Induction chemotherapy in metastatic neuroblastoma - does dose influence response? A critical review of published data standards, options and recommendations (SOR) project of the National Federation of French Cancer Centres (FNCLCC)

Citation
Cr. Pinkerton et al., Induction chemotherapy in metastatic neuroblastoma - does dose influence response? A critical review of published data standards, options and recommendations (SOR) project of the National Federation of French Cancer Centres (FNCLCC), EUR J CANC, 36(14), 2000, pp. 1808-1815
Citations number
22
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Oncology,"Onconogenesis & Cancer Research
Journal title
EUROPEAN JOURNAL OF CANCER
ISSN journal
0959-8049 → ACNP
Volume
36
Issue
14
Year of publication
2000
Pages
1808 - 1815
Database
ISI
SICI code
0959-8049(200009)36:14<1808:ICIMN->2.0.ZU;2-L
Abstract
The purpose of this study was to determine, from a review of published data . whether in stage 4 neuroblastoma in children over 1 seer of age. the dose or scheduling of induction chemotherapy influenced the response rate in di stant metastases. Publications relating to induction chemotherapy since the introduction of cisplatin/epipodophyllotoxin combinations were identified using Medline. Current Contents and personal reference lists. Thirteen publ ications were identified which described 17 regimens involving 948 children . The doses and the scheduling of the various regimens were compared with a standard regimen OPEC (vincristine, cisplatin. teniposide, cyclophosphamid e). These were correlated with the reported response rates in the bone marr ow. Due to a lack of standardisation in the nature of restaging investigati ons, timing of restaging and definitions of response it was difficult to co mpare all studies. The complete response rate at distant metastases ranged from less than 40% to over 90%. For individual drugs; the comparative doses given in each course ranged up to 4.2 g/m(2) for cyclophosphamide, 280 mg/ m(2) for cisplatin, 600 mg/m(2) for etoposide and 4.5 mg/m(2) for vincristi ne. There was no evidence of any positive correlation between response rate in the marrow and either the dose of any individual drug or the schedule u sed. In contrast to a previous study which included a number of older studi es where disease assessment was even more variable, this analysis has faile d to show any justification for the routine use of very intensive induction regimens in this disease. Such an approach should only be taken in the con text of randomised trials in which timing and methods of reassessment tan b e standardised. Until such studies demonstrate superiority tither in terms of response rate ir progression-free survival lower morbidity regimens shou ld remain the standard therapy. (C) 2000 Elsevier Science Ltd. All rights r eserved.