Irinotecan Plus Temozolomide for Relapsed or Refractory Neuroblastoma
- 20 November 2006
- journal article
- pediatric oncology
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 24 (33), 5271-5276
- https://doi.org/10.1200/jco.2006.06.7272
Abstract
Purpose: To report on an irinotecan and temozolomide regimen for neuroblastoma (NB). Quality of life and minimizing toxicity were major considerations. Patients and Methods: The plan stipulated 5-day courses of irinotecan 50 mg/m2 (1-hour infusion) and temozolomide 150 mg/m2 (oral) every 3 to 4 weeks, with a pretreatment platelet count more than 30,000/μL. Granulocyte colony-stimulating factor was used when the absolute neutrophil count was less than 1,000/μL. Results: Forty-nine NB patients received 1 to 15 courses (median, 5). Gastrointestinal and myelosuppressive toxicities were readily managed. Lymphocyte responses to phytohemagglutinin after 2 to 10 courses (median, 3.5) were normal in 10 of 10 patients treated after nonimmunosuppressive therapy, and normalized in five of seven patients first treated less than 2 months after high-dose alkylators. Of 19 patients treated for refractory NB and assessable for response, nine showed evidence of disease regression, including two complete responses and seven objective responses. Of 17 patients treated for progressive disease, three showed evidence of disease regression, including one partial response and two objective responses. Multiple courses entailed no cumulative toxicity and controlled disease for prolonged periods in many patients, including some who were unable to complete prior treatments because of hematologic, infectious, cardiac, or renal problems. Conclusion: This regimen has anti-NB activity, spares vital organs, is feasible with poor bone marrow reserve, causes limited immunosuppression, and allows good quality of life.Keywords
This publication has 41 references indexed in Scilit:
- Myeloablative megatherapy with autologous stem-cell rescue versus oral maintenance chemotherapy as consolidation treatment in patients with high-risk neuroblastoma: a randomised controlled trialThe Lancet Oncology, 2005
- Five-day courses of irinotecan as palliative therapy for patients with neuroblastomaCancer, 2005
- Camptothecin Analogs (Irinotecan or Topotecan) plus High-Dose Cyclophosphamide as Preparative Regimens for Antibody-Based Immunotherapy in Resistant NeuroblastomaClinical Cancer Research, 2004
- Targeted Radiotherapy With Submyeloablative Doses of 131I-MIBG Is Effective for Disease Palliation in Highly Refractory NeuroblastomaJournal of Pediatric Hematology/Oncology, 2003
- Cyclophosphamide Plus Topotecan in Children With Recurrent or Refractory Solid Tumors: A Pediatric Oncology Group Phase II StudyJournal of Clinical Oncology, 2001
- Successful clinical response to irinotecan in desmoplastic round blue cell tumorMedical and Pediatric Oncology, 1999
- Treatment of High-Risk Neuroblastoma with Intensive Chemotherapy, Radiotherapy, Autologous Bone Marrow Transplantation, and 13-cis-Retinoic AcidNew England Journal of Medicine, 1999
- Direct Translation of a Protracted Irinotecan Schedule From a Xenograft Model to a Phase I Trial in ChildrenJournal of Clinical Oncology, 1999
- Therapeutic activity of CPT-11, a DNA-topoisomerase I inhibitor, against peripheral primitive neuroectodermal tumour and neuroblastoma xenograftsBritish Journal of Cancer, 1996
- Effects of CPT‐11 (a unique DNA topoisomerase I inhibitor) on a highly malignant xeno‐transplanted neuroblastomaMedical and Pediatric Oncology, 1994