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Ifosfamide, carboplatin, and etoposide for neuroblastoma
Author(s) -
Kushner Brian H.,
Modak Shakeel,
Kramer Kim,
Basu Ellen M.,
Roberts Stephen S.,
Cheung NaiKong V.
Publication year - 2012
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.27783
Subject(s) - medicine , carboplatin , ifosfamide , etoposide , surgery , regimen , mucositis , chemotherapy , progressive disease , gastroenterology , cisplatin
BACKGROUND: The authors report a retrospective analysis of high‐dose ifosfamide, carboplatin, and etoposide (HD‐ICE) for patients with refractory or relapsed neuroblastoma (NB). A major reason for using this regimen was the long time since patients received previous treatment with a platinum compound. The authors also summarized the published experience on ICE in patients with NB. METHODS: Treatment comprised ifosfamide (2000 mg/m 2 daily for 5 days), carboplatin (500 mg/m 2 daily for 2 days), and etoposide (100 mg/m 2 daily for 5 days). Patients who had poor hematologic reserve (platelet count <100,000/μL) from previous therapy received peripheral blood stem cells (PBSCs) after HD‐ICE. Disease status before and after HD‐ICE was defined according to International Neuroblastoma Response Criteria (expanded to include 123 I‐metaiodobenzylguanidine findings). Publications that were informative about ICE for NB were reviewed. RESULTS: Seventy‐four patients received 92 cycles of ICE, including 37 patients who received PBSC rescue. Grade 3 toxicities were rare: 1–3 patients had encephalopathy, mucositis, or gastroenteritis. Bacteremia was documented in 24 of 92 cycles (26%). The absolute neutrophil count reached 500/μL on day 17–30 (median, day 22) in patients who had satisfactory hematologic reserve. Disease regressions (major and minor responses) were achieved by 14 of 17 patients (82%) with a new relapse, 13 of 26 patients (50%) with refractory NB, and 12 of 34 patients (35%) who were treated for progressive disease during chemotherapy ( P = .005). In the literature, patients received ICE at lower dosages and achieved major response rates >36% in phase 1 and 2 studies (in which less comprehensive staging evaluations were used) that involved resistant NB and >70% in induction for newly diagnosed NB. CONCLUSIONS: HD‐ICE is appealing as salvage treatment or consolidative therapy because of its anti‐NB activity and the low risk of major nonhematologic toxicity. PBSC support is unnecessary for patients who had intact hematologic reserve. Cancer 2013. © 2012 American Cancer Society.