This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kushner, B. H. Articles by Cheung, N.-K. V. Search for Related Content PubMed PubMed Citation Articles by Kushner, B. H. Articles by Cheung, N.-K. V. Social Bookmarking                            What's this?

Reduction From Seven to Five Cycles of Intensive Induction Chemotherapy in Children With High-Risk Neuroblastoma

From the Departments of Pediatrics and Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.

Address reprint requests to Brian H. Kushner, MD, Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021; e-mail: kushnerb{at}mskcc.org

PURPOSE: We previously reported a high response rate with a dose-intensive chemotherapy regimen in 24 children with high-risk neuroblastoma (NB). We now describe similar results with changes that reduce toxicity (fewer cycles, less vincristine, use of granulocyte colony-stimulating factor).

PATIENTS AND METHODS: Eighty-seven consecutive newly diagnosed children with high-risk NB underwent induction that initially had seven cycles (57 patients) but was later limited to five (30 patients). Cycles 1, 2, 4, and 6 used cyclophosphamide (140 mg/kg)/doxorubicin (75 mg/m²)/vincristine (0.15 mg/kg in the first 27 patients, 0.067 mg/kg subsequently). Cycles 3, 5, and 7 used cisplatin (200 mg/m²)/etoposide (600 mg/m²). Tumor resection followed a minimum of three cycles. The induction was eventually modified to include anti-G_D2 immunotherapy after each of the last three cycles (38 patients).

RESULTS: Bone marrow disease resolved in 70 (91%) of 77 patients and was not detected pre- and postinduction in 10 patients. After cycle 3 or 4, 86% of primary tumors were more than 50% smaller. Postinduction metaiodobenzylguanidine scans showed normal radiotracer distribution in metastatic sites in 74 (87%) of 85 patients. Overall results were: 68 (79%) complete/very good partial responses (CR/VGPR); 14 (16%) partial responses (PR); three (3%) less than PR; one (1%) death from infection; and one patient not assessable for response. Five cycles yielded a CR/VGPR rate of 83%, compared with a 77% rate from seven cycles. Side effects were myelosuppression, mucositis, and hearing deficits; neurotoxicity was insignificant with the lower vincristine dosage. Four patients (each received seven cycles) developed myelodysplasia/leukemia.

CONCLUSION: Five cycles of this induction regimen, plus surgery, suffice to achieve CR/VGPR in 80% of children with high-risk NB.

Supported in part by grants from the National Cancer Institute (CA61017, CA72868), Bethesda, MD; Hope St Kids, Alexandria, VA; the Justin Zahn Fund, New York, NY; the Katie's Find A Cure Fund, New York, NY; and the Robert Steel Foundation, New York, NY.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				J. Qiao, J. Kang, T. A. Ishola, P. G. Rychahou, B. M. Evers, and D. H. Chung Gastrin-releasing peptide receptor silencing suppresses the tumorigenesis and metastatic potential of neuroblastoma PNAS, September 2, 2008; 105(35): 12891 - 12896. [Abstract] [Full Text] [PDF]

				N.-K. V. Cheung, R. Sowers, A. J. Vickers, I. Y. Cheung, B. H. Kushner, and R. Gorlick FCGR2A Polymorphism Is Correlated With Clinical Outcome After Immunotherapy of Neuroblastoma With Anti-GD2 Antibody and Granulocyte Macrophage Colony-Stimulating Factor J. Clin. Oncol., June 20, 2006; 24(18): 2885 - 2890. [Abstract] [Full Text] [PDF]

				B. H. Kushner, K. Kramer, M. P. Laquaglia, S. Modak, K. Yataghene, and N.-K. V. Cheung In Reply: J. Clin. Oncol., September 1, 2005; 23(25): 6263 - 6263. [Full Text] [PDF]

				D. Valteau-Couanet Event-Free Survival of Patients With High-Risk Neuroblastoma Treated With an N6-Like Induction Treatment J. Clin. Oncol., September 1, 2005; 23(25): 6262 - 6263. [Full Text] [PDF]