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Carboplatin‐epirubicin regimen for the treatment of hepatoblastoma
Author(s) -
Blouin P.,
Brugières Laurence,
Tabone M.D.,
Leverger G.,
Rubie H.,
Branchereau S.,
De Kraker J.
Publication year - 2004
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.10397
Subject(s) - medicine , carboplatin , epirubicin , hepatoblastoma , regimen , leukopenia , chemotherapy , progressive disease , gastroenterology , surgery , cisplatin , cyclophosphamide
Background In order to lower the long‐term toxicity of chemotherapy for hepatoblastoma patients, a prospective study was designed based on pre‐operative chemotherapy combining carboplatin and epirubicin (CE). Procedures Patients under 16 years of age with an epithelial hepatic tumor diagnosed by ultrasound or CT scan and a high serum alpha‐foetoprotein (AFP) level were eligible. Patients were treated with a pre‐operative chemotherapy regimen combining carboplatin 600 mg/m 2 and epirubicin 80 mg/m 2 . Tumor resectability was assessed after four courses given at 3‐week intervals. After surgery, patients were given two more courses of CE. Response was assessed based on a drop in serum AFP and tumor shrinkage. Results Between July 1988 and August 1995, 27 patients with a hepatoblastoma were included. The initial PRETEXT group according to the SIOPEL classification was: group 2 (5 pts), group 3 (15 pts), group 4 (5 pts), and 2 pts were not assessed. Six patients had lung metastases. Response was partial response (PR) in 20/27 (74%) patients, disease was stable in 3 and 4 had progressive disease (PD). A complete surgical resection was performed in 21 pts. Five‐year overall and disease‐free survival (DFS) were respectively 56% (95%CI: 37–72%) and 63% (95%CI: 44–78%). During the same time period, 7 pts with a hepatocellular carcinoma were treated according to this protocol. Only one achieved a PR. Toxicity was mostly hematologic with ≥grade 3 leukopenia in 23% of the courses, ≥grade 3 thrombocytopenia in 29% of the courses and anemia in 22%. Conclusion The CE protocol is feasible and efficient in hepatoblastoma. However, only a randomized study will permit a valid comparison of the efficacy of cisplatin and carboplatin for the treatment of these patients. © 2003 Wiley‐Liss, Inc.