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Results of treatment of children with recurrent medulloblastoma/primitive neuroectodermal tumors with lomustine, cisplatin, and vincristine
Author(s) -
Lefkowitz Ilene B.,
Packer Roger J.,
Siegel Kathy R.,
Sutton Leslie N.,
Schut Luis,
Evans Audrey E.
Publication year - 1990
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19900201)65:3<412::aid-cncr2820650306>3.0.co;2-4
Subject(s) - lomustine , medulloblastoma , medicine , vincristine , cisplatin , oncology , primitive neuroectodermal tumor , chemotherapy , cancer research , cyclophosphamide
Primitive neuroectodermal tumors/medulloblastoma (PNET/MB) are the most common posterior fossa tumors in childhood. Despite surgery and radiation therapy, 40% to 50% of children with PNET/MB will have recurrent disease. Various chemotherapeutic agents are transiently effective in recurrent PNET/MB, but long‐lasting responses are rarely attainable. To increase the rate and duration of response in children with recurrent PNET/MB, the authors treated seven patients (ages 2–18 years; median, 10 years) with lomustine (CCNU) (100 mg/m 2 ), cisplatin (CPDD) (90 mg/m 2 ) and vincristine (VCR) (1.5 mg/m 2 ; maximum, 2 mg) in a 6‐week cycle for a maximum of eight cycles. Six of six evaluable patients responded to chemotherapy. Four patients had a complete response; three with complete disappearance of tumor by imaging studies; and one with eradication of extraneural disease for a median of 24 months from relapse (13–29 months). Overall disease‐free survival was 18.5 months. All six patients have subsequently died of recurrent tumor. Major toxicities consisted of reversible bone marrow suppression (six of six), high frequency hearing loss (six of six) and decreased renal function (three of six). All patients required dosage modification for toxicity. A regimen of CCNU, VCR, and CPDD is effective therapy in children with relapsed PNET/MB and can produce relatively long‐term disease control with good quality of life. Further investigation into the efficacy of this combination as adjuvant chemotherapy in newly diagnosed high‐risk PNET/MB is now being performed.