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Response, survival, and toxicity after iodine‐131–metaiodobenzylguanidine therapy for neuroblastoma in preadolescents, adolescents, and adults
Author(s) -
Polishchuk Alexei L.,
DuBois Steven G.,
HaasKogan Daphne,
Hawkins Randall,
Matthay Katherine K.
Publication year - 2011
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/cncr.25987
Subject(s) - medicine , common terminology criteria for adverse events , neuroblastoma , refractory (planetary science) , toxicity , radiation therapy , adverse effect , cumulative dose , retrospective cohort study , cancer , oncology , surgery , physics , biology , astrobiology , genetics , cell culture
Abstract BACKGROUND: Adolescent and adult patients with neuroblastoma appear to have a more indolent disease course but a lower survival rate compared with their younger counterparts. The majority of neuroblastoma tumors specifically accumulate the radiolabeled norepinephrine analogue iodine‐131–metaiodobenzylguanidine ( 131 I‐MIBG). Therefore, 131 I‐MIBG has become increasingly used as targeted radiotherapy for patients with recurrent or refractory neuroblastoma. The objective of the current study was to characterize the toxicity and activity of this therapy in older patients. METHODS: The authors performed a retrospective analysis of 39 consecutive patients aged ≥10 years with recurrent or refractory neuroblastoma who were treated with 131 I‐MIBG monotherapy at the University of California at San Francisco under phase 1, phase 2, and compassionate access protocols. RESULTS: Sixteen patients were aged ≥18 years at the time of MIBG treatment initiation, whereas 23 patients were ages 10 to 17 years. The median cumulative administered dose of 131 I‐MIBG was 17.8 millicuries (mCi)/kg. The majority of treatments led to grade 3 or 4 hematologic toxicities (graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 3]) that were similar in frequency among age strata. Three patients subsequently developed a hematologic malignancy or myelodysplasia. The overall rate of complete plus partial response was 46%. Patients aged ≥18 years at the time of first MIBG treatment had a significantly higher response rate compared with patients ages 10 to 17 years (56% vs 39%; P = .023). The median overall survival was 23 months with a trend toward longer overall survival for the subgroup of patients aged ≥18 years ( P = .12). CONCLUSIONS: The findings of the current study suggest that 131 I‐MIBG is a highly effective salvage agent for adolescents and adults with neuroblastoma. Cancer 2011;. © 2011 American Cancer Society.