Pilot Study of Adding Vincristine, Topotecan, and Cyclophosphamide to Interval-Compressed Chemotherapy in Newly Diagnosed Patients With Localized Ewing Sarcoma: A Report From the Children's Oncology Group

Leo Mascarenhas, Judy L. Felgenhauer, Mason C. Bond, Doojduen Villaluna, Joseph Dominic Femino, Nadia N Laack, Sarangarajan Ranganathan, James Meyer, Richard B. Womer, Richard Gorlick, Mark D. Krailo, Neyssa Marina

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12 Scopus citations

Abstract

Background: The combination of topotecan and cyclophosphamide is active in relapsed Ewing sarcoma family of tumors (ESFT). The feasibility of adding these agents combined with vincristine (vincristine-topotecan-cyclophosphamide [VTc]) to standard five-drug chemotherapy with vincristine-doxorubicin-cyclophosphamide (VDC) and ifosfamide-etoposide (IE) administered in an interval-compressed (2-week instead of 3-week intervals) schedule was investigated. Procedure: Newly diagnosed patients with localized ESFT < 31 years, with good performance status and adequate organ function were eligible. Seventeen alternating cycles of chemotherapy with VTc, VDC, and IE were administered at 2-week intervals. Local control (LC) of the primary tumor occurred following six cycles. Primary endpoints were the ability to deliver chemotherapy in an interval-compressed schedule, and the rate of grade 3 or greater nonhematologic toxicity and grade 4 hematologic toxicity, which delayed chemotherapy by ≥2 weeks. Secondary endpoints were event-free survival (EFS) and overall survival (OS). Results: Thirty-five patients with a median age of 11 years were enrolled. The mean time to last dose of chemotherapy prior to LC was 12.6 ± 1.4 weeks and 45.5% of patients received intended chemotherapy without any delay prior to LC. There were no toxic deaths or unexpected toxicities. Five-year EFS was 79.6% (95% confidence interval [CI]: 61.8-89.7%) and 5-year OS was 88% (95% CI: 71.4-95.3%). Conclusions: The addition of VTc to standard therapy was tolerable with sufficient interval compression compared to historical standard 3-week cycles.

Original languageEnglish (US)
Pages (from-to)493-498
Number of pages6
JournalPediatric Blood and Cancer
Volume63
Issue number3
DOIs
StatePublished - Mar 1 2016

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Keywords

  • Cyclophosphamide
  • Dose dense
  • Ewing sarcoma
  • Interval compression
  • PNET
  • Topotecan

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)
  • Hematology
  • Oncology

Cite this

Mascarenhas, L., Felgenhauer, J. L., Bond, M. C., Villaluna, D., Femino, J. D., Laack, N. N., Ranganathan, S., Meyer, J., Womer, R. B., Gorlick, R., Krailo, M. D., & Marina, N. (2016). Pilot Study of Adding Vincristine, Topotecan, and Cyclophosphamide to Interval-Compressed Chemotherapy in Newly Diagnosed Patients With Localized Ewing Sarcoma: A Report From the Children's Oncology Group. Pediatric Blood and Cancer, 63(3), 493-498. https://doi.org/10.1002/pbc.25837