Abstract | PURPOSE: PATIENTS AND METHODS: Enrolled patients received two cycles of topotecan (approximately 1.2 mg/m(2)/d) and cyclophosphamide (400 mg/m(2)/d) for 5 days followed by four cycles of multiagent chemotherapy (Memorial Sloan-Kettering Cancer Center [MSKCC] regimen). Pharmacokinetically guided topotecan dosing (target systemic exposure with area under the curve of 50 to 70 ng/mL/hr) was performed. Peripheral-blood stem cell (PBSC) harvest and surgical resection of residual primary tumor occurred after cycles 2 and 5, respectively. Patients achieving at least a partial response received myeloablative chemotherapy with PBSC rescue and radiation to the presurgical primary tumor volume. Oral 13-cis-retinoic acid maintenance therapy was administered twice daily for 14 days in six 28-day cycles. RESULTS: Thirty-one patients were enrolled onto the study. No deaths related to toxicity or dose-limiting toxicities occurred during induction. Mucositis rarely occurred after topotecan cycles (9.7%) in contrast to 30% after MSKCC cycles. Thirty patients underwent PBSC collection with median 31.1 × 10(6) CD34+ cells/kg (range, 1.8 to 541.8 × 10(6) CD34+ cells/kg), all negative for tumor contamination by immunocytochemical analysis. Targeted topotecan systemic exposure was achieved in 26 (84%) of 31 patients. At the end of induction, 26 patients (84%) had tumor response and one patient had progressive disease. In the overall cohort, 3-year event-free and overall survival were 37.8% ± 9.4% and 57.1% ± 9.4%, respectively. CONCLUSION: This pilot induction regimen was well tolerated with expected and reversible toxicities. These data support investigation of efficacy in a phase III clinical trial for newly diagnosed HRNB.
|
Authors | Julie R Park, Jeffrey R Scott, Clinton F Stewart, Wendy B London, Arlene Naranjo, Victor M Santana, Peter J Shaw, Susan L Cohn, Katherine K Matthay |
Journal | Journal of clinical oncology : official journal of the American Society of Clinical Oncology
(J Clin Oncol)
Vol. 29
Issue 33
Pg. 4351-7
(Nov 20 2011)
ISSN: 1527-7755 [Electronic] United States |
PMID | 22010014
(Publication Type: Clinical Trial, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
|
Chemical References |
- Topoisomerase I Inhibitors
- Topotecan
|
Topics |
- Adult
- Brain Neoplasms
(drug therapy, mortality)
- Child
- Child, Preschool
- Female
- Humans
- Induction Chemotherapy
- Infant
- Male
- Neuroblastoma
(drug therapy, mortality)
- Pilot Projects
- Topoisomerase I Inhibitors
(administration & dosage)
- Topotecan
(administration & dosage, adverse effects, pharmacokinetics)
|