Topotecan/CycophosphamideSalvage Chemotherapy in Children with Recurrent or Refractory Solid Tumors

Kim, Eun Sim; Jung, Hyun Ju; Park, Jun Eun

Abstract

PURPOSE
To review the effect of the topotecan/cyclophosphamide (TOPO/CPM) salvage chemotherapy in children who were treated for recurrent or refractory solid tumors in our hospital.
METHODS
We analyzed the medical records of 14 patients diagnosed with recurrent or refractory solid tumors who received TOPO/CPM salvage chemotherapy (topotecan 0.94 mg/m2/day for 4 days, cyclophosphamide 250 mg/m2/day for 5 days; modified POG 9464 protocol) at Ajou University Medical Center from January 2000 to August 2009.
RESULTS
Among the 14 patients, 9 were boys and 5 were girls. There were 7 cases of neuroblastoma, 2 cases of rhabdomyosarcoma, two medulloblastoma, one ependymoma, one atypical teratoid/rhabdoid tumor, and one hepatoblastoma. The median age at the time of the diagnosis was 5.3 years. The median treatment course was three, ranging from one to six courses. One of the patients achieved a complete response (CR) after 2 courses of the chemotherapy and 3 patients achieved a partial response (PR) after 2~3 courses. In the patients who achieved more than PR (28%), the clinical symptoms associated with tumor relapse such as dyspnea, abdominal pain, voiding difficulty, and bone pain disappeared. One of the patients achieved minor response and 2 have been in the stable disease state. 7 of the patients (50%) showed progression of the disease despite the salvage chemotherapy. Three of the four patients who achieved more than PR died due to tumor recurrence and one patient is alive. There were no life-threatening complications during the salvage chemotherapy.
CONCLUSION
We conclude that the state more than PR is achievable with TOPO/CPM salvage chemotherapy in the children with recurrent or refractory solid tumors. But, proof that this new treatment protocol maintains the response state is required.