Irinotecan plus temozolomide for relapsed or refractory neuroblastoma Journal Article

Authors: Kushner, B. H.; Kramer, K.; Modak, S.; Cheung, N. K. V.
Article Title: Irinotecan plus temozolomide for relapsed or refractory neuroblastoma
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/m 2 (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. © 2006 by American Society of Clinical Oncology.
Keywords: adolescent; adult; child; clinical article; controlled study; preschool child; treatment outcome; treatment response; child, preschool; cisplatin; diarrhea; side effect; temozolomide; topotecan; antineoplastic agent; carboplatin; dacarbazine; quality of life; infection; multiple cycle treatment; neoplasm recurrence, local; bone marrow suppression; gastrointestinal symptom; nausea; vomiting; antineoplastic combined chemotherapy protocols; drug administration schedule; camptothecin; alkylating agent; cyclophosphamide; stem cell transplantation; pathology; ifosfamide; irinotecan; cancer regression; infant; neuroblastoma; tumor recurrence; granulocyte colony stimulating factor receptor; drug derivative; thrombocyte count; cancer relapse; drug administration; alopecia; retinoic acid; phytohemagglutinin
Journal Title: Journal of Clinical Oncology
Volume: 24
Issue: 33
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2006-11-20
Start Page: 5271
End Page: 5276
Language: English
DOI: 10.1200/jco.2006.06.7272
PUBMED: 17114661
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 32" - "Export Date: 4 June 2012" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Brian Kushner
    190 Kushner
  2. Nai-Kong Cheung
    439 Cheung
  3. Kim Kramer
    168 Kramer
  4. Shakeel Modak
    159 Modak