Cancer Res Treat.  2022 Apr;54(2):563-571. 10.4143/crt.2021.178.

Vincristine, Irinotecan, and Temozolomide as a Salvage Regimen for Relapsed or Refractory Sarcoma in Children and Young Adults

• Ju HY
• Park M
• Lee JA
• Park HJ
• Park SY
• Kim JH
• Kang HG
• Yang HC
• Park BK

• KMID: 2528225
• DOI: http://doi.org/10.4143/crt.2021.178

Abstract

Purpose
No standard salvage regimen is available for relapsed or refractory sarcoma. We investigated the efficacy and toxicity of the vincristine, irinotecan, and temozolomide combination (VIT) for relapsed or refractory sarcomas of variable histology in children and young adults.
Materials and Methods
We retrospectively reviewed data from the relapsed or refractory sarcoma patients who were treated with VIT. The VIT protocol was given every 3 weeks as follows: vincristine, 1.5 mg/m² intravenously on day 1, irinotecan, 50 mg/m²/day intravenously on days 1-5, and temozolomide, 100 mg/m²/day orally on days 1-5.
Results
A total of 26 patients (12 males) with various sarcoma histology were included in the study. Most common diagnosis was rhabdomyosarcoma (n=8) followed by osteosarcoma (n=7). Median age at the start of VIT was 18.5 years (range, 2.0 to 39.9). VIT was delivered as 2nd to 7th line of treatment, with 4th line most common (9/26, 34.6%). Median number of VIT courses given was 3 (range, 1 to 18). Of the 25 evaluable patients, there was two partial response (PR) and 11 stable disease (SD) with an overall control rate (complete remission+PR+SD) of 52%. PR was seen in one (50%) of the two evaluable patients with Ewing sarcoma and one (14.3%) of the seven patients with osteosarcoma. Overall survival and progression-free survival rates were 79.3% and 33.9% at 1 year, and 45.5% and 25.4% at 2 years, respectively. There was no treatment-related mortality.
Conclusion
The VIT regimen was effective and relatively safe in our cohort of sarcoma patients.

Keyword

Salvage therapy; Sarcoma; Vincristine; Temozolomide; Irinotecan

Figure

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  Fig. 1 Pulmonary computed tomography image of two patients who showed partial response. Size change of single metastatic nodule (arrow) before VIT (vincristine, irinotecan and temozolomide combination) treatment (A) and after two courses of VIT treatment (B) in an osteosarcoma patient. Size change of a metastatic nodule (arrow) before VIT treatment (C) and after two courses of VIT treatment (D) in an Ewing sarcoma patient.

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  Fig. 2 Time to VIT-failure and subsequent outcome. ASPS, alveolar soft-part sarcoma; CR, complete remission; DSRCT, desmoplastic small round cell tumor; PD, progressive disease; SD, stable disease; VIT, vincristine, irinotecan and temozolomide combination.

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  Fig. 3 Survival outcome. (A) Overall survival. (B) Progression-free survival. (C) Overall survival according to vincristine, irinotecan and temozolomide combination response. (D) Overall survival according to patients who received surgery vs. no surgery. (E) Progression-free survival according to patients who received surgery vs. no surgery.

Reference

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