Topotecan, Cyclophosphamide, Etoposide in the Treatment of Recurrent or Refractory Solid Tumors in Children

Han, Young Joo; Lee, Ji Won; Kim, Hyery; Kim, Nam Hee; Song, Eun Sun; Kang, Hyoung Jin; Park, Kyung Duk; Shin, Hee Young; Ahn, Hyo Seop

Abstract

PURPOSE
We investigated the results of topotecan, cyclophosphamide, etoposide (TCE) salvage chemotherapy for children with recurrent or refractory solid tumors to find out suitable therapeutic indications.
METHODS
We analyzed medical records of 25 children with recurrent or refractory solid tumors who received TCE salvage chemotherapy (topotecan 0.75 or 1.0 mg/m2/day, d0~d4; cyclophosphamide 250 mg/m2/day, d0~d4; etoposide 100 mg/m2/day, d0~d2) in Seoul National University Children's Hospital from 2005 to 2009.
RESULTS
Seventeen were male and 8 were female with a median age of 5.3 years. Primary tumors were neuroblastoma (n=12, 48%), osteosarcoma (n=5, 20%), Ewing sarcoma (n=2, 8%), retinoblastoma (n=2, 8%), hepatoblastoma (n=2, 8%), and rhabdomyosarcoma (n=2, 8%). The mean numbers of treatment courses were 5 (1~24). Complete response was achieved in 3 (12%), partial response in 1 (4%), stable disease in 3 (12%), and progressive disease in 18 (72%). The expected 2-year survival, progression-free survival, and disease-free survival rate were 43, 28, and 20%, respectively. Responders survived after high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (HSCT). Patients with stable disease continued TCE chemotherapy and survived without progression. Patients who had not responded to standard chemotherapy showed progression in 93% after TCE chemotherapy. The most common side effect was neutropenia (77%) but treatment-related mortality did not occur.
CONCLUSION
TCE salvage chemotherapy showed effectiveness in patients with persistent or relapsed disease after initial treatment. For responders, high-dose chemotherapy followed by autologous HSCT could be a curative option. Patients with stable disease would expect progression-free survival by maintenance of TCE chemotherapy.