value of high-dose cisplatin and etoposide (VP-16); and (3) the Goldie-Coldman hypothesis that rapid cytoreduction plus the use of non-cross-resistant chemotherapy combinations will decrease the risk of drug resistance. PATIENTS AND METHODS The N6 protocol included seven courses of high-dose chemotherapy plus surgical resection of bulk disease. Courses 1, 2, 4, and 6 consisted of 6-hour intravenous infusions of cyclophosphamide 70 mg/kg/d on days 1 and 2 (ie, 140 mg/kg per course), a 72-hour intravenous infusion of doxorubicin 75 mg/m2 and vincristine 0.1 mg/kg beginning day 1, and vincristine 1.5 mg/m2 intravenous bolus on day 9. Courses 3, 5, and 7 consisted of 2-hour intravenous infusions of VP-16 200 mg/m2/d on days 1 to 3 (ie, 600 mg/m2 per course), and 1-hour intravenous infusions of cisplatin 50 mg/m2/d on days 1 to 4 (ie, 200 mg/m2 per course). Courses were to start after neutrophil counts reached 500/microL and platelet counts reached 100,000/microL. Response was defined by international criteria. RESULTS Among 24 consecutive previously untreated patients diagnosed with stage 4 neuroblastoma at more than 1 year of age, 21 patients achieved a complete or very good partial remission; one patient had no evidence of disease except by iodine-131-metaiodobenzylguanidine (MIBG) scan, which was markedly improved; and one patient had resolution of extensive metastatic disease, but still had an incompletely resected primary tumor. The sole patient to have a poor response had clinical features at diagnosis that are atypical for neuroblastoma, namely, 8 years of age and an unknown primary tumor. Severe toxicities included myelosuppression, mucositis, and hearing deficits. CONCLUSION The N6 approach reliably achieves significant cytoreduction against stage 4 neuroblastoma. This may eventuate in an improved cure rate, since consolidative treatments using myeloablative therapy, immunotherapy, or biologic response modifiers such as cis-retinoic acid are most likely to be effective against minimal residual disease. |
| Databáze: | OpenAIRE |
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