Chemotherapy with vincristine (VCR) and etoposide (VP-16) in children with low-grade astrocytoma

• Published in: Journal of neuro-oncology 1992-10, Vol.14 (2), p.151-158
• Main Authors: PONS, M. DE LOS A, FINLAY, J. L, WALKER, R. W, PUCCETTI, D, PACKER, R. J, MCELWAIN, M
• Format: Article
• Language: English
• Subjects: Adolescent; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Astrocytoma - drug therapy; Astrocytoma - mortality; Astrocytoma - therapy; Biological and medical sciences; Brain Neoplasms - drug therapy; Brain Neoplasms - mortality; Brain Neoplasms - therapy; Chemotherapy; Child; Child, Preschool; Combined Modality Therapy; Cranial Irradiation - adverse effects; Etoposide - administration & dosage; Etoposide - adverse effects; Female; Growth Disorders - etiology; Growth Disorders - prevention & control; Hematologic Diseases - chemically induced; Humans; Infant; Intellectual Disability - etiology; Intellectual Disability - prevention & control; Male; Medical sciences; Neoplasm Recurrence, Local - therapy; Neoplasms, Multiple Primary; Nervous System Diseases - chemically induced; Pharmacology. Drug treatments; Radiation Injuries - prevention & control; Remission Induction; Salvage Therapy; Treatment Outcome; Vincristine - administration & dosage; Vincristine - adverse effects
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1007/BF00177619

Twenty patients, aged 6 months to 20 years, with low-grade astrocytoma (LGA) participated in a chemotherapy trial of vincristine (VCR) and etoposide (VP-16). Fourteen children had recurrent progressive disease at entry on study. Prior treatment consisted of surgical resection alone (6), surgical resection and irradiation (4), surgical resection, irradiation and chemotherapy (2), surgery and chemotherapy (1), and irradiation and chemotherapy (1). Six patients were treated at initial diagnosis of LGA because they were less than 5 years old (5) or for a second primary tumor (1). Four recurrent patients and 3 newly diagnosed patients underwent surgical debulking of their tumors immediately prior to study entry. Tumors were located in the optic nerve/chiasm/hypothalamus (8), brain stem/cerebellum (4), cerebral hemispheres (3), midline structures (3), and spinal cord (2). The treatment plan administered in an out-patient setting consisted of weekly VCR 1.5 mg/m2 for 7 to 8 weeks and VP-16 100 mg/m2 for 5 days repeated every 6 weeks for a total of 18 months of therapy. Responses were evaluated by computerized tomography or magnetic resonance imaging. Of the 20 patients, 1 exhibited a partial response maintained for 12+ months, 3 exhibited minor responses maintained for a period of 10+ to 35 months, and 11 maintained stable disease for 10 to 42 months. Of the 11 patients with stable disease, 2 were withdrawn early from the study without further therapy. Five of the 20 patients developed progressive disease; for 4 of these 5, this occurred during the first course of therapy. Subsequently, these 5 died due to tumor.