Carboplatin-based chemotherapy for refractory and recurrent Ewing's tumours

• Published in: Pediatric blood & cancer 2004-09, Vol.43 (3), p.237-242
• Main Authors: Whelan, Jeremy S., McTiernan, Anne, Kakouri, Eleni, Kilby, Anne
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; carboplatin; Carboplatin - adverse effects; Carboplatin - therapeutic use; Child; Cohort Studies; Disease Progression; Drug Resistance, Neoplasm; Ewing's; Female; General aspects; Humans; Male; Medical sciences; Middle Aged; Neoplasm Metastasis; PNET; Prognosis; Recurrence; relapsed; Retrospective Studies; Sarcoma, Ewing - diagnosis; Sarcoma, Ewing - drug therapy; Sarcoma, Ewing - pathology; Survival Rate; Tumors
• ISSN: 1545-5009; 1545-5017
• DOI: 10.1002/pbc.20107

Background Failure of first line therapy for the Ewing's family of tumours (EFT) is associated with a very poor outlook. Studies of second line chemotherapy are therefore necessary to identify active agents and drug combinations. Cisplatin‐based therapy is frequently used in these circumstances but there are few studies to clearly define activity and toxicity. This report details outcome in a cohort of patients with poor risk EFT treated with a carboplatin‐based combination. Procedure Between 1990 and 1998, 23 males and 16 females aged between 6 and 48 years (median 23) with relapsed or refractory EFT were treated with carboplatin‐based chemotherapy. Previous chemotherapy had included ifosfamide and doxorubicin in all but two patients. Twenty patients were treated at the time of recurrence, and 19 after a poor response to initial chemotherapy. Treatment comprised of carboplatin to give an area under the plasma carboplatin concentration versus time curve of (AUC) 6 mg/ml, etoposide 120 mg/m2 for 3 days, and cyclophosphamide 500–750 mg/m2 for 2 days, repeated every 21 days. Results A total of 105 cycles were given, median 2 per patient (range 1–5). Overall response was 26%, with one complete response and nine partial responses. Median time to progression was 10 weeks (range 2–54). Haematological toxicity was severe requiring dose reductions in 53% of patients. Six patients proceeded to high dose consolidation treatment with bone marrow or peripheral stem cell rescue. Conclusions This combination results in a substantial response rate in previously treated patients but with significant toxicity. Responses are, however, relatively short. © 2004 Wiley‐Liss, Inc.