Short topotecan-based induction regimen in newly diagnosed high-risk neuroblastoma |
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Authors: | De Ioris Maria Antonietta Castellano Aurora Ilari Ilaria Garganese Maria Carmen Natali Gianluigi Inserra Alessandro De Vito Rita Ravà Lucilla De Pasquale Maria Debora Locatelli Franco Donfrancesco Alberto Jenkner Alessandro |
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Affiliation: | a Department of Paediatric Oncology-Hematology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy b Imaging, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy c Pediatric Surgery, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy d Pathology Unit, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy e Epidemiology Unit, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy f University of Pavia, Italy |
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Abstract: | PurposeTopotecan is an active drug in relapsed neuroblastoma. We investigated the efficacy and toxicity of a topotecan-based induction regimen in newly diagnosed neuroblastoma.MethodsPatients older than 1 year with either metastatic or localised stage 2-3 MYCN-amplified neuroblastoma received 2 courses of high-dose topotecan (HD-TPT) 6 mg/m2 and high-dose cyclophosphamide (HD-CPM) 140 mg/kg, followed by 2 courses of ifosfamide, carboplatin and etoposide (ICE) every 28 days. After surgery on primary tumour, a fifth course with vincristine, doxorubicin and CPM was given, followed by high-dose chemotherapy with stem cell support. Response was assessed in accordance with the International Neuroblastoma Response Criteria.ResultsOf 35 consecutive patients, 33 had metastatic disease. The median length of induction phase was 133 days (range 91-207) and time to high-dose chemotherapy was 208 days (range 156-285). The median tumour volume reduction was 55% after two HD-TPT/HD-CPM courses and 80% after four courses. Radical surgery was performed in 16/27 patients after chemotherapy. After the fifth course, 29/34 patients (85%) had achieved a partial remission (12) or a CR/very good partial remission (17). CR of metastases was achieved in 13/32 (41%) and bone marrow was in complete remission in 16/24 patients (67%). Grade 4 neutropenia and/or thrombocytopenia occurred in 100% of HD-TPT/HD-CPM and in 95% of ICE courses, while non-haematological toxicities were manageable.ConclusionsThese data indicate that our induction regimen is feasible and well tolerated. A major response rate of 85% with 41% complete metastatic response confirms this regimen as effective induction in high-risk neuroblastoma. |
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Keywords: | Neuroblastoma Metastasis Children Topotecan Remission Induction |
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